This thesis focuses on how reproductive health is made meaningful in the context of a Planned Parenthood clinic in Kentucky. Using ethnographic field methods, including participant observation and semi-structured interviews, the paper explores how staff members negotiate definitions of reproductive health as employees of Planned Parenthood health center. The analysis addresses reproductive health discourse among the clinic staff and how reproductive health is used as a site of intervention. It also explores the sociocultural processes and interactions the staff members engage in at the national and local levels and the role these play in shaping the conceptualization of reproductive health and how it is deployed at the clinic level. This analysis illuminates the fluid nature of reproductive health meanings and the ways in which health care delivery is contextually and socially mediated.

À l'heure actuelle, les résultats périnataux en France demeurent parmi les moins satisfaisants en Europe malgré une très forte médicalisation. Les autorités de santé affirment reconnaître l'influence de la prise en charge et de l'accompagnement pendant la grossesse, l'accouchement et la période néonatale sur l'état de santé de la mère et de l'enfant mais l'offre de soins peine à s'élargir. Contrairement à ce que prévoient les lois concernant le libre choix du praticien en France, les parturientes ne sont pas à même de choisir le professionnel de santé qui les accompagnera lors de leur accouchement. De même, les sages-femmes, contrairement à ce qu'impose leur code de déontologie, ne sont pas en mesure de garantir à leurs patientes ni les conditions, ni le lieu de leur accouchement. De surcroît, peu d'entre elles exercent leur profession de façon autonome tout en pratiquant le plein exercice de leur fonction. En centrant cette recherche anthropologique sur l'expérience des femmes et des sages-femmes dans leurs relations autour de la naissance et de l'accouchement, l'objectif de cette étude qualitative est de faire la lumière sur les tenants et les aboutissants de l'uniformisation de l'offre de soins. Dans un premier temps sont abordés les différents types d'accompagnement proposés aux femmes aujourd'hui ainsi que la place qu'y occupent les sages-femmes. Dans un second temps, l'étude de l'accompagnement global permet l'examen de la prise en charge des patientes et de ses liens de causalité avec les relations interprofessionnelles. Ainsi sont révélés les impacts de cette pratique sur le soutien à la parentalité et la nécessité d'une diversification de l'offre de soins. / Currently, the perinatal results in France remain among the least satisfactory in Europe in spite of a very strong medicalization. However, health authorities acknowledge the influence of maternity care during pregnancy, childbirth and neonatal period on the state of health of the mother and the child but health services hardly increase. Contrary to what French law says on free choice of practitioner, parturient women cannot choose the health professional who will assist them during labor. Likewise, midwives cannot guarantee their patients the place and conditions of childbirth, contrary to their code of ethics. In addition, few of them have the opportunity to work in an independent way and at the same time fully practice their profession. By focusing this anthropological research on women's and midwives' experience in their relationships around childbirth, the aims of this qualitative study are to clarify the ins and outs of the standardization of health services. Initially, the various types of care provided to women today and the place granted to midwives are discussed. Secondly, possible causal links between interprofessional relations and maternity care are searched for through the study of comprehensive care. So are revealed the impacts of a close and trusting relationship in supporting parenthood and of a diversification of health services.

No / Over the years there have been advances in the quality of care provision for people with dementia. How to measure the impact of care on the person with dementia has challenged researchers as, until recently, no evaluation tool offered a comprehensive overview of the behaviour patterns and well-being of persons with dementia. Dementia Care Mapping (DCM) is a tool used by care practitioners and researchers to capture both the process (behaviours) and outcome (well-being) of care and is therefore of use as a tool to evaluate quality of care. This study aims to assess, through DCM, the experience of dementia care provision in residential and nursing homes in two voluntary organizations in England. The data illustrates similarities in the well-being and behaviour patterns of 76 persons with dementia living in six care settings throughout England. Examples of instances when people with dementia were "put down" and when well-being was enhanced, are outlined. The homes in the study were meeting the physical care but not the broader psychosocial care needs of the observed residents. The action taken by the organizations as a result of the DCM evaluations is summarized.

