Masters of Science / The aim of this study was to develop a Stock Control Assessment Tool for use in the public health care sector and then to apply it to identify problems in the stock control system. This would help authorities to optimize the system. The advantages experienced with such a dynamic Assessment Tool were many: The Tool was quick and easy to apply; it was user friendly; it provided an immediate SWOT analysis of a particular facility; it is in line with the SA NDP directives and it provides an indication of which structures are in place and whether they are functioning properly. Furthermore; it could determine the increase or decrease in performance of a facility (therefore identify trends within the functional status of a system) when data is collected over a period of time; and finally, it could also be used to prioritize drug policy directives. The following steps were established in the development of the Tool: A literature review of pharmaceutical stock control and Drug Supply Management was addressed to provide the background information for the motivation of this study and to identify the various elements that could influence stock control at a facility level. Observational studies were applied at selected private and public facilities to observe the impact of these identified stock control elements. An 'ideal' stock control system was then generated from the literature review and observational assessment. A structured questionnaire was developed and surveyed at these facilities to generate key areas of concern of a stock control system. A study and adaptation of the indicator methods used by the World Health Organization (WHO) to monitor drug use in health facilities resulted in the formulation of a practical Stock Control Assessment Tool based on 11 key indicators and a number of sub-indicators, all of which were objectively defined. The Tool was then applied at selected public facilities and the results were analyzed quantitatively, qualitatively and subjectively. Each of the indicators was then applied and results examined closely with a view to possible refinements of the indicator. The refinements were made and the Tool was re-applied at two selected facilities. These two facilities were randomly selected from the original six facilities included for the testing of the Tool. Final conclusions and specific recommendations were generated to improve the stock control systems at the selected public health care facilities.

Cette thèse examine l’apport du travail statistique à la normalisation de la vaccination en France, des années 1950 au milieu des années 1990, une période au cours de laquelle la vaccination a fait l’objet de peu de controverses. Au moyen d’opérations statistiques de rationalisation, de régulation et de justification, l’épidémiologie (entendue comme un ensemble de pratiques plutôt qu’une discipline universitaire autonome) a largement contribué à maintenir cet état de fait – un processus que je qualifie de routinisation. L’enquête est construite sur des archives issues de diverses institutions, nationales et internationales, ainsi que sur une série d’entretiens avec les principaux acteurs du domaine. Elle éclaire le rôle d’un groupe d’épidémiologistes associés au Centre international de l’enfance (1949-1999), qui mit en œuvre un programme de rationalisation et de simplification de la vaccination. Dans cette période coloniale et postcoloniale, l’Afrique subsaharienne était un de leurs terrains de prédilection : ils y réalisèrent de nombreux essais, simultanément à leurs activités métropolitaines. L’implication de l’OMS dans le domaine de la vaccination a conforté la dimension internationale de cette routinisation : les épidémiologistes français se sont appropriés des opérations statistiques popularisées par Genève. À la fin de la période considérée, la controverse de la vaccination contre l’hépatite B a perturbé cette routinisation et mis en évidence un écart croissant entre les logiques de l’épidémiologie et l’expérience des individus vaccinés. Cette recherche éclaire d’une lumière nouvelle la façon dont l’intervention de santé publique la plus courante a été normalisée et gouvernée par des nombres. / This dissertation studies the entanglement between statistical production and the normalization of immunization practices in France from the 1950s to the mid-1990s, a period during which immunization remained largely uncontroversial. By rationalizing, regulating, and justifying immunization, epidemiology (understood as a collection of practices, rather than a discrete academic discipline) has contributed greatly to this normalization – a process I term “routinization.” This research project is based on archival findings, both in France and internationally, as well as a series of interviews with significant actors in the field. It is primarily focused on a group of epidemiologists affiliated with the Centre international de l’enfance (French International Children’s Center, 1949-1999), whose mission was to rationalize and simplify immunization for children. Throughout the institution’s history, which overlaps with the late colonial period and the process of de-colonization, there is a significant engagement with Francophone Africa: numerous trials were carried out simultaneously in Sub-Saharan Africa and the Paris region. The transnational nature of this activity is also due, in part, to the involvement of the World Health Organization in matters of immunization – French epidemiologists appropriated calculations popularized on a global scale. At the end of the period in question, the Hepatitis B vaccine controversy disrupted the routinization process and shed light on the rising gap between the discourse and practice of epidemiology and the experience of vaccinated individuals. This study offers new insights into the role of numbers in the maintenance and governance of the most common public health intervention.

