This investigation examines aspects of junior doctor training as perceived by both junior doctors and their supervisors. The studies were conducted as part of the role of educational facilitator at a district general hospital. The first and second studies report on surveys that were used to determine the experience of formal educational structures and informal training as reported by two cohorts of junior doctors. Qualities of the supervision relationship were explored using the Barrett Lennard Relationship Inventory (BLRI, Barrett Lennard 1962). Focus groups and in-depth interviews were used in the third and fourth studies to explore hospital consultants' perceptions of medical training. The main findings of this investigation are as follows. The salient learning experiences reported by the junior doctors were those referring to their practical experience, learning relationships and self-assessment methods. The junior doctors preferred learning from active involvement and informal situations. Associations were found between the junior doctors' ratings of the training experience and their perceptions of supervision relationships (BLRI). Those with an individual training plan were more satisfied with their training than those without. This investigation also highlighted tensions between the junior doctors' service provider and trainee roles. The functions of the learning relationship are presented in the discussion these include: teaching, role modelling, feedback and support. The generic skills (e.g. decision making) and learning practices (e.g. discussion) described by the hospital consultants in the interviews are discussed with reference to models of professional development (Eraut 1994), reflective practice (Schon 1983) and medical practice (Britten 1991). The findings have implications for the development and evaluation of strategies for training. evidence based medicine and clinical governance because they demonstrate the processes by which skills for medical practice are formed.

No description available.

This thesis addresses various food safety issues and investigates them from an economic perspective within four different, but related, studies. The studies are intended to provide policy-makers and other decision-makers in the industry with valuable information that will help them to implement better mitigation strategies and policies. The studies also present some applications of advancements in choice modelling, and thus contribute to the literature. To address these issues, various surveys were conducted in the UK.The first study investigates different stakeholder groups’ perceptions of responsibility among the stages of the meat chain for ensuring the meat they eat does not cause them to become ill, and how this differed with food types. The means by which this is achieved is novel, as we elicit stakeholders’ relative degrees of responsibility using the Best-Worst Scaling (BWS) technique. BWS is particularly useful because it avoids the necessity of ranking a large set of items, which people have been found to struggle with. The results from this analysis reveal a consistent pattern among respondents of downplaying the extent of their own responsibility. The second study explores people’s perceptions of various food and non-food risks within a framework characterised by the level of control that respondents believe they have over the risks, and the level of worry that the risks prompt. The means by which this is done differs from past risk perception analyses in that it questions people directly regarding their relative assessments of the levels of control and worry over the risks presented. The substantive analysis of the risk perceptions has three main foci concerning the relative assessment of (i) novel vs. more familiar risks, (ii) food vs. non-food risks, (iii) differences in the risk perceptions across farmers and consumers, with a particular orientation on E. coli. The third study investigates consumers’ willingness to pay (WTP) for reductions in the level foodborne health risk achieved by (1) nanotechnology and (2) less controversial manners in the food system. The difference between consumers’ valuations provides an implicit value for nanotechnology. This comparison is achieved via a split sample Discrete Choice Experiment study. Valuations of the risk reductions are derived from conditional, heteroskedastic conditional, mixed, and heteroscedastic mixed logit models. General results show the existence of heterogeneity in British consumers’ preferences and variances, and that the value of nanotechnology differs for different types of consumers. The fourth study investigates consumers’ perceptions of trust in institutions to provide information about nanotechnology and its use in food production and packaging. It is shown how the use of BWS and Latent Class modelling of survey data can provide in-depth information on consumer categories useful for the design of effective public policy, which in turn would allow the development of best practice in risk communication for novel technologies. Results show heterogeneity in British consumers’ preferences. Three distinct consumer segments are identified: Class-1, who trust “government institutions and scientists” most; Class-2, who trust “non-profit organisations and environmental groups” most; and Class-3, who trust “food producers and handlers, and media” most.

