Darbo tikslas - įvertinti pirminės sveikatos priežiūros įstaigų pacientų teisės į valstybės laiduojamą (nemokamą) asmens sveikatos priežiūrą įgyvendinimą ir jo skirtumus privataus ir viešojo sektoriaus pirminės sveikatos priežiūros įstaigose. Metodika. 2013 metų liepos – 2014 metų sausio mėnesiais anoniminės anketinės apklausos būdu apklausti 328 Telšių miesto viešų ir privačių pirminės sveikatos priežiūros įstaigų pacientai (atsako dažnis 82 proc.). Statistinė duomenų analizė atlikta naudojantis SPSS statistiniu paketu (20.0 versija). Hipotezės apie požymių priklausomybę buvo tikrinamos naudojant chi kvadrato (χ²) ir z kriterijus bei binarinę logistinę regresiją. Skirtumas laikytas reikšmingu, kai p < 0,05. Rodikliai buvo standartizuoti pagal amžių tiesioginės standartizacijos metodu. Rezultatai. Dauguma apklaustųjų žinojo, jog Lietuvoje nemokamai teikiama būtinoji medicinos pagalba ir šeimos gydytojo konsultacijos ir tai, jog teisę gauti nemokamas sveikatos priežiūros paslaugas turi pensininkai, asmenys iki 18 metų, asmenys, kurie yra apsidraudę PSD, studentai ir bedarbiai, kurie yra užsiregistravę darbo biržoje. Apie pusė apklaustųjų teigė, kad Lietuvoje pacientams yra garantuojama nemokama sveikatos priežiūra ir bendrai daugiau respondentų palankiai vertino Lietuvos sveikatos draudimo sistemą. Gerai ir puikiai vertinantys savo sveikatą respondentai palankiau vertino nemokamos sveikatos priežiūros įgyvendinimą ir Lietuvos sveikatos draudimo sistemą lyginant su blogai ir... [toliau žr. visą tekstą] / The aim of study is to assess the implementation of the patients‘ rights to the state-guaranteed (free) health care provision in primary health care institutions and to evaluate implementation differences in the public and private sectors. Methods. In the period of July, 2013 and January, 2014 328 respondents (patients of public and private primary health care institutions in Telsiai) were asked to complete an anonymous questionnaire (the response rate 82%). Statistical data analysis has been carried out using SPSS statistical package (20.0 version). The hypotheses on the feature dependence have been checked by the chi square (χ²) and z criteria as well as by the binary logistic regression. The difference is considered significant when p < 0,05. The rates have been standardized according to age using the direct standardization method. Results. Most of the respondents were aware of the fact that Lithuania provides free medical aid and family doctor's consultations and the fact that there is a right to free health care services to the retired, persons under the age of 18, CHI insured persons, students and the unemployed, who are registered at the labour exchange. About half of the respondents said that Lithuania's patients are guaranteed free health care and, generally, more respondents were in favor of the Lithuanian health insurance system. The respondents who claimed to be in a good or excellent health condition evaluate the implementation of the free health care and the... [to full text]

