The development of the infant from birth to four years will approximately parallel the stages of development of the profoundly retarded children enrolled in the Development Centers for Handicapped Minors ( DCHM ) in California. The retarded child is a human being and may be assumed to have the same basic equipment as the normal child. If we expand and prolong the development stated of the normal child we will be able to lead the DCHM child through these states in slow motion to insure progress. To develop a curriculum, an assessment of the abilities of the child was necessary. A screening device as designed to measure the development of the child in four areas --- Gross Motor, Fine Motor, Social, and Language. Skills leading towards ambulation were included in the Gross Motor area; skills leading toward manipulation of objects in space were included in the Fine Motor area; skills leading toward independent living were included in the Social area, while skills leading to improvement in communication were included in the Language area. Tasks in the Social area were divided into sub-groups of social interaction, feeding, dressing, and toileting. Language included two sub-groups – Receptive Language and Expressive Language. Over 800 tasks were reviewed from 18 sources. Three hundred and fifty-nine tasks were finally chosen on the basis of criteria established. The tasks were to be observable, describable, and development. The tasks were then arranged into areas mentioned above and then into levels of development. Twenty-two levels of development were necessary to show the progress of development sufficiently to be useful in the DCHM. The tasks were organized so that the teacher could determine the child developmental level of the child with very little demand on the child. Most of the assessment could be done by observation or with knowledge of the child already possessed by the teacher. A card for recording the progress and the assessment of the child was designed that would also give the teacher a graphic picture of the level of the child and would also keep an ongoing record of the progress of the child with little interruption of the normal activities in the classroom. Each of the 359 tasks was listed on a separate 5X8 Activity Card. Each Activity Card included the abbreviated description of the task, the area, the level, and a three character code designed for that task. Under this information, a behavioral description of the task was given. Next, the tasks expected at the next level were listed, and then suggested classroom activities associated with the next level were given. The Activity Card was designed so that when a teacher observed a new behavior in a child, he could refer to the card on file to note the level and area of the behavior and plan lessons or activities accordingly. A Gestalt of all tasks is included in the Appendix. The tasks selected were from recognized source and because of this, no effort was made to standardize the results. There were three purposes for this study: (1) To provide a tool for the teachers in the DCGM that would allow them to look at the developmental levels of the children; (2) To assess the functioning level of the children; and (3) To provide information about the curriculum suitable for the various levels of development.

The present study sought to determine whether or not state anxiety levels were significantly reduced when individuals participated in aerobic dance workouts of 15 minutes and 30 minutes. Undergraduate university students and faculty enrolled in an aerobic dance class were volunteers in this study. As hypothesized, subjects in the aerobic dance classes did reduce anxiety acutely following both their 15 minute and 30 minute workout as assessed by the STAI (Y-Form State Anxiety). Thus, results indicate that state anxiety may be reduced through aerobic dance with similar situations and individuals. In addition, the study also looked at the posttest state anxiety score differences between the 15 minutes and 30 minutes. The results were not significant, indicating neither length of aerobic dance workout session was superior to the other. These results contribute to a currently expanding area of research examining the relationship between anxiety reduction and aerobic dance.

The purpose of this experimental study was to investigate mindfulness strategies and their influence on working memory. The potential role of music in facilitating mindfulness practice is explored. Various listening exercises were investigated along with their influence on working memory (i.e. attention control). Thirty-four individuals were randomly assigned to participate in one of four listening groups: 1) mindfulness with music, 2) mindfulness without music, 3) music only, and 4) silence. Thirty-four participants engaged in a computerized digit-span task before and after the listening exercise to assess pre- and post-test working memory performance. Thirty participants were included in data-analysis due to technical errors in data collection. Differences between listening exercises were explored and comparisons were made between mindfulness, non-mindfulness, music, and non-music based exercises. Two-tailed independent samples t-tests found no significant differences in working memory when comparing mindfulness versus non-mindfulness and music versus non-music based exercises. An Analysis of Variance (ANOVA) indicated no significant differences in working memory for any of the listening conditions. Results call for further examination of control variables and methodology to explore the role of music listening in mindfulness practice. Implications for further research and contributions to music therapy and music education are considered.