Pražské nemocnice v letech 1948-1968 Ing. Mgr. Kateřina Murtingerová Summary: This work presents a development of Prague hospitals during 1948 and 1968. The first part of my thesis describes theoretical and historical background of health care provision in the first half of the 20st century and it is focused on development of Czech healthcare system. This part of thesis also includes reform plans and concepts proposed during the first republic and the Second World War, with special attention to Albert and Nedvěd's plans playing a key role in setting of healthcare provision after the year 1948. The second part of this thesis is based on legislative and institutional analysis after the Second World War that was developing hand in hand with social, political, and economic changes in Czechoslovakia. Important part of this capture is also an assessment of the results of health care provision during 1948-1968 from the perspective of the whole country, including structure and availability of hospital care, demographic trends and population health trends, expenditure of health care provision and preventive measures etc. Thesis also includes historical overview of academic environment. The issue of Prague hospitals and hospital care is framed in the context of institutional and legal framework of health care system...

En dépit d’une riposte planétaire développée depuis un quart de siècle, l’infection à VIH/sida continue de toucher de plus en plus de personnes, même si par ailleurs un déclin est relevé dans plusieurs pays. L’Afrique subsaharienne demeure son territoire privilégié avec plus des deux tiers des contaminations et des décès. Le Burkina Faso présente une évolution favorable avec une diminution du taux d’infection estimé, dans la population des 15-49 ans, à 7,17 % en 1997 et à 1,6 % en 2007. Mais la maladie aurait emporté 12 000 personnes en 2005 et 9 200 en 2006, en relation avec les niveaux d’infection des années 1990 et les difficultés d’accès aux traitements. En effet, bien que la thérapie antirétrovirale existe et que son accessibilité s’améliore au fil du temps, on estime que les besoins sont loin d’être couverts : seulement 17 263 personnes sous ARV dans 76 structures de soins pour plus de 46 000 besoins de traitements estimés. Vivre avec le VIH et accéder aux traitements est facteur de déstabilisation pour les individus. Cette déstabilisation a plusieurs expressions : elle peut être sociale, économique et/ou spatiale. L’analyse enseigne que, malgré les progrès et les champs d’action des structures publiques, privées, auxquelles s’ajoutent les structures communautaires agréées, les disparités spatiales sont encore grandes pour la prise en charge thérapeutique des personnes vivant avec le VIH. Partant de là, et en fonction des accessibilités aux traitements, on observe chez les personnes vivant avec le VIH des itinéraires thérapeutiques différenciés, facteurs de nouvelles territorialités. Celles-ci révèlent non seulement des logiques personnelles mais encore les logiques spatiales et sociales des acteurs du soin, illustrant pour partie le fonctionnement du territoire national. Des enquêtes réalisées auprès des personnes sous traitement permettent de mettre en évidence ces territorialités et les processus de territorialisation / Despite a global response developed over the past quarter century, HIV / AIDS continues to affect more and more people, even if further decline is observed in several countries. Sub- Saharan Africa remains his preferred territory with more than two thirds of infections and deaths. The Burkina Faso has a favorable trend with a decrease in the rate of infection found in the population of 15-49 years, to 7.17% in 1997 and 1.6% in 2007. But the disease would have prevailed 12 000 in 2005 to 9 200 in 2006, in connection with infection levels of the 1990s and the difficulties of access to treatment. Indeed, although antiretroviral therapy exists and that its accessibility improves over time, it is estimated that the needs are far from being covered only 17 263 people on ARVs in 76 care facilities for more than 46 000 needs treatment estimated. Living with HIV and access to treatment is destabilizing factor for individuals. This destabilization has several expressions: it can be social, economic and / or space. The analysis shows that, despite progress, public organizations, private, plus the structures approved does not cover needs and that the disparities are even larger space. From there, depending on accessibility to treatment, there is among people living with HIV differentiated therapeutic routes, new factors territoriality. They reveal not only logical but also personal space logic and social care players, illustrating in part the functioning of the national territory. Surveys conducted among people under treatment can highlight these territoriality and regionalization processes

