1,708 members of the Australian Infection Control Association were surveyed to describe the practices of Australian infection control practitioners. The study details the methods infection control practitioners use to co-ordinate and measure nosocomial infections as clinical outcomes of Australian infection surveillance and control programs. Administrators' and clinicians' perceptions of the elements and infrastructure of infection surveillance and control programs and the role of the infection control were measured in 316 hospitals in New South Wales, Australia. A literature review found that the development of Australian infection surveillance and control programs is behind that of U.S.A and the United Kingdom. The survey of the infection control practitioners identified that their role and duties varied between facilities as did the time allocated to infection control tasks. The survey of infection control practitioners demonstrated variation in their levels of skill, education and experience. Infection control practitioners' use and application of evidence and associated skills was examined and found to be limited in relation to clinical decision making and policy development. The survey also examined the methods infection control practitioners use to undertake surveillance of nosocomial infections. The methods reported indicated non-standard approaches to surveillance activity. A survey of administrators and clinicians in NSW hospitals was undertaken to identify variation in administrator and clinician perceptions and to describe their level of support for recommended essential infrastructure and criteria for infection surveillance and control programs and the role of the infection control practitioner in accordance with Scheckler's model. The survey indicated divergent views regarding the role of the infection control practitioner and the essential elements of infection surveillance and control programs. The study identified that education of infection control practitioners is necessary to facilitate standard approaches to co-ordinating infection surveillance and control activity. The development of Australian infection surveillance and control programs require a strategic alliance between stakeholders. to define essential elements of infection surveillance and control programs. In addition, the role of the infection control practitioner must be defined before key stakeholders can agree on the minimum skills, qualifications and experience required by an infection control practitioner.

Objective: The aim of the study was to evaluate the clinical outcomes of oral implant treatment provided at the School of Dentistry, University of Otago from 1989 to 2005. Methods: Oral implant patients (n=320) with 586 implants were identified and invited to attend for a clinical examination. Implant demographics of all the patients were extracted from the files. Implant demographics of the examined and unexamined patients were compared to assess if the examined patients were representative of the total group. One hundred and three patients with 214 implants agreed to attend for an examination. In the clinical examination full mouth plaque scores, probing depths, bleeding on probing and suppuration were measured. In addition, around implants recession and width of keratinized gingiva were also recorded. For the radiographic examination, baseline radiographs and radiographs taken at the time of examination were digitized and compared to measure the amount of bone lost or gained around implants using NIH Image J software. Results: There were equal numbers of males and females with a mean age of 46.3 � 15 years at the time of implant placement. The smoking history at the time of examination was recorded, 56% of the patients were non-smokers, 37% former smokers, and 7% were current smokers. More than half of the implants (56%) were placed in the anterior region. Based on the type of implant system, 79% were Branemark implants, 10% Straumann, 6% Southern implants and 4% were unknown. Most of the patients (64%) had implant-supported crowns, 19% had fixed denture prostheses, and 17% had implant-supported overdentures. The overall implant survival rate was 97.7% with five implants lost (2.3%) and 8 implants treated for peri-implantitis (3.8%). The mean PD around implants was 2.3mm (SD 0.6mm), mean recession was 0.5mm (SD 0.8mm) and mean attachment level of 2.8mm (SD 0.9mm). Probing depths [greater than or equal to] 4mm with BOP were recorded around implants in 8.9% of patients. The mean full mouth plaque score was 30% while mean plaque score around implants was 15.9%. The average bone loss around implants was 0.3mm (SD 0.8). Maximum bone loss observed was 2.9 mm. Conclusion: The prevalence of peri-implant inflammation and implant survival rates in this group of patients appeared comparable to that reported in the literature. The prevalence of peri-implant lesions was low in the group of patients examined.

This research aims to assess the existing relationship and characteristics between Maori health providers (MHPs) and pharmacy services in New Zealand and to provide future direction, pathways and strategies for collaboration, planning and improving health outcomes for Maori within the primary health care environment. The characteristics of the relationship were identified and discussed before exploring strategies to strengthen the relationship and to improve Māori health outcomes. The assessment and analysis of the characteristics required an exploration of MHPs current knowledge of pharmacy services, the expectations of MHPs of pharmacy services and the current knowledge of pharmacists of MHP services and Maori health. Themes identified that characterised the relationship were related to knowledge, health philosophies, interaction, service and capacity issues. Knowledge issues incorporated themes of group dynamics, historical context, participant knowledge, pharmacy participant knowledge, MHP participant knowledge, solutions/ outcome knowledge, consideration of Maori. Health philosophies related to themes of paradigms/worldviews, kaupapa Maori, capacity, culture and delivery of services, Treaty of Waitangi, knowledge of culture, communication and te reo, rongoa Maori, environmental culture, access, tino rangatiratanga. Interaction issues discussed the themes of collaboration and communication, extent of collaboration, contact with Maori, community relationships, cost, benefits and opportunities. The pharmacy environment, cost and health service delivery were identified as themes relating to service issues. Capacity issues included themes of mana, direct workforce development (education, employment, promotion), indirect workforce development (education, environment, relationship building, funding), and the Maori Pharmacists Association. This research attempted to follow kaupapa Maori qualitative research methodology, methods and the epistemology of kaupapa Maori throughout the research and design process. One to one semi-structured interviews were conducted with participants from each group. The sample size was established based on the purposeful sampling strategy of maximum variation sampling (7 MHP participants, 8 pharmacy participants. Responses were directly related to differences in world-views and the historical context of the two health provider groups with respect to their roles in health. Variations within each group were related to knowledge, location and previous experience working with their counterparts. Recommendations were associated with themes/issues of environment, knowledge, communication, cultural awareness, collaboration, services and the increased awareness of the roles and responsibilities with respect to each health provider group. This dissertation also highlighted a number of key components that formed a collaborative, empowerment model of health created between organisations with different world-views, which can be adapted to a number of environments where there are different or opposing world-views within the overall same patient population. It is anticipated that the results and outcomes from this research will help develop Maori responsive pharmacy services based on health promotion and wellness to Maori locally, regionally, nationally and have a positive impact on Maori health in collaboration with MHPs. Areas of pharmaceutical care are highlighted which may encourage projects or initiatives in collaboration with MHPs to enhance health gains for Maori, while increasing professional practice roles and scope for pharmacy.