<p>Substance abuse is a major public health concern. Scholars predict a growing proportion of people aged 50 years and older suffering from addiction to alcohol, prescription or over-the-counter medications and/or illegal substances (Wu & Blazer, 2011; Han et al., 2009). Available Canadian statistics reveal that 6-10% of older adults experience alcohol problems, 1% use illegal substances and approximately 6% seek addiction treatment for prescription opioids (Public Health Agency of Canada, 2010; Tjepkema, 2004; CAMH, 2008). Older adults face personal, social, and structural barriers to treatment, which result in a significant number of people living with addiction and remaining undiagnosed and untreated in the community (Crome & Bloor, 2005b). Nevertheless, this issue is significantly understudied and under-recognized, particularly within Canadian literature.</p> <p>This qualitative research study examined the perspectives of addiction service providers regarding the issue of addiction among older adults. A descriptive, qualitative research design was used to explore the perspectives of addiction service providers using in-depth, semi-structured personal interviews. Purposive sampling techniques were used to recruit 24 service providers employed by Hamilton addiction services. Semi-structured interviews included questions on (a) the current provision of addiction services for older adults, (b) characteristics of older adults (c) perceived barriers to treatment, and (d) recommendations for addressing the needs of older adults living with addiction. The interview also collected demographic information to describe the demographic profile of agencies and research participants involved in the study.</p> <p>By using Braun and Clarke’s (2006) phases of thematic analysis, this study observed several key themes that confirmed and extended existing literature. New contributions highlight the following: (1) according to service providers, older adults demonstrate a greater readiness for change and stronger commitment to their treatment plan regardless of whether they are enrolled in a mixed-age or age-specific program. (2) Some older adults use substances to cope with cumulative shame that stems from unresolved, traumatic early-life experiences. This new finding supports principles of the life course perspective by highlighting the impact of early life events on late life experiences. (3) Service providers can address some of the age-specific needs of older adults by assigning them to an older counselor in treatment. (4) In order to enhance treatment outcomes, older adults should <em>direct</em> their care and be viewed as experts in their treatment needs. (5) From the perspective of service providers, older and younger adults benefit from interactions with each other when the older adult is in recovery and the younger adult is recovering. Older adults recovering also benefit from interactions with older peers in recovery, particularly when they are in mixed-age programs. Opportunities for peer interaction during and after treatment can produce favourable recovery outcomes.</p> / Master of Arts (MA)

<p>Approximately 4.2 million Canadian adults suffer from a physical or psychological disability, of whom up to 30% suffer from depression. Those receiving disability benefits versus those not receiving benefits may be at greater risk of unsatisfactory outcomes because their circumstances or psychological status may interfere with successful implementation of standard therapies. This thesis addresses the effectiveness of therapies for depression in patients receiving disability benefits, using an individual patient data meta-analysis of all published randomized controlled trials evaluating Cognitive Behavioural Therapy and a secondary analysis of an administrative database from a large, private, Canadian insurer. Additionally, this thesis addresses an important methodological issue: assessing the impact of missing participant data for continuous outcomes in systematic reviews. Missing participant data may bias results of individual trials or systematic reviews of individual trials if participants with missing data have different expected outcomes from those with available data. No methods have been proposed for investigating the extent to which missing participant data for continuous outcomes might bias the results of systematic reviews, and this dissertation addresses that gap.</p> / Doctor of Philosophy (PhD)

El actual proyecto surge a través de una necesidad, la cual es realizar un modelo de Arquitectura Empresarial del proceso de Compra de Prestaciones de Salud para la empresa estatal ESSALUD, con la finalidad de poder cubrir las inconsistencias que existen entre los procesos, usuarios, stakeholders, etc., las mismas que ocasionan pérdida de recursos, tiempo, además de afectar directamente la reputación y seriedad de la compañía. Así mismo, existe la necesidad de expandir la cobertura de los servicios de salud ofrecidos en el plano de una serie de restricciones financieras y políticas aplicadas por el gobierno de turno. De esta manera, gracias al desarrollo de la arquitectura empresarial para el proceso de compra de prestaciones de salud se puede optimizar y reducir los costos, gastos y tiempos utilizados actualmente en la entidad de salud; lo cual genera no solo un cuello de botella en el procedimiento general no solo internamente afectando al personal, sino, también, a la sociedad, pues existe actualmente un porcentaje muy alto de personas disconformes con el servicio que se ofrece. Para ello, es necesario que los procesos a los que se recurren esten correctamente definidos, de igual manera sus entradas, flujo interno y salidas, de tal manera que, al auditar estos procedimientos los números y estadísticas cuadren con el balance anual que se realiza para las entidades reguladoras de los presupuestos. / The current project comes through a necessity, which is to make a design model of the Enterprise Architecture Process Purchase benefits for the state company ESSALUD, in order to be able to cover the inconsistencies between processes, users, stakeholders, etc., the same that cause loss of resources, time, as well as directly affect the reputation and reliability of the company. Also, there is a need to expand the coverage of health services offered in terms of a number of financial and political restrictions imposed by the government. In this way, thanks to the development of the enterprise architecture for the process of buying health services in EsSalud, costs, expenses and time of use can be optimized and reduced at the health entity. Don’t make a change in this procedure generates not only a trouble in the general procedure, so it is not only internally affecting the staff, also affects to society, since there is a very high percentage of people that doesn’t like the service offered. For this, it is necessary that the processes that are used should be correctly define, as well as their inputs, the internal flow and outputs, this can generate that the numbers and the statistics match the annual balance that is made for the budgets regulatory entities. / Tesis