Bakgrund   The Gugging Swallowing Screen - Intensive Care Unit (GUSS-ICU) är ett screeningtest med syfte att fånga upp indikationer på sväljsvårigheter efter långvarig intubering hos inneliggande patienter på intensivvårdsavdelningar (IVA). I dagsläget finns det inget svenskt översatt och validerat screeningtest för omvårdnadspersonalen att använda vid bedömning av sväljförmågan efter extubering på IVA. Syfte Syftet med studien var att översätta det internationella screeningtestet GUSS-ICU till svenska för användning i en svensk intensivvårdspopulation. Vidare syftade studien till att utföra en pilotstudie av den svenska versionen på extuberade patienter på IVA. Metod En framåt-bakåtöversättningsmetod användes vid översättningen av screeningtestet GUSS-ICU. Översättningsprocessen omfattade tre steg: framåtöversättning, granskning och kommentarer från en expertpanel och en bakåtöversättning. I översättningsprocessen deltog två logopedstudenter, två handledare, en expertgrupp och en översättare. Expertgruppen bestod av 10 deltagare med olika professioner inom hälso- och sjukvården. Fem inneliggande patienter från IVA planerades delta i en pilottestning av den svenska översättningsversionen. En innehållsanalys genomfördes för att kunna jämföra samtliga översättningar. Syftet med jämförelsen var att identifiera skillnader i ord och satser samt kulturella och kontextuella skillnader. Resultat       Studien resulterade i en svensk översättning (GUSS-IVA) av screeningtestet GUSS-ICU. Analysen visade på skillnader i val av ord, koncept och satser mellan de olika översättningarna. Flertalet skillnader var ej betydelseskiljande utan analyserades istället som resultat av skillnader i erfarenhet, kunskap och språkbruk. Översättningsmetoden bidrog till språklig, kontextuell och kulturell anpassning av översättningen. Slutsats Den svenska versionen av GUSS-ICU stämmer bra överens med originalversionen och enbart ett fåtal skillnader observerades mellan översättningarna. Skillnaderna mellan bakåtöversättningen och originalversionen var inte betydelseskiljande, vilket tyder på att den svenska versionen mäter det den avser att mäta. Framtida studier behöver pilottesta och validera den svenska versionen av GUSS-ICU, innan testet kan implementeras i en svensk intensivvårdspopulation. / Validering av screeningtest för sväljsvårigheter för användning inom svensk vårdkontext

VOVES, Petr. Úloha Světové zdravotnické organizace v případu epidemie viru eboly na území západní Afriky v roce 2014. Praha, 2017. 95 s. Diplomová práce (Mgr.) Univerzita Karlova, Fakulta sociálních věd, Institut politologických studií. Katedra mezinárodních vztahů. Vedoucí diplomové práce PhDr. Irah Kučerová, Ph.D. Abstract The M.A. thesis deals with the World Health Organization's response to the outbreak of the ebola virus disease in Guinea, Liberia and Sierra Leone in 2014. The spread of the disease is mapped from its very beginning at the end of December 2013 until the creation of UNMEER in September 2014, which was the first international medical mission ever created by UN Security Council. The purpose of this thesis is to evaluate the particular problems, which limit WHO's role in a timely and effective response to the public health threats of international concern (PHEIC) under the reformed International Health Regulations (IHR). The response of WHO representatives to the spread of the disease is evaluated taking into account the available material and competence capacities of the organization as well as its previous practice in this field. The specific misconduct of WHO representatives is explained in the context of longstanding WHO's problems, which are mainly linked to the vertical fragmentation...

The thesis titled The quality of life among hearing impaired people focuses on the current issue regarding the assessment of the quality of life in adult hearing impaired people in the Czech Republic. The conceptual basis of the submitted work is the current professional paradigm, with the emphasis on well-being in the lives of individuals with specific needs. The text deals with the multidimensional character of the concepts of the quality of life and the quality of life relating to health. It illuminates the subjective and the objective part of this broad and current concept. One theoretical chapter focuses on the area of hearing impairment in adult people in connection with the aspects which are bound to the quality of life in this part of the population. Mentioned are the personality traits of a hearing impaired person and the current social dilemma, which is connected to hearing loss, and is projected in the overall assesment of the quality of life of the people with this sensory handicap. One of the sub- chapters of this part of the text focuses on the key factors which influence the personal experience of life quality in the case of hearing loss. The research part of the work deals with method, continuation and assesment of the executed quantitative and qualitative research investigation. In...