Darbo tikslas Išanalizuoti ir įvertinti sveikatos priežiūros specialistų nuomonę apie įstaigoje diegiamos elektroninės sveikatos poreikį bei įtaką ambulatorinės asmens sveikatos priežiūros įstaigų veiklos pokyčiams. Darbo uždaviniai: 1. Išanalizuoti sveikatos priežiūros specialistų nuomonę apie e sveikatos įdiegimą gydymo įstaigose ir naudojimąsi e. sveikatos paslaugomis. 2. Įvertinti e. sveikatos paslaugų ambulatorinėje medicinos priežiūroje poreikį medicinos darbuotojų požiūriu. 3. Išanalizuoti ir palyginti poliklinikų sveikatos priežiūros specialistų nuomonę apie įdiegtų informacinių technologijų veiklos pokyčių poveikį sveikatos priežiūros paslaugų teikimui ir naudojimui. Darbo metodika: Kiekybinis momentinis tyrimas atliktas 2013 gruodžio - 2014 sausio mėn. Tiriamųjų imtį sudarė medikai, administracijos ir statistikosdarbuotojai, dirbantys Kėdainių miesto poliklinikose. Atlikta anoniminė anketinė apklausa (N = 154). Rezultatai: Didžioji dalis apklaustų respondentų (73 proc.) teigė,kad kompiuteris jų darbo vietoje yra reikalingas, o geriau vertinantiems savo kompiuterinį raštingumą kompiuteris jų darbo vietoje būtinas.63 proc. gydytojų savo kompiuterinį raštingumą vertina, kaip vidutinį ar blogą.Pagrindine įstaigos informacine sistema naudojasi93,1 proc. Kėdainių PSPC ir 59,7 proc. (p<0,05). Konsultacinės poliklinikos darbuotojų. Elektroninio nedarbingumo sistema reikšmingai dažniau naudojasi gydytojai (92,6 proc.).Reikšmingai (p<0,05) skiriasi PSPC ir poliklinikos... [toliau žr. visą tekstą] / The aim of the study. To analyse and evaluate the opinions of health care specialists about the demand of eHealth and its impact on performance changes of outpatient health care institutions. The tasks of the study.1. To analyse the opinions of health care specialists about eHealth implementation in medical institutions and the use of eHealth services. 2. To evaluate the demand of eHealth servicesinoutpatient health care according to health care specialists. 3. To analyse and compare the opinions of health care specialists in polyclinics about the influence of implemented information technology on health care services. Study methods. The survey was conducted in December2013 – January 2014. Anonymous questionnaires (N=154) were distributed to health care specialists, administration staffand employees of statistics department in polyclinics of town Kedainiai. Results.The major part (73%) of the respondents reported that a computer is required in their workplace, and the ones who considered their computer literacy skills as highclaimed it as necessity. 63% of doctors self-evaluated their computer literacy skills as intermediate or poor. The main IT system of the institution is used by 93,1 % of employees of Kedainiai PHCC and 59,7% of employees of Consultants Polyclinic. Electronic sick-list system is mainly (92,6%) used by doctors. There is a significant difference (p<0,05)in the opinions of the employees of PHCC and the employees of the polyclinic about important factors... [to full text]

In recent times, the sports sector across the globe has attracted economic interests both from the public and the private sector. For example, the cost of hosting the 2014 FIFA World Cup in Brazil was estimated at over $14.5 billion, with huge investments made intorenovating old stadia and building new ones in preparation for the games. Similarly, the 2014 Commonwealth Games in Glasgow generated over 5,000 jobs and apprenticeships for the locals, £200m worth of contracts to local firms, £198m investments in sporting facilities, and £700m worth of transport-related infrastructural development. It is thus clear that sport hasassumed more relevance in society than merely serving the purpose of recreation and leisure such that stakeholders now commit resources into sport performance improvement. Consequently, countries (particularly, those in Europe, Australia and North America) consider the sports sector among the key factors of social and economic development. Given the considerably large youthful population of Nigeria, it is possible to take advantage of sports to advance social and economic wellbeing of the people. It is however regrettable that the Nigerian government does not appear to have realised the potentialopportunities a robust sports economy could provide for a nation in the quest for social, political and economic development. The opportunities provided by sports for social and economic growth will not be fully grasped unless efforts are made to create effective talent development frameworks; unfortunately, anecdotally at least, the reality on the ground suggests that the contrary is the case in Nigeria. Previous research investigating the process of talent identification and development has highlighted a number of features of effective talent development environments. Research informing these guidelines and principles comes from a variety of research activity including understanding the nature of the talent development pathway, the characteristics of successful and developing athletes, the features of effective coaching and support environments, factorsof effective talent transfer, and effective talent development policies. However, it is important to note, that the current TID literature is based predominantly on European, Australian and North American studies. This is particularly important given that there is strong evidence to suggest that TID is culturally and context specific. Certainly the specific context must be taken into consideration when transferring and/or using recommendations (either research orapplied) from one context to another. Since there has been very little work carried out within a Nigerian context, this thesis aims to take a broad examination of the nature of talent identification and development processes within a Nigerian context. This is with the aim of understanding potential barriers to TID and facilitating effective practice to aid successful talent development within Nigeria To address these objectives, three studies were carried out. First, a literature review examined the relevant TID literature in relation to the specific context of TID in Nigeria, taking into account the role(s) of important stakeholders (i.e. coach, parents, teacher, siblings,and peers). Based on the lack of evidence from the Nigerian environment and the exploratory nature of this thesis, three qualitative studies were designed and implemented to examine a broad, in-depth perspective of the nature of athlete and sports development in Nigeria. These three studies included the elite athletes' perspectives of the nature of talent identification and development, the elite coaches' perspectives and finally the community stakeholders' perspectives. A total of 21 participants (i.e. 8 elite athletes, 7 coaches and 6 community stakeholders) were purposefully sampled and interviewed to provide triangulated, and informed perspectives on the specific nature of TID in Nigeria. The data revealed a number of challenges to effective TID in Nigeria including, lack of policy implementation, corruption, poverty, and family resistance, as well as poor infrastructure for sports development. Furthermore, luck played a large role in successfuldevelopment, especially due to the ad hoc nature of access to coaching and supportive people in the community (e.g. head teachers). Interestingly, in case successful development, theextremely challenging circumstances faced by athletes attempting to develop their sporting potentials acted as a mechanism to develop their mental resilience and independence, which facilitated success. Furthermore, findings suggest that widespread cultural practice through early years (e.g. festivals, physical labour) developed a general physicality among Nigerian children, which could serve as bedrock of TID, if the other talent development environmentswere put right.