BACKGROUND: In order to accelerate universal health coverage, Nigeria’s National Health Insurance Scheme (NHIS) decentralized the implementation of government health insurance to the States in 2014. Lagos has passed its State Health Scheme (LSHS) into law with a statewide roll out set to commence in 2018. The LSHS aims to improve access to quality care by reducing the financial burden of obtaining care for Lagos residents. Public and private healthcare providers are a critical component of this ambitious insurance roll out. Yet, little or no understanding exists on how to engage providers, the factors that influence their participation in insurance and expectations from the LSHS. In addition, little is known about the geographic distribution of NHIS accredited facilities and enrollees in Lagos State. METHODS: This study used a mixed-methods cross sectional design to analyze primary and secondary data. Primary data included both quantitative and qualitative data and were collected from representatively selected 60 healthcare providers in 6 Local Government Areas (LGAs) in Lagos State through questionnaires probing issues on the challenges and benefits of insurance participation, capacity pressure, resource availability and changes in financial management. Secondary data were obtained from NHIS and Lagos State inventory of health facilities, and household survey reports, and were visually mapped using a geographic information system (GIS) software. RESULTS: Facilities participating in insurance were more likely to be bigger with mid to very high patient volume and workforce. In addition, private were more likely than public facilities to participate in insurance. Furthermore, increase in patient volume and revenue were motivating factors for providers to participate in insurance, while low tariffs, delay and denial of payments, and patients’ unrealistic expectations were inhibiting factors. Also, NHIS enrollees were more likely to be located in the urban than rural LGAs. However, many urban LGAs have larger population sizes and as a result, were also characterized with higher number of non-NHIS enrollees and fewer NHIS accredited facilities. For the LSHS, many private facilities anticipate an increased patient volume and revenue but also worry that low tariffs without guaranteeing a high patient volume would be a major challenge. For many public facilities, inadequate infrastructure, lack of workforce, and insufficient drugs and commodities remain major challenges. CONCLUSION: For the LSHS to be successful, effective contracting of healthcare providers especially those in the low income and densely populated LGAs is essential. However, this would require that provider payment is adequate and regular. In addition, the government would need to invest heavily in improving the infrastructure and the amount of workforce, drugs and commodities available to public facilities.