Philosophiae Doctor - PhD / Injuries, and head injuries in particular, are a common cause of childhood, adolescent and young adulthood morbidity and mortality. The risk factors for injuries in general have been well researched. But it remains uncertain whether these factors are similar for specific injuries, such as head injuries. The inter-relationships between individual and environmental risk factors are difficult to study. Whilst much is know of the short-term consequences of head injuries, relatively little information is available on their long-term conseque~ces. The follow-up period in most research is short (often less than 1 year) and studies are weak in terms of design. Studies generally find a variety of social, cognitive and psychological consequences in children and young adults experiencing head injuries. This study assessed in two large, nationally representative samples, a 1946 birth cohort and a 1997 cross-sectional health survey: 1) the occurrence and risk factors for childhood, adolescent and early adulthood head and other injuries, and 2) the long-term cognitive and psychiatric effects of skull injuries. The overall findings for the risk factors across the two data sets and over 5 decades of data collection were strikingly similar. Maleness was a major risk factor for the head and other injuries. Some of the behaviour and personality factors such as hyperactivity and being neurotic, even after adjusting for sex, socioeconomic status and family type, remained significantly related to injuries, particularly those affecting the head region. A clustering of demographic, socioeconomic, family and behavioural risk factors significantly increased the likelihood of injuries, particularly recurring injuries with at least one being a head injury. In the unadjusted analyses socioeconomic status and family type were less consistently related to injuries. The long-term psychiatric and cognitive consequences of skull injuries causing concussion and skull fractures in childhood and early adulthood were negligible. Other childhood factors such as educational ability, behaviour and personality, and level of education achieved were more predictive of psychiatric symptoms and cognitive problems in adulthood. This study suggests that children and adolescents with behavioural and personality problems were at greater risk of head and other injuries in childhood, adolescence and later in adulthood. Children and adolescents with behavioural and personality problems were more likely to live in manual social class families and families with a single parent or stepparent. This combination of behavioural problems and deprived socioeconomic and family circumstances may increase tendencies for violent behaviour, alcohol dependence and manual occupations later in adulthood, which all increase the risk of injuries. There is therefore a need to identify children and adolescents with behavioural and personality problems as early as possible to prevent the impact in the short- and longterm. This will not only reduce the burden of injuries but also the many other consequence of behavioural and personality problems, particularly when located within deprived socioeconomic and family circumstances.

Magister Public Health - MPH / The introduction of National Health Insurance (NHI) and the Ideal Clinic Monitoring System have highlighted gaps and challenges with regard to medicine supply management (MSM) at primary health care (PHC) facilities. PHC facilities are the first point of contact communities have for their health needs, however, frequent stock-outs of medicines at PHC facilities in uMkhanyakude district, a rural district in KwaZulu-Natal, and have raised questions as to how medicine stock is managed at these facilities.

Background: Higher protein diets, especially from animal sources, have seen a rise in popularity due to potential metabolic. This may have consequences for kidney function particularly in rising middle class populations who are allocating more income towards meat. The objective of this systematic review and meta-analysis was to evaluate the effects of higher versus lower protein intake on glomerular filtration rate (GFR) in adult populations without renal impairment. Methods: Search strategies were developed and electronic databases searched: MEDLINE and EMBASE. Data were extracted up until June 3, 2015. The main outcome measure was GFR and a random effect model (Cochrane’s Review Manager Version 5.3) was used to pool mean differences in GFR values. Results: Database searches yielded 25 trials from 1914 articles that were eligible for analysis based on inclusion/exclusion criteria. 12 studies were randomized controlled trials and 11 studies were crossover trials. As a result of data presented, 2 crossover studies were treated as 4 trials to result in 25 total trials. A total of 810 subjects from 25 trials were included in this systematic review and meta-analyses. The age of participants was 24-62 years and their BMI was 21-36 kg/m2. Higher protein compared to lower protein-containing diets were associated with increased GFR values [mean difference (MD): 8.33 ml/min (95% CI 4.87 to 11.79), P < 0.00001] but this was less pronounced when assessing change from baseline GFR values [MD: 4.71 ml/min (95% CI 0.06 to 9.36), P = 0.05]. Moreover, significant heterogeneity was present and funnel plot asymmetry indicated potential publication bias in both meta-analyses. Conclusion: Higher protein diets were associated with increased GFR, however, these results were inconclusive due to significant heterogeneity and overestimation by random effect analyses. There is still no clear evidence that high protein diets negatively impact renal function in healthy populations. / Thesis / Master of Science (MSc) / Globally, the leading causes of mortality in industrialized countries are cardiovascular disease (CVD), stroke, and type 2 diabetes (T2D). Deaths from these chronic diseases now outpace deaths due to malnutrition. Being overweight and obese increases the risk of both morbidity and mortality from CVD, stroke, and T2D. Global rates of overweight and obesity have now reached ‘epidemic’ proportions and the World Health Organization has stated that, “… [a] global epidemic of overweight and obesity – ‘globesity’ – is taking over many parts of the world. If immediate action is not taken, millions will suffer from an array of serious health disorders.” Over the past 20-30 years, the popularity of higher protein energy restricted diets have grown due to the potential benefits regarding weight loss, appetite regulation, and maintenance of lean (muscle) mass. Additionally, the expansion of the global ‘middle-class’ has resulted in families allocating more income towards meat products as a primary protein source in their diet. A health concern is that higher protein intake may have an adverse effect on kidney function. In individuals with chronic kidney disease, higher protein diets have been shown to result in further renal impairment. However, the effects of increased protein intake in healthy populations are unclear. The aim of this systematic review and meta-analysis was to compare higher versus lower protein diets on kidney function in healthy populations based on the literature to date. This was accomplished by looking at changes in glomerular filtration rate (the rate at which kidneys filter blood), which is the ‘gold standard’ marker of kidney function.