Aim: The aim of this thesis was to investigate the psychophysiological response to the dynamic working environment within a cohort of higher education employees via ambulatory assessment of psychosocial and physiological measures. Methods: Data was collected from two observational studies. Study one employed a cross-sectional design to investigate relationships between work-related psychosocial hazard, work-time heart rate variability, blood pressure, and the cortisol awakening response. Consideration was given to occupation type and acute work-related demand. Study two, a single-subject case study, employed an experience sampling methodology to peform a 24 hour assessment over 21 days. Workload, affect and demand were sampled during working hours, while heart rate variability and physical activity were continually sampled (24 hours), with salivary cortisol, being sampled at 3 time points during the awakening period. This study also investigated some of the methodological issues associated with ambulatory assessment of both heart rate variability and the cortisol awakening response. Findings: Chronic work-related demand was found to be positively associated with sympathetic dominance of the autonomic nervous system. Acute work-related demand was associated with ambulatory heart rate variability during work time and evening time whilst the rise in salivary free cortisol over the immediate post awakening period varies according to acute anticipatory demand and prior day's workload. Substantial intra--individual variation in both the cortisol awakening response and ambulatory heart variability was found to occur across work-days. Work time activity levels accounted for little of the variation in ambulatory heart rate variability and blood pressure. The cortisol awakening response was associated with both heart rate variability and nocturnal movement in the latter stage of sleep. Conclusion: Attending to the psychophysiological response to work at the individual level by means of ambulatory assessment appears to provide a useful means of assessing the balance between employee and environment. This could have significant implications for work design, employee selection and targeting of workplace interventions.

This thesis is concerned with young women's health and well-being, with a specific focus on young women's beliefs, behaviours and attitudes towards smoking, substance use, sexual health, diet and exercise and well-being. These issues are identified as priorities in 'The Health of the Nation: a Strategy for Health in England', (Department of Health, 1992). This document which was published by a previous (Conservative) government in July 1992,set objectives and targets relating to health status to be met by the year 2000. (There are similar separate documents for both Wales and Scotland.) It identified five key areas for action: coronary heart disease and stroke; cancers; mental illness; HIV/AIDS and sexual health and accidents. Some of its targets apply specifically to young women. Informed by a feminist theory and using ethnographic and qualitative research techniques, this study examines young women's health-related beliefs and behaviours within the context of their day-to-day lives.

Engaging youth with Type 1 diabetes (T1D) in the self-management of daily tasks and decision- making provides opportunities for positive health outcomes. However, emerging adulthood and care transitions are associated with decreased clinic attendance and diabetes complications. The process of shared decision making (SDM) comprises four key elements – acknowledge, consider, decide, act - and is identified as an optimal approach to making self-management decisions, yet it has been difficult to implement in practice. Personal health record (PHR) technology is a promising approach for overcoming such barriers. Still, today PHRs have yet to root themselves into care and present an opportunity for improvement in SDM and engagement in self-management decision making. Using a sequential two-phased investigation, this dissertation describes how PHRs can be designed to enable SDM and integrated into clinical practice to engage youth with T1D in self-management decision making. Phase 1 proposed an integrated SDM–PHR (e-PHR) functional model justified by youth with T1D (n=7) and providers (n=15) via a user-centered design approach. Located within an interconnected EHR ecosystem, e-PHR integrates 23 PHR functionalities for the SDM process, whereby each SDM element was mapped to PHR functions with a moderate level of agreement between patients and providers (Cohen's kappa 0.60-0.74). The Phase 2 mixed methods, pre-implementation evaluation utilized an online measurement instrument and survey and individual interviews, underpinned by the Normalization Process Theory (NPT), to describe the four cognitive and behavioural processes (coherence, cognitive participation, collective action, reflexive monitoring) known to influence the success of complex socio-technical implementations. Youth with T1D (n=8), providers (n=11), and EHR/clinical leaders (n=8) in British Columbia participated. Reliability tests of NPT-based instrument negated the use of scores for the coherence and reflexive monitoring constructs. Qualitative results indicated that e-PHR made sense as explained by two themes for ‘Coherence’: game changing technology and sensibility of change. Participants strongly agreed (mean score=4.6/5) with ‘Cognitive Participation’ processes requiring an investment in commitment, explained by two themes: sharing ownership of the work and enabling involvement. Weak agreement (mean score=3.6/5) was observed with ‘Collective Action’ processes requiring an investment in effort, explained by one theme, uncovering the challenge of building collective action, and 3 sub-themes, assessing fit, adapting to change together, and investing in the change. Participants appraised e-PHR as explained by two themes for ‘Reflexive Monitoring’: reflecting on value, and monitoring and adapting. Finally, participants strongly agreed (mean score=4.5/5) that e-PHR would positively affect engagement in self-management decision making in two themes: care is efficient and care is person-centred. The establishment of a e-PHR functional model is a precursor to system design requirements. Using the NPT framework, findings from the process evaluation indicated participants invest in sense-making, commitment and appraisal work of this technology. However, successful integration of e-PHR into clinical practice to positively affect engagement in self-management decision making will only be attained when systemic effort is invested to enact it. Further research is needed to explore this gap to inform priorities and approaches for future implementation success. / Graduate