Master of Public Health - MPH / Background: Parental perceptions of health and child health needs have not been explored within Early Childhood Care and Development (ECCD) centres in the Eastern Cape of South Africa. Although the relationship between social, economic and environmental conditions and health status has been well documented in the literature, it is unknown whether parents of children attending rural ECCD centres, share this understanding. Children have the right to a healthy environment. Many children in rural Eastern Cape live in environments that present challenges in regards to water and sanitation, food security and safety. ECCD centres are the daily environment for the attending pre-school children and have a role to play in promoting child health. In order to develop effective, sustainable health promotion initiatives in ECCD centres a baseline recording was needed of the parental understanding of health, their children’s health needs and perceived solutions. Study Design: This study was an exploratory study, which used qualitative research methods to describe the parents’ perceptions of health and health needs of their children in ECCD centres in Amathole District, South Africa. Data Collection: Focus group discussions were the data collection method used to record the parental perceptions of health and child health needs. Because there was limited parental involvement in the ECCD centres, it was hoped that the focus groups would be a suitable method to generate more community involvement. Four focus groups were conducted using a semi-structured. The researcher facilitated the focus group discussions with the assistance of an isiXhosa speaking research assistant. The voice recordings of the discussions were professionally translated and transcribed for analysis. Analysis of Results: Content analysis of the transcriptions revealed a thick description of parental perceptions of health and child health needs. Participants saw health in holistic terms and identified a complex inter-relationship of various social determinants of health, consistent with Dahlgren and Whitehead's determinants of health model. Parents were aware of the absence of many of these determinants of health and the challenges to child health that this brought. The child health needs perceived by parents were related to nutrition, hygiene, social interaction, safety and protection from disease. Five recurring themes emerged as a result of this study, including individual lifestyle factors, social interaction, environmental challenges to health, safety and lastly poverty. The ECCD centres were considered a resource for child health and suggestions were given as to how to strengthen the ECCD centres' role in further promoting health. Conclusion: The participants' broad definition of health and depth of understanding regarding the determinants of health, allows for a range of stakeholders to be involved in the promotion of health in the ECCD centres. The majority of the perceived challenges to health existed in the living conditions of the children and families. The Health Promoting Schools (HPS) framework could enhance the current work of the Eco-Schools Programme in the ECCD centres.

In this Master's of Public Issues Anthropology thesis I examine the perceptions of health and healthcare services within a small rural subsistence farming community in South-Western Paraguay from a political ecology of health perspective. Qualitative research data was collected from May to September of 2010 in Lindo Manantial, a subsistence farming village, and Piribebuy, the closest town to Lindo Manantial and the location of the nearest health centre, the Piribebuy Centro de Salud. The primary goals of this research project were to gain an ethnographic understanding of current local health perspectives and concerns, as well as the local frameworks for health provision in Piribebuy. I argue that the introduction of culturally competent healthcare services could greatly improve individual and community health statuses and outcomes in Lindo Manantial and other similar rural subsistence farming communities in Paraguay. / Social Sciences and Humanities Research Council of Canada (SSHRC)

Made available in DSpace on 2014-12-17T14:46:59Z (GMT). No. of bitstreams: 1 AnaARQ_DISSERT.pdf: 1628961 bytes, checksum: 76cb55c766edc58ebcd8828acbccae74 (MD5) Previous issue date: 2012-12-14 / This study thus sought to examine knowledge about TB and attitudes of patients families in disease treatment in Primary Health Care in Natal- RN. To this end, a cross-sectional study was undertaken through a questionnaire with families of patients diagnosed with TB and follow up by APS from Natal. The study subjects were recruited from a non-probabilistic way, by convenience, contemplating a sample of 50 families. Among the criteria considered for inclusion of subjects, older than 18 years were considered, as well as residing with the TB patient and in Natal and availability to participate in the research. Data collection was performed by own researcher and an assistant, through a questionnaire with families of patients diagnosed with