The diploma thesis deals with the identification of risks which threaten students in the fields of Radiology Assistant, General Nurse and Paramedic. The aim of the thesis is to map the knowledge of risks during providing health care in students of selected fields at the Faculty of Health and Social Studies at the University of South Bohemia. Four hypotheses were set in the thesis. Hypothesis no. 1 saying that there are statistically significant differences in risk knowledge between students of the first and last year of individual fields of health care. Hypothesis no. 2 that there are statistically significant differences in stress perception as a risk-enhancing factor between paramedics and general nurses. Hypothesis no. 3 states that there is a statistically significant difference in the knowledge of the risk of ionizing radiation between radiological assistants and general nurses and hypothesis no. 4 that paramedics will call their future occupation more risky than general nurses. To achieve the objectives and verify the hypotheses, a questionnaire was prepared, a questionnaire survey was conducted and everything was evaluated using graphic and statistical methods. The questionnaire contained 23 questions and the research sample consisted of 105 respondents from the studied fields. The results show that hypothesis no. 1 was confirmed in the fields of Radiology Assistant and Paramedic and rejected by the General Nurse. Hypothesis no. 2 was also confirmed. Hypothesis no. 3 was rejected and hypothesis no. 4 was also rejected. The contribution of the thesis is a complex picture of the knowledge of risks during providing health care in the studied fields. The results can serve the faculty to further more effective teaching.

La démographie médicale est un sujet de préoccupation ancien en France. Les disparités de la répartition des médecins libéraux sont reconnues depuis plusieurs siècles. Des témoignages contemporains et de nombreux travaux de recherche ont largement démontré la persistance de leur attirance pour le milieu urbain. Or, l’urbanisation du pays dès le milieu du XIXème siècle a rendu confuse la lecture de ces liens. Le développement urbain a été particulièrement important en Ile-de-France en raison de la présence de la capitale. Il se poursuit, accéléré par la métropolisation générée par la mondialisation. Grâce à une approche dynamique ignorée en France, l’objectif de cette thèse est de comprendre les déterminants géographiques de l’installation en libéral et leurs adaptations aux dynamiques urbaines. Nous avons utilisé une démarche quantitative à différentes échelles et périodes grâce à l’exploitation d’archives administratives anciennes et de données actuelles. Une recherche qualitative complémentaire a été mise en oeuvre dans deux communes de banlieue. Notre étude révèle que depuis le XIXème siècle, l’installation des médecins libéraux est guidée par la recherche de la centralité dont ils sont des indicateurs. La reconstitution de leur répartition fait apparaître l’ancienneté et la stabilité des déséquilibres fonctionnels de l’espace francilien, accentués par la métropolisation. Le recul temporel permet de constater les spatialisations différenciées de ce groupe professionnel et de la population. Leur démarche ne répond donc pas à de quelconques logiques sanitaires. / The amount of the physicians has been a cause of concern for a long time. The private practitioners uneven distribution is well known since several centuries. Contemporary accounts and numerous research works have demonstrated the persistence of their attraction for urban environment. But, the urbanization of the country since the middle 19th century has muddled up the deciphering of these links. Urban development has been particularly important in Paris area because it includes the french capital. That development still goes on, accelerated by the metropolization generated by globalization. Thanks to a dynamic approach ignored in France, the objective of this thesis is to reveal and explain the private physicians distribution due to their adaptation to the urban dynamics. We have used a quantitative approach by using of historical archives and current data. In addition, the qualitative research was implemented in two suburb towns. Our study demonstrates that since the 19th century, centrality is the determining factor of their distribution. In fact, private doctors are an indicator of that spatial property. The noticed evolutions reveal the oldness and the stability of spatial functional imbalances in Paris area. They are stressed by the metropolization. The benefit of hindsight highlights different spatial logics of population and physicians. There are no sanitary logics in their spatial behavior.