Submitted by JÚLIO HEBER SILVA (julioheber@yahoo.com.br) on 2018-03-29T17:39:53Z No. of bitstreams: 2 Dissertação - Mariana Oliveira Veras - 2018.pdf: 920574 bytes, checksum: b6f2becc207b9a8f2ebb8d260ad1dd39 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2018-04-02T12:16:49Z (GMT) No. of bitstreams: 2 Dissertação - Mariana Oliveira Veras - 2018.pdf: 920574 bytes, checksum: b6f2becc207b9a8f2ebb8d260ad1dd39 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-04-02T12:16:49Z (GMT). No. of bitstreams: 2 Dissertação - Mariana Oliveira Veras - 2018.pdf: 920574 bytes, checksum: b6f2becc207b9a8f2ebb8d260ad1dd39 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-03-23 / The administrative reform that took place in the 1990s through the Fernando Henrique Cardoso government brought a series of changes in the State apparatus, bringing even to this structure the so-called social organization. This is a type of non-profit entity that can act in several areas of the public context, one being the health area. This scenario instigated the present study, whose purpose was to make a parallel between hospitals that were previously administered directly by the State of Goiás and are currently managed by social health organizations. Four hospitals were in this situation. Therefore, six study variables were delimited, being: average of permanence, mortality rate, total value, value of hospital services, number of hospitalizations and value of professional services. The data were collected from DATASUS and for its analysis a means test was performed to evaluate if there were significant changes after the implantation of the social health organization in the hospitals examined in this study. It was found that the significant changes were concentrated around the values. The variables: number of hospitalizations and mean length of stay did not show a significant change in relation to any hospital. There was a health unit that did not present significant changes in relation to any variable. Considering the dysfunctions perceived in this study, it was pointed out a proposal of intervention with the objective of indicating improvements to the process of supervision and monitoring carried out by the public power to the health services provided by social organizations. The focus of this proposal is directed to the improvement of the methodology used by the public administration in the evaluation of the performance of these entities. / A reforma administrativa que ocorreu nos anos 90 por meio do governo Fernando Henrique Cardoso trouxe uma série de mudanças no aparelho do Estado trazendo inclusive para essa estrutura a denominada organização social. Este é um tipo de entidade sem fins lucrativos que pode atuar em diversas áreas do contexto público, sendo uma delas a área da saúde. Este cenário instigou o presente trabalho, cujo propósito foi fazer um paralelo entre hospitais que antes eram administrados diretamente pelo Estado de Goiás e atualmente são geridos por organizações sociais de saúde. Fizeram parte desta pesquisa quatro hospitais que se encontram nesta situação. Para tanto, foram delimitadas seis variáveis de estudo, sendo elas: média de permanência, taxa de mortalidade, valor total, valor dos serviços hospitalares, número de internações e valor dos serviços profissionais. Os dados foram coletados do DATASUS e para sua análise foi realizado um teste de médias para avaliar se houve alterações significativas após a implantação da organização social de saúde nos hospitais examinados neste estudo. Constatou-se que as alterações significativas ficaram concentradas em torno dos valores. As variáveis número de internações e média de permanência não apresentaram alteração significativa em relação a nenhum hospital. Houve uma unidade de saúde que não apresentou mudanças significativas em relação a nenhuma variável. Considerando as disfunções percebidas neste estudo, foi apontada uma proposta de intervenção com o objetivo de indicar melhorias ao processo de fiscalização e acompanhamento realizado pelo poder público aos serviços de saúde prestados pelas organizações sociais. Sendo o enfoque dessa proposta direcionado ao aprimoramento da metodologia utilizada pela administração pública na avaliação do desempenho dessas entidades.

Abstract The concept of waiting has received limited attention in the world of research. In modern society, waiting has become a commonplace event, especially in healthcare. Although the waiting experience can produce anxiety, healthcare environments can be easily manipulated in order to increase human comfort and reduce situational anxiety. One such way of accomplishing this is to introduce music to an environment. This paper will discuss the findings related to short wait periods, anxiety, and music within the literature, and the findings within this research study. This study found listener-selected music to be statistically effective in reducing anxiety for patients waiting in the exam room to be seen by a primary healthcare provider in an urgent care clinic.

Mental health disorder is the leading cause of disease burden in women worldwide. Pregnant women with mental disorder are especially at risk of having offspring with adverse outcomes. This study aimed to investigate risk factors of mental health disorder among Chinese pregnant women in the third trimester. A total of 462 pregnant women in their third trimester completed interviews at three hospitals in Shandong Province, China from July to December, 2010. The Symptom Checklist-90-R (SCL-90-R) was used to evaluate mental health disorder, and was defined as total score ≥160, or scores of any symptom dimensions ≥3, or total of positive symptoms ≥43. Multiple logistic regression was used to examine the risk factors of mental health disorder, and to adjust for covariates. The total score and scores of somatization, obsessive-compulsive, anxiety, and phobic anxiety were higher than corresponding national norm by SCL-90-R assessment (all p<0.05). Multiple logistic regression showed family income, relationship with parents-in-law, concerns about child's health, fear of delivery, and pregnancy complications were negatively associated with mental health disorder (all p<0.05). More specifically, relationship with parents-in-law, fear of delivery, preference on mode of delivery (Caesarean section), and body image concerns were positively associated with anxiety (all p<0.05); Fear of delivery was positively associated with depression (p=0.023). Family income, relationship with parents-in-law, concern about child's health, fear of delivery, and pregnancy complications were identified as potential risk factors of mental health disorder in this Chinese pregnant women population. Strategies to reduce mental health disorder are needed among Chinese pregnant women.