Study Objective The objectives of this study are: (1) to explore the impact of the national consolidated guidelines for Option B+ PMTCT on the work of healthcare professionals at both clinical and management levels (including nurses, physicians and management) (2) to understand pregnant HIV-positive women views and experiences with ART for life, as a way to better manage the Option B+ PMTCT programme within state hospitals Research Questions The following research questions will be used to explore both perceptions of healthcare professionals and patients: 1.How have the national consolidated guidelines for Option B+ PMTCT affected the work of healthcare professionals? 2.What are pregnant HIV-positive women’s views and experiences about going on lifetime treatment with ARVs? / ABSTRACT Background. South Africa’s National Department of Health has adopted World Health Organization’s (WHO) 2013 consolidated guidelines on the use of ARVs for treatment and prevention of HIV infection. The guidelines include changes for prevention of mother to child transmission (PMTCT) through Option B+. Option B+ aims to reduce the HIV prevalence rate amongst these women by placing them on ART for life, no matter their CD4 count. As a result, in January 2015, these guidelines were implemented for the PMTCT programme at RMMCH. Little is known about the impact of these new guidelines on the work of healthcare professionals in state hospitals. Most importantly, no research has focused on how these changes have affected adherence for the patients. Purpose. The purpose of this research project is (1) to explore the impact of the Option B+ PMTCT programme on the work of healthcare professionals, and (2) to understand pregnant HIV-positive women views and experiences with ART for life, as a way to better manage the Option B+ PMTCT programme. Methods. A qualitative study design is used with a phenomenological approach. The methodology uses demographic questionnaires and semi-structured interviews with healthcare professionals and patients. The study is situated in Johannesburg, South Africa. Findings. The findings demonstrate that work has changed and become difficult to manage for all healthcare professionals because of (1) the need for strengthening indicators for tracking to decrease loss to follow-up (LTFU); (2) inconsistency in delivery of counseling and support services and the need for communication across clinical departments; and (3) the lack of compassion and understanding by service providers. The difficult healthcare environment has affected overall views and experiences of pregnant HIV-positive women going on ART for life. All 55 patient participants responded that they chose to take the fixed-dose combination (FDC) for life to protect the health of the baby and felt ART for life can be stopped after giving birth. Conclusion. Implications for future research include the need to address changes within the healthcare system at both clinical and management levels. It is crucial to incorporate the perspective of patients in policy implementation; uptake and adherence are key indicators in informing whether the Option B+ PMTCT programme is being adapted into state hospitals effectively. There needs to be extensive research on how to strengthen indicators for long term scalability and sustainability of the programme. Future evaluations need to address, will interdisciplinary collaboration within hospitals improve the management and understanding of Option B+? / Thesis / Master of Science (MSc)

This dissertation analyses public health service delivery at the Sir Seewoosagur Ramgoolam National Hospital (S.S.R.N.H.) in Mauritius. Particular emphasis is laid on the historical development of public health service delivery at S.S.R.N.H. Public health service delivery has been approached from the view points of its nature and scope. The core components of the research survey have been on some major obstacles and flaws in effective public health service delivery at S.S.R.N.H. The measuring instrument used for the research survey was a self­ administered questionnaire. The main findings were discussed especially absenteeism, personnel turnover, stress, burnout, morale, sexual harassment, lethargy and disobedience, nepotism, shirking responsibility, alcohol and drug abuse, active political interference, bribery and corruption, dishonesty and retaliation and neglect of duty. Attention was also devoted on the current national health policy for improving public health service delivery at S.S.R.N.H., inter-alia, the National Policy for Public Heath Act 17 of 2000 and the White Paper on Health Sector Development and Reform of December 2003. The public health environment is constantly altering. Therefore, it is essential to adjust to the changing health environment. This dissertation has addressed the future challenges in the micro health environment and macro health environment of S.S.R.N.H. Ultimately, a holistic instead of a parochial approach to addressing shortcomings identified in public health service delivery at S.S.R.N.H. has been advocated in this dissertation. / Public Administration / M.Admin. (Public Admin)