Bakgrund: Idag är det många barn som i hemmet inte får tillräckligt god omvårdnad. För att få rätt stöd och hjälp behöver dessa barn komma till socialtjänstens kännedom. Dock förekommer en underrapportering från hälso- och sjukvårdens sida av barn som far illa, trots att en anmälningsplikt föreligger. Syfte: Att beskriva skolsköterskans upplevelse av processen att göra en anmälan till socialtjänsten vid misstanke om att barn far illa. Metod: Studien genomfördes med en kvalitativ metod med en fenomenologisk ansats, där 13 skolsköterskor via e-post fick skriva ner sina berättelser. Datamaterialet analyserades med innebördsanalys. Resultat: Skolsköterskornas upplevelser i samband med en orosanmälan sammanställdes i fem teman; att bli känslomässigt berörd av barnets situation, att uppleva obehag i samband med en anmälan, att uppleva trygghet i samband med en anmälan, Att samverka med socialtjänsten påverkar samt att det fanns upplevelser av att hantera egna känslor i olika forum. Slutsats: Skolsköterskorna upplever att det finns komplexa omständigheter i samband med en orosanmälan. Resultatet visar därmed angelägenheten om att få ökad kunskap om detta för att antingen kunna förändra eller ytterligare förbättra arbetet med att göra en orosanmälan när barn far illa. / Background: Today, it is common that many children do not receive proper care in their own homes. In order to obtain proper support and help, the Social Welfare Services needs to be alerted as to the predicament of these children. Unfortunately, medical and health care personnel too often fail to report maltreatment, even though it is their obligation to do so. Aim: The aim of this study is to describe the experience of the school nurses in the process reporting child maltreatment. Method: The study was conducted using a qualitative method with a phenomenological approach, where 13 school nurses participated and shared their experiences via email correspondance. The data was analyzed by meaning analysis. Result: The experiences of the school nurses in connection with reporting suspicions of maltreatment were summarized into five different categories: experiencing emotional involvement in the child's situation, experiencing discomfort associated with reporting, experiencing a sense of security in the reporting process, experiencing that cooperation with Social Welfare Services has impact, and experiences of dealing with their own emotions in various forums. Conclusion: The school nurses experienced complex circumstances in connection with reporting suspicions of maltreatment. The result therefore shows the need for increased knowledge regarding this, in order to either change or further improve upon the work of reporting child maltreatment.

Objectives. To describe the qualitative aspects of the notifiable diseases surveillance system of the Gauteng Province, South Africa; to conduct a cross-sectional survey on knowledge and practices pertaining to disease notification among private sector primary health care providers in Gauteng Province; to measure the degree of underreporting of notifiable diseases versus positive laboratory diagnoses using malaria as a cases study; and to identify the correctible short-comings in the Gauteng Health Department’s diseases surveillance system and to recommend ways of addressing these to improve the system and its performance. Design. This is an evaluation study consisting of both the qualitative aspects and quantitative descriptive components of the notifiable disease system in Gauteng Province. The study designs used for the qualitative description were literature and policy review and a semi-structured interview with communicable disease coordinators. The quantitative research comprised of a telephonic questionnaire administered to a random sample of private general practioners and secondary data analysis comparing malaria cases notified to the Gauteng Provincial Department of Health with public and private sector laboratory data and clinical surveillance data. Setting. The study setting was the Gauteng Provincial Health Department and public and private health care service providers in Gauteng Province. The study period extended from 1 January to 30 June 2006. Subjects. The subjects of the study were the Gauteng Health Department’s disease surveillance system, public and private sector health care providers including private primary health care practitioners. Outcome measures. Outcome measures for the qualitative system description were the status of selected system attributes namely usefulness, simplicity, flexibility, data quality, acceptability, sensitivity, positive predictive value, representativeness