Syftet med denna studie är att undersöka eftervård för klienter som vårdats under Lagen (1988:870) om vård av missbrukare i vissa fall (LVM). Detta genom att undersöka avgörande faktorer för utfall av eftervård för klienterna. Vidare ämnar studien att undersöka klienternas motivation till eftervård från socialarbetares perspektiv. Studien syftar till att belysa en verklig bild av eftervården och eventuella utmaningar gällande eftervården för dessa klienter. För att undersöka detta utgår studien från följande frågeställningar:-Vilka faktorer avgör vilken eftervårdsinsats klienter som vårdats med stöd av LVM får? -Hur upplever och förstår socialarbetare sina klienters motivation till eftervård?För att besvara dessa frågeställningar användes semistrukturerade intervjuer som metod för att samla information från åtta informanter. Fem arbetar på socialtjänsten i olika kommuner och tre arbetar på institutioner styrda av Statens Institutionsstyrelse (SiS). Resultatet av studien visar att alternativen för eftervård är begränsade. När olika alternativ är tillgängliga påverkar andra faktorer eftervården, såsom kommunernas budget, klienters komplexa problematik och klienters förmåga att tillgodose sig behandling. Informanterna anger även att vissa klienter likställer tvångsvården med att sitta i fängelse, vilket innebär en utmaning i motivationsarbetet som socialarbetarna utför. Vidare visar resultatet på att motivationen är låg för klienter som återkommer inom tvångsvård. Klienternas motivation till eftervård tenderar att gå igenom olika faser under tiden på institutionen vilket skapar utmaningar för socialarbetarna. Studien visar även på att ett samarbete mellan socialtjänsten och SiS är grundläggande för positiva utfall för klienterna. / The aim of this study is to examine aftercare for clients who have been in compulsory treatment under the Substance Abusers (Special Provisions) Act 1988. This is done by examining determining factors for what kind of aftercare the clients receive. Furthermore the study aims to find out clients motivation to aftercare from the perspective of social workers. The study aims to highlight the reality of aftercare and the challenges of providing care to clients post-compulsory treatment. To examine this, the study is based on the following questions:-What factors impact clients post-compulsory treatment paths?-How do social workers experience and understand their clients’ motivation for care post-compulsory treatment?To answer these questions, the used method was semi-structured interviews to gather data from five informants working at social services in different municipalities, and three informants working at institutions run by the National Board of Institutional Care. The result of this study show that the options for care post-compulsory treatment are limited. When options are available other factors impact the aftercare, such as organisational budgets, the clients’ other complex life situations apart from yet related to the addiction and the clients’ ability to embrace the treatment. The respondents also state that for some clients, compulsory treatment is like being in jail, which means engaging in motivating clients can be very challenging. Furthermore, motivation for change is low for clients who re-entry compulsory treatment. The clients’ motivation for aftercare tends to go through different phases during the time they are under care at the institutions which provide challenges for the professionals working with them. The study also found that cooperation between the relevant organisations is essential for good outcomes for clients.

Composer Michael Nyman wrote the one-act, minimalist opera The Man Who Mistook His Wife for a Hat, based off the neurological case study written by Oliver Sacks under the same title. The opera is about a professional singer and professor whom suffers from visual agnosia. In chapter 1, the plot and history of the opera are discussed. Chapter 2 places The Man Who Mistook His Wife for a Hat alongside a selection of minimalist operas from Philip Glass and John Adams. Chapter 3 contains a history of the Fluxus art movement and shows where Fluxus-like examples appear in the opera. Chapter 4 includes Nyman's usage of minimalism, vocal congruencies, and Robert Schumann as musical elements that convey the drama.