Maori health development advanced with the Hui Taumata (1984) and with the emergence of by Maori for Maori health service delivery. Rapua te ora, by Maori for Maori health service delivery. Rapua te ora, by Maori for Maori health service delivery is an expression of tino rangatiratanga. The case study of budget holding presents a Maori analysis of contemporary health services delivery to meet the needs of Maori. Maori engage in research as dynamic participants who define their roles. Maori provide new analyses of health whilst adding to the diversity of views within health research, health services administration, and health services management. Nested case study method is used to prepare this thesis. Methods nested within the case study are a literature review; empowerment evaluation, information systems strategy, provider profile method, and structural analysis. Kaupapa Maori theory, which underpins the Maori centered research approach, is used to ensure the research objectives are relevant and meet needs of Maori. Budget holding is a mechanism for provider development, systematically linking national public health oblectives to local and regional needs. At different levels of development Maori providers, new to public health, require careful anf thoughtful administration, where necessary, thoughtful management. The benefits for administrating the provision of public health services for Maori are clear vertical accountability to the purchaser, clear local accountabilities, and provider development consistent with local Maori health needs. Conclusions drawn from this case study are that Maori provider development is a response to health reforms characterised by multiple transformations of health service funding. Provider development and meeting disparate accountabilities are important issues for sustainability and the development of Maori providers for public health, and are applicable to the wider community, both national and international.

The concept of cultural safety arose in Aotearoa me Te Waipounamu/New Zealand in the late 1980�s in response to the differential health experience and negative health outcomes of the first nation people of Aotearoa me Te Waipounamu/New Zealand, the New Zealand Maori. It was introduced and developed by Maori nurses initially, as they recognised the effect culture had on health and understood safety as a common nursing concept. The concept of cultural safety has developed into a disipline which is taught as part of all nursing and midwifery curricula in Aotearoa me Te Waipounamu/New Zealand. As cultural safety has developed the concept of culture has been extended to include people who differ from the nurse by reason of: age, migrant status, sexual preference, socioeconomic status, religious persuasion, gender, ethnicity, and in Aotearoa me Te Waipounamu/New Zealand, the Treaty of Waitangi status of the nurse and recipient/s of her/his care. Nationally and internationally, health experience and health outcomes are poorer for people of minority group status than for people who are part of the dominant group. Public-health research is therefore generally conducted on, or with, people with minority group status. Public-health researchers, by education, are members of the dominant culture and may be unaware that their own and their clients; responses may relate to one/other or both cultures being diminished do not always ensure the safety of their own culture or the culture being researched. This study�s objective was to develop a flexible, culturally safe public health research framework for researches to use when researching people who are culturally different from themselves. The study will argue that the use of such a framework will contribute significantly to improved health outcomes for people with minority status and will assist the movement towards emancipatory social change. The methods undertaken included: gaining permission from Irihapeti Ramsden, the architect of cultural safety to undertake the research, conducting a literature review, consideration of primary sources and their key concepts, consulting widely with people in the field of public health and cultural safety, self reflecting on the writers own personal and professional experience and finally designing the culturally safe public health research framework.

Bibliography: leaves 372-389 / 389 leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (M.D.)--University of Adelaide, Dept. of Community Medicine, 1984

Thesis (M. Phil.)--University of Hong Kong, 2006. / Title proper from title frame. Also available in printed format.

Thesis (Ph.D.)--McMaster University, 2006. / Supervisors: Martin D. Dooley ... [et al.]. Includes bibliographical references (p. 304-318).

Low-income women in an Oregon city of approximately 35,000 inhabitants have limited access to prenatal care services during their pregnancies. The purpose of this study was to uncover the impacts of several factors on the experiences of twenty-seven health department clients with public health department prenatal care practitioners and with local private obstetricians. Ethnographic interviews were conducted with the clients, two health department practitioners, two local obstetricians, and one local direct-entry midwife. The focal finding that emerged from the research was that the clients preferred the care of the health department practitioners to that of obstetricians, even though the health department providers could not deliver the women's babies. The major impacts on the clients' experiences included fragmented service delivery and availability, economic and social restrictions on prenatal care options, biomedical constructs of a healthy pregnancy, and provider role constructions and attitudes towards Medicaid recipients and uninsured pregnant women. Local physicians' mechanistic philosophy, professional dominance and profit orientation afforded them a narrow understanding of the needs and identities of low-income women. Local public health workers are less professionally autonomous than medical doctors but their service orientation allowed them the potential to better serve low-income clients. Based on the twenty-seven clients' perceptions of their care providers and the services available to them, recommendations are made for more empowering, comprehensive prenatal care services in this county. Recommended changes to the public health system entail expanded funding for more appropriate programs and to establish continuity of care for health department clients from pregnancy through the postpartum period. The incorporation of direct-entry midwives into the prenatal and birthing care options open to low-income women is also recommended. Senate Bill 1063, which creates a process for direct-entry midwives to become state-licensed in order to be reimbursed by the Office of Medical Assistance Programs for perinatal services, is considered in terms of its implications for low-income women, the Oregon community of direct-entry midwives, and the texture of Oregon reproductive health care. / Graduation date: 1994

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