and stability. Outcome measures for the knowledge and practice survey of private general practitioners were reporting compliance and knowledge of notifiable conditions. The primary outcome measure for the secondary data analysis was the proportion of laboratory diagnosed cases of malaria notified to the provincial health department. Results. The notifiable disease surveillance system in Gauteng is deemed useful by the public sector communicable disease coordinators but less so by the private sector general practitioners. Data quality as indicated by completeness of residential detail reporting on meningococcal notifications varied between 29% and 57% by district. Thirty seven percent of general practitioners report compliance with notifications and the mean score for knowledge on notification status of medical conditions was 56%. The sensitivity of notifications of malaria compared with laboratory notifications was 26% with relatively higher notification rates where cases occurred in children under 15 years of age. Conclusions. The notifiable disease surveillance system in Gauteng Province is relatively flexible and reasonably structured however this research suggests that there is suboptimal use of the information for local action in certain areas. Private General Practitioners self-report a low level of compliance citing time constraints and lack of motivation; knowledge of the notification status of selected medical conditions is lower than expected. The completeness and accuracy of notification data, as demonstrated in malaria notifications, is insufficient to gauge a true picture of burden of disease in the province. / Dissertation (MMed)--University of Pretoria, 2007. / School of Health Systems and Public Health (SHSPH) / Unrestricted

MPH / Department of Public Health

Introdução: O Sistema de Informação de Agravos de Notificação (SINAN) é uma importante ferramenta no apoio às ações da vigilância epidemiológica, sendo capaz de fornecer informações necessárias para o planejamento e intervenções em saúde. Com a descentralização da gestão dos serviços de saúde, as ações de vigilância epidemiológica foram colocadas sob responsabilidade dos municípios, que contam com distintos graus de capacidade administrativa. Objetivo: Analisar as condições de operação do SINAN nos municípios paulistas, segundo o porte populacional, em relação à infraestrutura, processo e apoio institucional. Métodos: Foi aplicado questionário eletrônico para 644 responsáveis pela vigilância epidemiológica, em 2017. Os dados foram analisados segundo porte populacional dos municípios: pequenos (<30.000 habitantes), médios (30.001-200.000) e grandes (>200.000) e por meio de estatística descritiva, com medidas de distribuição e de tendência central; teste de qui-quadrado e ANOVA foram utilizados na comparação entre os grupos. Resultados: Obteve-se 63,2% de retorno. Nos municípios pequenos, os responsáveis são mulheres (88,5%), jovens com <40 anos (60,2%); formação superior (88,3%), experiência com o SINAN <=9 anos (70,3%); com vínculo efetivo (56,4%); as equipes contam com <=2 profissionais (49,6%) receberam capacitação (75,9%) e apoio técnico do GVE (98,1%) para trabalhar com o SINAN; apresentam maior proporção de alta dificuldade em capacitação (16,9%) junto com os municípios médios (16,8%), e avaliam o preenchimento das fichas como bom (59,8%). Os municípios médios apresentam o perfil profissional e tempo de experiência com SINAN semelhante aos pequenos; com mais pós-graduados (47,7%); equipe com 3-6 membros; receberam mais capacitação (79,6%) em relação aos demais grupos. Receberam apoio técnico do GVE (91,2%); apresentam maior proporção de alta dificuldade no item fluxo de retorno (22,1%), como os grandes municípios (21,4%); avaliam o preenchimento das fichas como razoável (48,7%). Nos grandes municípios, predominou o responsável técnico com idade >=50 anos (60,7%) e mais pós-graduados (75,0%); maior número de efetivos (64,3%); profissionais com mais experiência no SINAN; 80,0% possuem >=11 funcionários; receberam capacitação (71,4%) e apoio do GVE (64,3%) para trabalhar com o SINAN em menor proporção que os demais; apresentam maior proporção de alta dificuldade com recursos humanos e avaliam o preenchimento das fichas como razoável (48,7%). Conclusões: O SINAN está implantado nos municípios paulistas, bem consolidado nos municípios grandes, porém os pequenos precisam de medidas de apoio que diminuam a disparidade entre os municípios: políticas e estratégias que estimulem a estabilidade profissional, bem como investimentos na capacitação profissional, aprimoramento dos recursos tecnológicos, avaliações periódicas do