Black Same-Gender Loving Men (BSGLM) are a population at the juncture of multiple marginalized identities, which may make it difficult to successfully form their identity due to experienced racism and heterosexism from communities to which they belong. Current paradigms of racial/ethnic and sexual identity do not fully capture the complexities of identity development among BSGLM. Moreover, there is scant literature available detailing what the process of identity development looks like among this population and which factors influence identity development among BSGLM. As such, the current study used an exploratory sequential mixed methods design to first discover what healthy identity looks like among BSGLM and which factors influence the process of developing a healthy identity. The study then empirically tested the elucidated factors in order to understand which of them influence identity development among BSGLM. First, a sample of BSGLM living in the U.S. (n = 19) were recruited via online and interviewed for the qualitative phase of the study about their identity development process. Using a Grounded Theory approach, the qualitative data revealed three unique components of healthy identity among BSGLM (e.g., self-affirmation, freedom from social conventions, having unconditional acceptance) and 13 factors that either inhibited or facilitated their identity development process. Qualitative findings were subsequently used to create a survey battery to quantitatively explore the relationships between the identified factors and components of healthy identity among another sample of BSGLM. The generated survey battery was administered to another sample of BSGLM living in the U.S. (n = 54) recruited from social media and organizations that service BSGLM. Bivariate correlations and multiple regression analyses examined inhibiting and facilitating factors as predictors of healthy identity. Findings revealed that minority stress-related factors were robust predictors of healthy identity. Specifically, rejection sensitivity from one’s family negatively predicted self-affirmation, frustration with concealing one’s sexual identity positively predicted freedom from social conventions, and experiencing threats/violence positively predicted unconditional acceptance. Results from the study may contribute to the refinement of identity development models among BSGLM and inform clinical interventions that bolster identity development among BSGLM such as transdiagnostic interventions that target minority stress and identity-related concerns.

Background: Social networks, norms, and discussions about sexual health may inform sexual practices, influencing risk of human immunodeficiency virus (HIV) or sexually transmitted infection (STI) acquisition. To better understand social networks of Peruvian men who have sex with men (MSM) and transgender women (trans women), we examined key social network members (SNMs), participant perceptions of these network members’ opinions toward sexual health behaviors, and associations between network member characteristics and condomless anal intercourse (CAI). Methods: In a 2017 cross-sectional study, a convenience sample of 565 MSM and trans women with HIV-negative or unknown serostatus was asked to identify three close SNMs; describe discussions about HIV and STI prevention with each; and report perceived opinions of condom use, HIV/STI testing, and partner notification of STIs. Generalized estimating equations evaluated relationships between SNM characteristics, opinions, and discussions and participant-reported CAI. Results: Among participants who identified as MSM, 42.3% of key SNMs were perceived to identify as gay. MSM “never” discussed HIV and STI prevention concerns with 42.4% of heterosexual SNMs, but discussed them “at least once weekly” with 16.9 and 16.6% of gay- and bisexual- identifying SNMs, respectively. Among participants who identified as trans women, 28.2% of key SNMs were perceived as heterosexual; 25.9%, as bisexual; 24.7%, as transgender; and 21.2%, as gay. Trans women discussed HIV/STI prevention least with cis-gender heterosexual network members (40.2% “never”) and most with transgender network members (27.1% “at least once weekly”). Participants perceived most of their close social network to be completely in favor of condom use (71.2% MSM SNMs, 61.5% trans women SNMs) and HIV/STI testing (73.1% MSM SNMs, 75.6% trans women SNMs), but described less support for partner STI notification (33.4% MSM SNMs, 37.4% trans women SNMs). Most participants reported CAI with at least one of their past three sexual partners (77.5% MSM, 62.8% trans women). SNM characteristics were not significantly associated with participant-reported frequency of CAI. Conclusions: Findings compare social support, perceived social norms, and discussion patterns of Peruvian MSM and trans women, offering insight into social contexts and sexual behaviors. Trial registration: The parent study from which this analysis was derived was registered at ClinicalTrials.gov (Identifier: NCT03010020) on January 4, 2017. / National Institutes of Health / Revisión por pares