TB following the double independent digitalization of data. In the analytical phase, was initially conducted an exploratory phase and univariate data, with description of the position measurements (mean, median, mode) and dispersion (confidence interval and standard deviation). In bivariate analysis, it was conducted an intersection of dependent variables of knowledge e and changes of attitude dichotomous, with each of the independent variables, using contingency tables and calculating the chi-square test and, when appropriate, the Fisher exact test. In 2x2 tables, calculated the odds ratio (OR) with confidence intervals of 95% (95% CI). From the selected sample, 43 (86%) subjects were female, average age and median respectively of 46.64 and 46.50 years, 25 (50%) had elementary school. The knowledge expressed by family members about TB was considered satisfactory. However, the lack of interest of the family (54%) in seeking information about tuberculosis; the wrong way of reply in relation to the organism causing the disease (64%); the water content (62%) and contaminated food (54% ) as a means of spreading TB was a weakness identified in the investigation. Regarding the time of transmission, 90% of respondents indicated not know or answered wrong. From investigated independent variables, only two were associated with lack of knowledge of TB, and they did not have religion (OR: 0.146, 95% CI: 0.027 to 0.800) and income below 1, 7 minimum wages (OR: 0.155, 95% CI: 0.029 to 0.813). Thus they seem to exercise a protective effect on this outcome. As for the changes in attitude, most of the found variables had no association with statistical significance, except no internet access (OR: 0.212, 95% CI: 0,048-0, 935). Most attitudes were positive in relation to TB patient. Results have demonstrated weaknesses in TB care, which has taken on a more individual and welfare character. Data not only express health outcomes produced by health services, but also the political and social situation of the families that are affected by TB / A presente investiga??o analisa o conhecimento sobre TB e as atitudes das fam?lias de pacientes em tratamento da doen?a na Aten??o Prim?ria ? Sa?de em Natal/RN. Consiste em um estudo de corte transversal, realizado atrav?s da aplica??o de question?rio junto ?s fam?lias de pacientes diagnosticados de TB e em seguimento pela APS de Natal. Os sujeitos da pesquisa foram recrutados de forma n?o probabil?stica, por conveni?ncia, contemplando uma amostra de 50 familiares. Dentre os crit?rios de inclus?o dos sujeitos, est?o idade acima de 18 anos, residir com o doente de TB em Natal e disponibilidade de participa??o da pesquisa. A coleta de dados foi realizada pela pesquisadora e uma assistente, atrav?s de um formul?rio previamente testado em realidade semelhante, junto aos familiares do doente de TB.Procedeu-se a dupla digita??o independente dos dados. Na etapa anal?tica, inicialmente foi conduzida a fase explorat?ria e univariada dos dados, com descri??o das medidas de posi??o (m?dia, mediana, moda) e dispers?o (intervalo de confian?a e desvio-padr?o). Na an?lise bivariada, os autores efetuaram o cruzamento das vari?veis dependentes e dicot?micas − conhecimento e mudan?as atitudes ,com cada uma das vari?veis independentes, por meio de tabelas de conting?ncia, sendo aplicado o teste qui-quadrado e, quando necess?rio, o teste exato de Fisher. Nas tabelas 2x2, computou-se o odds ratio (OR) com respectivos intervalos de confian?a de 95% (IC 95%). Da amostra selecionada, 43 (86%) sujeitos eram do sexo feminino, com idade m?dia e mediana respectivamente de 46,64 e 46,50 anos; 25 (50%) possu?am o ensino fundamental. O conhecimento expresso pelos familiares sobre a TB foi considerado satisfat?rio. Entretanto, a falta de interesse dos familiares (54%) em procurar informa??es sobre a tuberculose; a forma incorreta da resposta em rela??o ao microrganismo causador da doen?a (64%); a indica??o de ?gua (62%) e alimentos contaminados (54%) como meios de dissemina??o da TB foi uma fragilidade identificada na investiga??o. Em rela??o ao tempo de transmiss?o da doen?a, 90% dos entrevistados indicaram n?o saber ou responderam errado. Das vari?veis independentes investigadas, apenas duas apresentaram associa??o com o n?o conhecimento de TB, sendo elas n?o possuir religi?o (OR: 0,146; IC95% : 0,027-0,800) e renda abaixo de 1,7 sal?rios m?nimos (OR : 0,155; IC95%: 0,029-0,813), parecendo elas exercerem um efeito protetor sobre este desfecho. Quanto ?s mudan?as de atitude, a maioria das vari?veis consideradas n?o teve associa??o com signific?ncia estat?stica, exceto o n?o acesso ? internet (OR: 0,212; IC95%:0,048-0,935). A maioria das atitudes foi positiva em rela??o ao doente de TB. Os resultados demonstram fragilidades na aten??o ? TB, que tem assumido um car?ter mais assistencialista e individual. Os dados n?o somente expressam os resultados sanit?rios produzidos pelos servi?os de sa?de, mas a conjuntura pol?tica e social das fam?lias que s?o acometidas pela TB