SINAN, além de incentivos financeiros voltados para gestão do SINAN. / Introduction: Notifiable Diseases Information System is an important tool in supporting actions of epidemiological surveillance, being able to provide information necessary for health planning and interventions. Regards to decentralization of health services management, actions of epidemiological surveillance were placed under the responsibility of municipalities, which have different degrees of administrative capacity. Objective: To analyze SINAN\'s operational conditions in the municipalities of São Paulo State, according to population size, in relation to infrastructure, process and institutional support. Methods: An electronic questionnaire was applied to 644 epidemiological surveillance managers in 2017. Data were analyzed according to the population size of the municipalities: small-sized (<30,000 inhabitants), medium-sized (30,001-200,000) and large-sized (> 200,000). We conducted a descriptive statistic analyse, distribution and central tendency measures were calculated. Chi-square test and ANOVA were used in the comparison between the groups. Results: 63.2% of questionnaires were answered. In small-sized municipalities, managers are female (88.5%), younger (<40 years old) (60.2%), with higher education degree (88.3%); mainly nurses; with experience with SINAN <=9 years (70.3%); with career civil servant (56.4%); teams have <=2 professionals (49.6%), that received training (75.9%) and technical support from the GVE (98.1%) to work with SINAN. Small-sized municipalities present a higher proportion of high difficulty in the training item (16.9%) as well as the medium-sized municipalities (16.8%), and evaluated the completion of records as good (59.8%). Medium-sized municipalities is similar to smaller ones in relation to time of experience with SINAN and professional profile. Team have more postgraduate persons (47.7%), being composed of 3-6 members. staff received more training (79.6%) in relation to the other groups. Team received technical support from the GVE (91.2%). Staff reported a higher difficulty for flow of return item (22.1%), as well as the large-sized municipalities (21.4%). Team evaluated completeness of the records as reasonable (48.7%). In the large-sized municipalities SINAN\'s managers are >=50 years old (60.7%). This group have a higher percentage of postgraduate professionals (75.0%); higher number of career civil servant (64.3%), 80.0% of teams have >=11members, that received training (71.4%) and GVE support (64.3%) to work with SINAN; professionals have more experience with SINAN. Units have higher number of computers. Managers reported higher difficulty for human resources item, and evaluated completeness of records as reasonable (48.7%). Conclusions: SINAN was implemented in the municipalities of São Paulo State, being consolidated in large-sized municipalities, but small ones need government support measures that reduce disparities between municipalities: policies and strategies that stimulate professional stability, as well as investments in professional training, improvement of technological resources, periodic evaluations of SINAN and financial incentives for the management of SINAN.

Introdução: O Sistema de Informação de Agravos de Notificação (SINAN) é uma importante ferramenta no apoio às ações da vigilância epidemiológica, sendo capaz de fornecer informações necessárias para o planejamento e intervenções em saúde. Com a descentralização da gestão dos serviços de saúde, as ações de vigilância epidemiológica foram colocadas sob responsabilidade dos municípios, que contam com distintos graus de capacidade administrativa. Objetivo: Analisar as condições de operação do SINAN nos municípios paulistas, segundo o porte populacional, em relação à infraestrutura, processo e apoio institucional. Métodos: Foi aplicado questionário eletrônico para 644 responsáveis pela vigilância epidemiológica, em 2017. Os dados foram analisados segundo porte populacional dos municípios: pequenos (<30.000 habitantes), médios (30.001-200.000) e grandes (>200.000) e por meio de estatística descritiva, com medidas de distribuição e de tendência central; teste de qui-quadrado e ANOVA foram utilizados na comparação entre os grupos. Resultados: Obteve-se 63,2% de retorno. Nos municípios pequenos, os responsáveis são mulheres (88,5%), jovens com <40 anos (60,2%); formação superior (88,3%), experiência com o SINAN <=9 anos (70,3%); com vínculo efetivo (56,4%); as equipes contam com <=2 profissionais (49,6%) receberam capacitação (75,9%) e apoio técnico do GVE (98,1%) para trabalhar com o SINAN; apresentam maior proporção