Masters of Science / There is evidence of the rising incidence and prevalence of chronic diseases of lifestyle in developing countries. It is estimated that by 2020 chronic diseases of lifestyle in Sub-Saharan Africa will be almost 50% of the burden of disease. Rapid urbanization with changes in lifestyle, such as physical activity patterns could explain at least partially the ongoing epidemiological transition. The purpose of this study was to assess levels of participation in physical activity among working Rwandan women in Kigali, in relation to socio-economic demographic characteristics. A cross-sectional study design using both quantitative and qualitative methods was used. Participants' level of participation in physical activity and influence of socio-economic demographic factors on questionnaire adapted from Sub-Saharan African Questionnaire. A focus group discussion assessed the need for a health promotion program related to physical activity participation among working women. Data analysis, using Statistical analysis version 8e, was used to obtain frequency tables and histograms. Chisquare tests and Fisher's exact tests were utilized to test for association between variables. Focus group discussion data were transcribed and translated into English. Data were then coded and put into themes and categories. There were 352 participants, with a mean age of 33.4 years. 71.9% of the participants were classified as sedentary and only 28.1 % of the participants were classified as physically active. Participation in physical activity decreased with age, and there were more participants classified as sedentary people in the married group (77%) than in non-married group (63.2%). A lower level of education and income of participants, the higher the level of participation in physical activity. Among the reported prevalence of chronic diseases, high blood pressure and diabetes were only reported by participants classified as sedentary. During the focus group discussion, participants reported facilitators and benefits of physical activity including, routine, relaxation, socialization and fitness, managing obesity and health purposes. Barriers limiting the participants' ability to engage in physical activity included lack of time, lack of knowledge, laziness, domestic helper, lack of motivation and culture. The main themes, which were identified as important in the development of a health promotion program were: The education and encouragement of girl children; education of women in the community, finding facilities and appropriate venues, a suitable environment and the contribution of physical activity program towards unity and reconciliation was emphasised. The findings of this study demonstrate a problem concerning sedentary lifestyle among the working women in Kigali/Rwanda. It is alarming that the participants who are already classified as sedentary and who will probably experience the consequences of sedentary lifestyle in the future are already reporting chronic diseases like high blood pressure and diabetes. There is therefore an urgent need to design, implement and evaluate a health promotion intervention aimed at promoting a physically active lifestyle in Rwanda.

Personalized cognitive counseling (PCC) is an evidence-based intervention designed to modify HIV-related risk behavior. We assessed the impact of PCC on sexual behavior, drinking expectancy, and incidence of sexually transmitted infections (STIs) in a 6-month randomized controlled trial among 153 HIV-uninfected men who have sex with men (MSM) and transgender women (TW) in Peru. Study retention was ≥ 90%, with three HIV infections (3 Control) and 19 cases of GC/CT (10 Control, 9 PCC) at 6 months. There was a decline in condomless receptive anal intercourse in the Control (0.74, 95% CI 0.60-0.91; p < 0.01) and PCC arms (0.72, 0.55-0.94; p = 0.02) at 6-month follow-up. There was a decrease in drinking expectancy at 6 months among participants endorsing alcohol use in the PCC arm (0.89, 0.83-0.96; p < 0.01), versus no change in the Control arm (0.98, 0.92-1.04; p = 0.54). PCC was efficacious in reducing drinking expectancy and HIV risk among MSM and TW in Peru. / National Institutes of Health / Revisión por pares

Bakgrund: 2008 infördes WHO:s checklista för säker kirurgi för att minska antal dödsfall, förbättra patientsäkerheten och reducera risken för vårdskador i samband med kirurgi genom att ha ett kommunikationsverktyg som säkrar att kontroller och insatser blir utförda. Tidigare studier visar varierande följsamhet till checklistan och att olika delmoment inte utförs i sin helhet. Syfte: Att undersöka operationsteamets följsamhet till time-out och sign-out i WHO:s checklista för säker kirurgi. Metod: En kvantitativ tvärsnittsstudie utförd som en icke-deltagande observationsstudie. Data samlades in via 24 observationer vid två sjukhus med hjälp av ett strukturerat observationsprotokoll. Data analyserades med hjälp av SPSS och redovisas genom deskriptiv statistik i form av cirkel- och stapeldiagram, tabeller samt löpande text. Resultat: Time-out initierades i 95,8 % av observationerna och utfördes komplett i 4,2 %. Sign-out initierades i 100 % av observationerna och 29,2 % utfördes komplett. Ingen i operationsteamet intog rollen som checklisteansvarig. Vid 19 av 22 observationer signerades samtliga tre delmoment i Orbit innan sign-out var genomförd. Slutsats: Både time-out och sign-out genomförs i hög grad, dock varierar följsamheten till checklistans samtliga kontrollpunkter vid de två delmomenten. Studien påvisar att diskrepans finns mellan den faktiska användningen av checklistan och den administrativa inrapporterade användningen av checklistan. / Background: In 2008, the WHO Surgical safety checklist was introduced to reduce mortality, improve patient safety and reduce risk of medical injuries in connection to surgery by means of a communication tool ensuring that checks and interventions are performed. Previous studies show a variation in compliance to the checklist, and that different items not are entirely performed. Aim: To describe the surgical team’s compliance to time-out and sign-out in the WHO Surgical safety checklist. Method: A quantitative cross-sectional study conducted as a non-participatory observational study. Data was collected during 24 observations at two hospitals using a structured observational protocol. Data was analysed using SPSS and reported through descriptive statistics, using pie and bar charts as well as tables and discussion. Result: Time-out was initiated in 95,8 % of the observations and completed in 4,2%. Sign-out was initiated in 100 % of the observations and 29,2 % were completed. No member of the surgical team was responsible for performing the safety checks. In 19 of 22 observations, all three parts of the checklist were signed in Orbit before the sign-out was completed. Conclusion: Both time-out and sign-out are carried out to a great extent, however, compliance with all items of the checklist varies. The study shows a discrepancy between the actual use of the checklist and the administratively reported use of the checklist.