The study examined the relationship between building conditions and overall student behavior as well as the relationship between building conditions and the behaviors of student subgroups that include Caucasian, African American, Hispanic, and Students with Disabilities (SWD). The study controlled for over-crowdedness, socioeconomic status, and attendance. The study included 10 school facilities in a medium-sized school division in Virginia. Building conditions were determined through facility engineering and educational condition. Facility Condition Indexes (FCIs) described facility engineering conditions. The Revised Commonwealth Assessment of Physical Environment (CAPE) instrument initially developed by Cash (1993) and revised by Cash and Earthman (2019) assessed facility educational conditions. The CAPE instrument provided overall, structural and cosmetic facility condition scores and was administered to principals. Student behavior was determined by student overall behavior indexes as well as subgroup-based behavior indexes representing the ratio of discipline incidents divided by student population. School-specific over-crowdedness indexes were utilized. Free and reduced lunch percentages were used as a measure of socioeconomic status. For attendance, the study used attendance indexes described by the percentage of students who were absent for at least 10% of the academic year. To establish the potential relationships between building conditions and student behavior in each student subgroup, the study used quantitative analysis utilizing hierarchical multiple-variable regression and analysis of variance (ANOVA) through the Statistical Package for Social Sciences (SPSS). The researcher conducted individual single-predictor and multiple-variable hierarchical regression models. ANOVA was utilized to explain the total variance in the regression model, and the variance due to each predictor. The researcher identified regression relationships, their statistical significance, and interpreted results to reach a conclusion addressing each research question. Potential relationships between building conditions and student behavior were highlighted. The study identified that higher numbers of disciplinary incidences were related to higher absenteeism rates within all student groups. Further, lower numbers of Hispanic student disciplinary incidences were associated with poorer student populations. In terms of facility conditions, lower numbers of Hispanic student and SWD disciplinary incidences were associated with improved cosmetic facility conditions and lower numbers of SWD disciplinary incidences were associated with improved overall facility conditions. / Doctor of Education / The study examined the relationship between building conditions and overall student behavior as well as the relationship between building conditions and the behaviors of student subgroups that include Caucasian, African American, Hispanic, and Students with Disabilities (SWD). Over-crowdedness, socioeconomic status, and attendance were mediating factors. The study included 10 school facilities in a medium-sized school division in Virginia. Building conditions were determined through facility engineering and educational condition. Facility Condition Indexes (FCIs) described facility engineering conditions. The Revised Commonwealth Assessment of Physical Environment (CAPE) instrument initially developed by Cash (1993) and revised by Cash and Earthman (2019) assessed facility educational conditions. The CAPE instrument provided overall, structural and cosmetic facility condition scores and was administered to principals. Student behavior was represented by the ratio of discipline incidents divided by student population for overall students and student subgroups. School-specific over-crowdedness measures were utilized. Free and reduced lunch percentages were used as a measure of socioeconomic status. For attendance, the study used the percentages of students who were chronically absent. To establish the potential relationships between building conditions and student behavior in each student subgroup, the study used quantitative analysis utilizing hierarchical multiple-variable regression and analysis of variance (ANOVA) through the Statistical Package for Social Sciences (SPSS). The researcher assessed the impact of each facility condition individually as well as collectively on student behavior. ANOVA was utilized to explain the total contribution attributed to each predictor. The researcher identified relationships, their statistical significance, and interpreted results to reach a conclusion addressing each research question. Potential relationships between building conditions and student behavior were highlighted. The study identified that higher numbers of disciplinary incidences were related to higher absenteeism rates within all student groups. Further, lower numbers of Hispanic student disciplinary incidences were associated with poorer student populations. In terms of facility conditions, lower numbers of Hispanic student and SWD disciplinary incidences were associated with improved cosmetic facility conditions and lower numbers of SWD disciplinary incidences were associated with improved overall facility conditions.