de alta dificuldade em capacitação (16,9%) junto com os municípios médios (16,8%), e avaliam o preenchimento das fichas como bom (59,8%). Os municípios médios apresentam o perfil profissional e tempo de experiência com SINAN semelhante aos pequenos; com mais pós-graduados (47,7%); equipe com 3-6 membros; receberam mais capacitação (79,6%) em relação aos demais grupos. Receberam apoio técnico do GVE (91,2%); apresentam maior proporção de alta dificuldade no item fluxo de retorno (22,1%), como os grandes municípios (21,4%); avaliam o preenchimento das fichas como razoável (48,7%). Nos grandes municípios, predominou o responsável técnico com idade >=50 anos (60,7%) e mais pós-graduados (75,0%); maior número de efetivos (64,3%); profissionais com mais experiência no SINAN; 80,0% possuem >=11 funcionários; receberam capacitação (71,4%) e apoio do GVE (64,3%) para trabalhar com o SINAN em menor proporção que os demais; apresentam maior proporção de alta dificuldade com recursos humanos e avaliam o preenchimento das fichas como razoável (48,7%). Conclusões: O SINAN está implantado nos municípios paulistas, bem consolidado nos municípios grandes, porém os pequenos precisam de medidas de apoio que diminuam a disparidade entre os municípios: políticas e estratégias que estimulem a estabilidade profissional, bem como investimentos na capacitação profissional, aprimoramento dos recursos tecnológicos, avaliações periódicas do SINAN, além de incentivos financeiros voltados para gestão do SINAN. / Introduction: Notifiable Diseases Information System is an important tool in supporting actions of epidemiological surveillance, being able to provide information necessary for health planning and interventions. Regards to decentralization of health services management, actions of epidemiological surveillance were placed under the responsibility of municipalities, which have different degrees of administrative capacity. Objective: To analyze SINAN\'s operational conditions in the municipalities of São Paulo State, according to population size, in relation to infrastructure, process and institutional support. Methods: An electronic questionnaire was applied to 644 epidemiological surveillance managers in 2017. Data were analyzed according to the population size of the municipalities: small-sized (<30,000 inhabitants), medium-sized (30,001-200,000) and large-sized (> 200,000). We conducted a descriptive statistic analyse, distribution and central tendency measures were calculated. Chi-square test and ANOVA were used in the comparison between the groups. Results: 63.2% of questionnaires were answered. In small-sized municipalities, managers are female (88.5%), younger (<40 years old) (60.2%), with higher education degree (88.3%); mainly nurses; with experience with SINAN <=9 years (70.3%); with career civil servant (56.4%); teams have <=2 professionals (49.6%), that received training (75.9%) and technical support from the GVE (98.1%) to work with SINAN. Small-sized municipalities present a higher proportion of high difficulty in the training item (16.9%) as well as the medium-sized municipalities (16.8%), and evaluated the completion of records as good (59.8%). Medium-sized municipalities is similar to smaller ones in relation to time of experience with SINAN and professional profile. Team have more postgraduate persons (47.7%), being composed of 3-6 members. staff received more training (79.6%) in relation to the other groups. Team received technical support from the GVE (91.2%). Staff reported a higher difficulty for flow of return item (22.1%), as well as the large-sized municipalities (21.4%). Team evaluated completeness of the records as reasonable (48.7%). In the large-sized municipalities SINAN\'s managers are >=50 years old (60.7%). This group have a higher percentage of postgraduate professionals (75.0%); higher number of career civil servant (64.3%), 80.0% of teams have >=11members, that received training (71.4%) and GVE support (64.3%) to work with SINAN; professionals have more experience with SINAN. Units have higher number of computers. Managers reported higher difficulty for human resources item, and evaluated completeness of records as reasonable (48.7%). Conclusions: SINAN was implemented in the municipalities of São Paulo State, being consolidated in large-sized municipalities, but small ones need government support measures that reduce disparities between municipalities: policies and strategies that stimulate professional stability, as well as investments in professional training, improvement of technological resources, periodic evaluations of SINAN and financial incentives for the management of SINAN.