Magister Pharmaceuticae - MPharm / The World Health Organisation (WHO) has stated that “there is no health without a workforce” (Campbell et al., 2013). The health workforce is essential for every health care system. The availability, accessibility and quality of health care workers play an important role in improving and overcoming health system challenges, in particular the call to universal health coverage (UHC) as stipulated in sustainable development goal 3. It has been observed that there is limited collaboration between healthcare systems and academic institutions. According to an article by Frenk et al., 2010, this limited collaboration has resulted in a mismatch between health care graduates’ competencies (such as inter-professional collaboration) and the needs of the population that they serve. One of the problems of health education institutions is the emphasis on curriculum content and learning methods as opposed to social purpose and moral obligations. / 2021-08-30

CHARLES UNIVERSITY FACULTY OF SOCIAL SCIENCES Institute of Political Studies Department of Political Science Abstract 2020 Kateřina Krestová Abstract A decade ago, the WHO decided to make a commitment of reforming itself. Above all, the funding situation was unsustainable. The main source of WHO's funding is voluntary contributions. Anyhow promising the term voluntary might seem, the reality is more complicated since the majority of these contributions is tightly earmarked towards specific programmes. Implying the WHO is not allowed to use the money where it is needed but it must be spent according to donor's wishes. This makes budgeting highly inflexible, the financing is imbalanced between categories and efficiency of fulfilling WHO's mandate declines. The reform launched in 2010 ought to fix these issues. This thesis evaluates the efficiency of the reform; firstly, total budget patterns are compared. Followingly, the attention is given to a specific category of Noncommunicable diseases due to its most severe underfunding. The analysis was conducted based on extensive datasets never gathered before comparing all types of contributions for every category from 1999 to 2019. Findings indicate unsatisfactory results of the reform; flexible sources have not increased, contrarily earmarked donations have...

Magister Scientiae Dentium - MSc(Dent) / The Human Immunodeficient Virus (HIV) is escalating in South Africa at an alarming rate. The impact of HIV today and in the future could have grave consequences for the South African population as it affects adults in their most productive years. To ease costs on the health system, health workers should be familiar with HIV patients needs in general, and specifically in areas such as oral disease which can contribute to the wellness or ill health of the patient. This could facilitate more appropriate and cost effective care ofHIV patients. World-wide reports indicate that the HIV virus is more prevalent in females than males. Women are also experiencing greater virulence of HIV and therefore greater severity of the disease. This research assessed whether there were differences in the prevalence and severity of oral symptoms ofHIV positive men and women. Oral health practices were also examined. As oral disease is very prevalent in HIV positive persons and has been a neglected area for research and program development, it was included in this study. This study also aimed to assess the perceived needs of patients affected by HIV. Such a study presents HIV positive patients an opportunity to participate in a process which allows patients to voice their needs and problems, as well as be involved in setting priorities. The study sought to assess whether needs differed according to the patients gender, age and symptom levels. A needs questionnaire with five domains which included medical and oral needs, social, economic, psychological and informational domains of needs was developed. The measure also included a section on demographics and oral health questions, and was administered as a structured interview. The sample consisted of 338 HIV positive males and females residing in Cape Town and its environs and attending the Out Patients' Departments of three major provincial hospitals, as well as two community clinics during May to November of 1995.