This research asks whether a focus on nature enables participants on a mindfulness programme to better assimilate mindfulness practice into their daily lives with resultant improvement in health and wellbeing, greater resilience and a more successful approach to their self-management of chronic illness. In doing so it has implications for approaches to healthcare delivery in the management of chronic conditions as well as the teaching and practice of other mindfulness approaches and similar therapeutic interventions. Improvements in participant health and wellbeing, particularly the impact on self-efficacy, the belief that the integration of mindfulness into their lives, their building of a regular practice, helps manage their health conditions and improve their sense of wellbeing, form a key element in the ‘sense of coherence’ that is the mainstay of the Salutogenic approach to health and wellbeing (Antonovsky, 1979). More than 15 million people in the UK live with chronic illness, accounting for more than 50% of all visits to general practitioners and 70% of hospital inpatient stays. This accounts for 70% of the NHS primary and acute care budget and yet it is felt that 70 - 80% of cases could be supported to manage their own conditions with mindfulness based approaches providing a low cost, long term form of such support. Although the separate fields of mindfulness, nature connection and chronic illness have each received attention in the academic literature, little academic research has examined the conjunction of these fields. This thesis builds bridges between the three areas. A research bricolage is constructed which follows participants with diverse backgrounds and chronic health conditions as they engage in a nature based mindfulness programme and subsequent follow-up over 12 months. These case studies are documented by participants using a variety of media and explored through a interpretative phenomenological lens. The study found that a nature focus did help participants incorporate mindfulness practice into their daily lives with resultant benefits in the management of their conditions and their perceived wellbeing. However it also highlighted barriers to successful integration including the impact of family support and ongoing medical interventions. In doing so it contributes to the teaching of mindfulness, providing new ways of engaging participants and a route to its improved integration in daily life. It provides insights into the difficulties faced by those learning mindfulness and leads to greater self efficacy in the management of chronic illnesses. A nature based mindfulness approach to health can improve self management while reducing health care costs in populations with diverse chronic illnesses.

<p>In spite of numerous benefits that are suggested for consumers’ utilizing integrated personal health record (PHR) systems, research has shown that these systems are not yet popular or well known to consumers. Therefore, research is needed to understand what would rise adoption rates for these systems. Hence, the main objective of this dissertation is to develop and empirically validate a theoretical model for explaining consumers’ intention to use integrated PHR systems.</p> <p>In developing the theoretical model of this dissertation, theories of information systems adoption were integrated with Self-Determination Theory (SDT), which is a well established theory from the Psychology literature that explains the mechanism through which individuals become more self-determined, i.e., motivated to take more active (rather than passive) roles in undertaking different behaviours. Taking such an active role by consumers, in the context of personal health management, is suggested to be necessary for realizing the full benefits of integrated PHR systems.</p> <p>The proposed theoretical model was validated using the PLS approach to structural equation modeling, on data collected from a cross-sectional survey involving 159 participants with no prior experience in using PHR systems. A stratified random sampling was employed to draw a representative sample of the Canadian population. The results show that consumers with higher levels of self-determination in managing their health are more likely to adopt integrated PHR systems since they have more positive perceptions regarding the use of such systems. Further, such self-determination is fueled by autonomy support from consumers’ physicians as well as consumers’ personality trait of autonomy orientation.</p> <p>This study advances the theoretical understanding of integrated PHR system adoption, and it contributes to practice by providing insightful implications for designing, promotion, and facilitating the use of integrated PHR systems among consumers.</p> / Doctor of Philosophy (PhD)