Mandatory notification of disease forms the backbone of disease surveillance in New Zealand and overseas. Notification data is used by public health professionals and academics to identify cases requiring public health control, monitor disease incidence and distribution, and in epidemiological research. However, there is emerging evidence that notification rates do not accurately reflect the true extent of notifiable diseases within the community, resulting in the underascertainment of many notifiable cases. While adequate surveillance does not necessarily require that all cases of notifiable disease be captured, the systematic underascertainment of disease can have significant implications for perceived spatial and demographic trends in disease prevalence; potentially threatening the credibility of spatial epidemiological research by under or overestimating the burden of disease in different populations. There is evidence that systematic underascertainment occurs as a result of the differential actions of laboratories and general practitioners. It has also been recognised that that underascertainment can be influenced by a patient's willingness to seek medical attention and participate in laboratory tests. However, few studies have investigated whether these factors systematically influence notification either in New Zealand or overseas. Furthermore, the discipline of health geography has been slow to engage with this topic of public health importance, despite the inherently spatial nature of the processes involved, and the close ties to the geographic literature on health service utilization and healthcare provision. This thesis explores the spatial and temporal variation in notification rates in New Zealand for the period 1997-2005 and the potential relationships between notification rates and different variables. Unlike many underascertainment studies, which have used individual data and capture-recapture methods, data constraints inspired a unique ecological approach to investigating the factors which may be associated with notification in New Zealand. Variables were divided into categories based on Anderson's behavioural model for healthcare utilization and the influence of these variables on notification was determined through multiple regression analyses. The main findings of this research indicate that in New Zealand notification rates have increased during the period 1997-2005 and that there is a north-south gradient in notifications, with substantially lower rates in the North Island than in the South Island. Furthermore, it is also evident that the variables associated with notification vary according to disease, spatial aggregation and spatial scale. Notification rates are significantly associated with a range of predisposing and enabling factors which might influence patient choice to consult for many frequently underascertained diseases. More variation in enteric diseases is explained by the independent variables analysed than the variation in non-enteric diseases. However, further research into these relationships, and underascertainment in general, is required before firm conclusions can be drawn.

Mandatory notification of disease forms the backbone of disease surveillance in New Zealand and overseas. Notification data is used by public health professionals and academics to identify cases requiring public health control, monitor disease incidence and distribution, and in epidemiological research. However, there is emerging evidence that notification rates do not accurately reflect the true extent of notifiable diseases within the community, resulting in the underascertainment of many notifiable cases. While adequate surveillance does not necessarily require that all cases of notifiable disease be captured, the systematic underascertainment of disease can have significant implications for perceived spatial and demographic trends in disease prevalence; potentially threatening the credibility of spatial epidemiological research by under or overestimating the burden of disease in different populations. There is evidence that systematic underascertainment occurs as a result of the differential actions of laboratories and general practitioners. It has also been recognised that that underascertainment can be influenced by a patient's willingness to seek medical attention and participate in laboratory tests. However, few studies have investigated whether these factors systematically influence notification either in New Zealand or overseas. Furthermore, the discipline of health geography has been slow to engage with this topic of public health importance, despite the inherently spatial nature of the processes involved, and the close ties to the geographic literature on health service utilization and healthcare provision. This thesis explores the spatial and temporal variation in notification rates in New Zealand for the period 1997-2005 and the potential relationships between notification rates and different variables. Unlike many underascertainment studies, which have used individual data and capture-recapture methods, data constraints inspired a unique ecological approach to investigating the factors which may be associated with notification in New Zealand. Variables were divided into categories based on Anderson's behavioural model for healthcare utilization and the influence of these variables on notification was determined through multiple regression analyses. The main findings of this research indicate that in New Zealand notification rates have increased during the period 1997-2005 and that there is a north-south gradient in notifications, with substantially lower rates in the North Island than in the South Island. Furthermore, it is also evident that the variables associated with notification vary according to disease, spatial aggregation and spatial scale. Notification rates are significantly associated with a range of predisposing and enabling factors which might influence patient choice to consult for many frequently underascertained diseases. More variation in enteric diseases is explained by the independent variables analysed than the variation in non-enteric diseases. However, further research into these relationships, and underascertainment in general, is required before firm conclusions can be drawn.