Aim: The aim of this comprehensive thesis is to explore different perceptions of public health nursing practice. The intention being to contribute to developing the service, theoretically and practically, in throe with current and future public health needs. Methods: The thesis comprises five studies. Public health nurses, young people, parents and decision makers are interviewed and share their perceptions of public health nursing practice (studies I, II, III and IV). Consultations at local child health clinics, clinics for young people and at school health services are observed (study III). A cross sectional study amongst a sample of doctors, public health nurses, midwives and child protection workers is carried out (study V). The first four studies have an explorative, descriptive design. Study V, with its focus on interprofessional collaboration, is based on the results of studies I, II, and IV. Findings: Study I, a case study, provides a backdrop for the remaining four studies. It focuses on changes the nurses have faced during the period 1984-2005. The results point to issues of visibility and that respect is more important for the nurses than authority or status. Study II is a philosophical study based on interviews with public health nurses. It gives an introduction to the philosophy of Emmanuel Levinas and develops a novel theoretical and practical understanding of aspects of responsibility in public health nursing. Study III shows the importance of relationships with service users in public health nursing practice; and that not only pleasantness but also honesty and openness are important. This study has contributed to further developing models of public health nursing interventions. Decision makers in study IV point to the challenges public health nurses face regarding collaboration, visibility and boundaries. Study V is a cross sectional questionnaire study that focuses on interprofessional collaboration. The results show that size of municipality can influence frequency of meeting points and views on issues relating to collaboration; and that mental health services are those most missed in collaborative relationships. The findings warrant further research and should be of interest when organising municipal health- and social services in Norway. Conclusions: The thesis concludes that service users and decision makers are satisfied with public health nursing services, but that public health nurses face challenges related to collaboration, to boundaries for knowledge and involvement, and in making their health promotive function visible / Denne doktorgradsavhandling: Perceptions of public health nursing practice - on borders and boundaries, visibility and voice, fokuserer på ulike oppfatninger av helsesøsters praksis. Helsesøstre, ungdom, foreldre, samt lokale politikere og administratorer er intervjuet om deres syn på helsesøstertjenesten. Konsultasjoner på helsestasjon for barn, ungdom og i skolehelsetjenesten er observert. Et utvalg av samarbeidspartnere har svart på et spørreskjema om samarbeidsforhold. Avhandlingen består av fem studier. De første fire studier har eksplorativ, deskriptiv design. Studie V er en tverrsnittsstudie som bygger på resultatene fra studiene I,II, og IV. Avhandlingen har til hensikt å løfte frem områder som respondentene mener fortjener oppmerksomhet og som kan ha praktiske og teoretiske implikasjoner for utvikling av tjenesten. Studie I, en case studie danner et bakteppe for de andre studiene. Den fokuserer på endringer i helsesøstertjenesten i perioden 1984-2005. Resultatene fra denne studien peker på helsesøstrenes opplevelse av usynlighet og at respekt er mer viktig for helsesøstrene i studien enn autoritet og status. Studie II er en filosofisk studie basert på intervjuer med helsesøstre. Den gir en introduksjon til Levinas’ filosofi og utvikler en dypere forståelse for teoretiske og praktiske aspekter av etisk ansvar i helsesøsters praksis. Studie III peker på betydningen av relasjoner i helsesøsters praksis. Det var viktig at konsultasjonene var hyggelige for helsesøstrene og brukerne, men ærlighet og åpenhet var også vesentlig for gode relasjoner. Beslutningstakere i studie IV peker på utfordringer helsesøstre har når det gjelder samarbeid, usynlighet, samt grenser for deres kunnskap og involvering. Studie V er en spørreskjemaundersøkelse som fokuserer på samarbeid. Resultatene viser at kommunestørrelse har betydning for hyppighet av møtepunkter og syn på samarbeid og at psykiske helsetjenester er savnet mest i samarbeidsrelasjoner. Disse funn burde være av interesse i fremtidig organisering av helse- og sosialtjenester. Avhandlingen konkluderer med at foreldre, ungdom og beslutningstakere er fornøyde med helsesøstertjenesten, men at helsesøstre står overfor viktige utfordringer i samarbeidsrelasjoner, i forhold til grenser for involvering og i å synliggjøre deres helsefremmende funksjon