<p>Pregnancy is one of the most important periods of a woman’s life, during which lots of potentially worrying changes occur in her body. Being aware of the nature of these changes can help her to make informed decisions and decrease her level of uncertainty and anxiety. Delivering information to pregnant women to help understand these changes is not a new idea. Brief searches of the web turned up many related resources and information. One important aspect of pregnancy that was found to be widely used was keeping daily records in a paper-based format. However, to the author’s best knowledge, there is no pregnancy specific electronic personal health record (ePHR) currently being used in Canada. In this study, a preliminary pregnancy specific PHR module was developed, and its usefulness and usability evaluated.</p> / Master of Science (MSc)

Aims. This research investigated the health status (e. g. weight perception and BMI, mental health conditions and general health complaints), and the lifestyle behaviours (e. g. smoking, alcohol consumption, and dietary behaviour) of Libyan higher education students (HES). The objectives were to compare their health status and lifestyle behaviours in the different regions of Libya; and to compare Libyan HES with those from other countries. In addition to this, the study aimed to determine if any association existed between demographic and academic variables and health and lifestyle variables. Purpose. The purpose of the study was to provide baseline data required by university health programmes in Libya for planning related to the health needs of students. Methods. The sample consisted of 1300 higher education students from different higher education institutes and different disciplines. The self-administered health questionnaire used included questions on health and health-related behaviours and their associated social and economic factors. It was conducted during lecture time. Data were analysed with SPSS. Binary logistic regression analysis was used to identify sociodemographic variables associated with health and lifestyle variables. Results. In this sample of students, the prevalence of overweight was higher than the prevalence of underweight and obesity (14.5%, 18.2%, and 4.2% respectively), and 40% of students were trying to lose weight. High rates (45%) of depressive symptoms were found, however; overall 8.8% of respondents reported being diagnosed with anxiety, and 4.3% with depression. The findings of this study also indicated that students reported high levels of subjective health complaints. The majority of students reported that their physical activity levels were insufficient; only 5% of students met the international recommended levels of physical activity. Only one in ten students was found to be consuming an adequate amount of fruit and vegetables (at least five times a day). About 6% of the students self-identified themselves as current smokers, and the results revealed that smoking was a male phenomenon in Libya. Alcohol consumption is not very common among Libyan students, and only 3.5% reported drinking alcohol; overall, 1.6% reported using drugs, and all students who reported using drugs reported cannabis use. A gender difference was noticeable and consistent across types of complaints; depressive symptoms, dietary behaviour, physical activity, smoking and alcohol and drug consumption. Females reported significantly worse health status than males in terms of health complaints, and depressive symptoms. Males reported higher levels of physical activity and higher levels of smoking and alcohol and drug consumption than females. Students in North Libya showed the highest levels of physical activity, and also the highest levels of smoking, alcohol and drug consumption, whereas students in East Libya had the highest levels of fruit and vegetable consumption. Logistic regression analysis revealed substantial associations between females and depressive symptoms, dietary behaviour and higher levels of complaints, and also between social support and anxiety and depression. The comparisons with other survey data showed that the Libyan rates of overweight and obesity were similar to rates reported amongst students at Alexandria University in Egypt, and much higher than those reported in other countries such as Poland, Japan and Korea. Depressive symptom rates were similar to the rates reported among university students in Bulgaria and higher than those reported in Germany, Denmark and Poland with respect to male students, and Libyan HES reported lower rates of health complaints than students in certain other European countries. In addition, the levels of fruit and vegetable consumption amongst Libyan HES were lower than those reported amongst Australian students. The prevalence of physical activity levels was lower than that reported amongst university students in the United Arab Emirates. The results of this study clearly indicate that the prevalence of smoking and alcohol and drug consumption among students in Libya was " lower than among those from other Arabic countries such as the United Arab Emirates and Saudi Arabia. Conclusion. Efforts to promote a healthy lifestyle among students are needed and should place greater emphasis on physical activity and increased fruit and vegetable consumption, and on discouraging smoking and body dissatisfaction. There is a need for future research on student health, which should be carried out with a larger sample group to develop a national standardized instrument. Future research will be helpful for accurately identifying perceived barriers to, and recommending changes to enhance, physical activity among HES.