The purpose of this study was to explore and describe the perceptions of health professionals on the changes brought about by health system reforms in Zimbabwe. Qualitative, explorative and descriptive research was conducted to identify concerns of health care provision, as described by health professionals in Zimbabwe, and to provide awareness for future reforms. Data collection was done using semi-structured interviews. Ten health professionals from two study sites participated in the research. The findings revealed that health professionals have an understanding of health system reforms and how these have changed the way health services have been delivered over the years. There is a general outcry among health professionals regarding the deteriorating provision of quality health care amidst the challenges that the health system is facing under a collapsing economic situation. The study recommends inclusion of health professionals in policy making as well as timely dissemination of any information regarding changes in policy. The study also recommends further research on the same topic with a larger diverse group of participants. / Health Studies / M. P. H.

The purpose of this study was to examine Residential Care Aides’ (RCAs) experiences of good quality dementia care provision. Informed by a political economy perspective, I sought to understand how RCAs conceptualize quality dementia care, whether such conceptualizations are reflected in their daily care practice and how the organizational care context impedes or facilitates such care provision. Drawing on a focused ethnographic approach, I utilized in-depth interviews, participant observation and the review of selected documents to contextualize RCAs’ experiences within the organizational care environment. Over a 12-month period, in-depth interviews with 29 staff (21 RCAs, 3 LPNs and 5 managers) and 239 hours of participant observation were conducted in four small-scale dementia units in two nursing homes in British Columbia, Canada. In-depth interviews yielded information-rich data about RCAs’ care experiences and their relationships with residents, while participant observation afforded the opportunity to strategically link RCAs’ actions and interactions with what was said, a feature missing from much of the previous research examining staff perceptions of quality dementia care. A select review of facility documents and provincial licensing regulations provided additional insight regarding the relevance of the larger structural context for RCAs’ care experiences. In general, RCAs conceptualized, and exhibited in their daily physical care provision, quality dementia care as that which focused on tangible care outcomes (i.e., keeping residents clean, comfortable, calm and happy), on their care approach (i.e., delivering care in a compassionate, patient and affectionate manner) and was guided by family ideology (i.e., invoking of family metaphors). Inherent in their care provision was a sense of role tension, as they sought to incorporate social interaction with task completion and their co-workers’ conflicting expectations. Study findings also illustrated how, in the face of continued disempowerment and organizational constraints, RCAs sought to provide quality dementia care by negotiating their peer and supervisory relationships and selectively breaking formal and informal policies/procedures. Salient to RCAs’ experiences of personhood was the limited recognition and appreciation they received from management and the manner in which work-life balance, staffing coverage, human resource management practices and limited information sharing further devalued them and their work. Study findings draw attention to the importance of: acknowledging the role of structural constraints in the pervasiveness of a task-oriented work culture; attending to (and facilitating) staff personhood; facilitating supportive peer and supervisory relationships and; fostering effective management practices as a means of potentially improving care quality. As such, the study sheds important light on what RCAs require within their work environments to help facilitate resident well-being, reinforcing the assertion that residents’ care conditions are inextricably linked to RCAs’ care work conditions. / Graduate / 0351

The present dissertation, which focuses on the needs of particularly vulnerable older people in home health care, was written within the framework of the PhD study in Longevity at the Faculty of Humanities, Charles University and was carried out as part of the project supported by the Charles University Grant Agency "Met and Unmet Needs of Particularly Vulnerable Older Patients in Home and Inpatient Care" (GA UK No. 760219). The overall aim of the three researcher project, where I was the research coordinator, was to clarify the needs of particularly vulnerable older patients in both home health care and inpatient care, including the needs of patients living with dementia. The aim of this dissertation was to identify the needs of vulnerable older patients in home health care. This dissertation consists of four papers. At the time of writing, two articles had been published in peer-reviewed journals and two articles were under review. The thesis has chapters in the introduction and conclusion that set the professional articles in context, creating a comprehensive view of the needs of particularly vulnerable older people in home health care. As three of the four peer-reviewed articles submitted have been published (1) or under review (2) in international journals, the entire dissertation is written...