This study explored and described the experiences of Eritrean immigrants regarding utilisation of healthcare services in Indianapolis. Qualitative descriptive phenomenological design was utilised. Data were collected using a semi-structured interview format, on eight conveniently selected Eritrean immigrants, living in Indianapolis. Data were analysed using Interpretive Phenomenological Analysis Framework for data analysis. Three superordinate themes emerged from data analysis: Healthcare financing system, Positive side of healthcare services and Challenges related to utilisation of healthcare service. All these factors have an impact on the utilisation of the Healthcare services by Eritrean immigrants. Recommendations have been put forward to advocate for policy change regarding financing of healthcare services for immigrants and improved healthcare services to accommodate cultural diversity. Further research should be conducted on ways of improving utilisation of healthcare services by Eritrean immigrants in Indianapolis. / Public Health / M.A. (Health Studies)

L’objectif de cette recherche qualitative était de porter un regard sur la problématique du poids chez l’homme à partir des déterminants de la santé masculine définis par Courtenay (2003). En donnant la parole à 17 hommes québécois en surpoids lors d’entrevues individuelles, différentes variables associées à leur préoccupation à l’égard du poids, sont examinées. Selon ces hommes, il existe un comportement alimentaire typiquement masculin autant dans le choix des aliments que dans la façon de manger. La présence féminine joue pour eux un rôle prépondérant dans ce domaine. La vision masculine de la santé suit souvent la fonctionnalité de leur corps tandis que leur description du surpoids semble davantage partir du « vécu » et être moins stricte que la définition purement médicale. Néanmoins, beaucoup d’hommes sentent la pression de l’image du corps idéal masculin et sont souvent insatisfaits de leur corps selon la masculinité valorisée et selon la stigmatisation subie. La préoccupation des hommes à l’égard de leur santé est très présente parmi les hommes de 30-45 ans et perdre du poids dans ce contexte devient alors légitime mais les raisons évoquées varient : la santé, l’apparence, le bien-être. L’expression des douleurs émotionnelles autour du poids est difficile pour les hommes et trop souvent la masculinité traditionnelle constitue une barrière de taille à la consultation pour ces problèmes. Pour le futur, il sera donc important pour les professionnels de la santé d’intégrer les différentes caractéristiques de cette masculinité traditionnelle dans leur approche et leur communication avec les hommes en surpoids. / The purpose of this study was to explore different weight issues of men by using the « key determinants of the health and the well-being of men » established by Courtenay (2003). By interviewing 17 overweight men of Québec, different variables were examined that could possibly explain the preoccupation with their weight. According to these men, a typical masculine behaviour in the food choice and in the way of eating can be acknowledged and by traditional masculine standards, women often play an important role in this area. The health beliefs of men is often limited to the functionality of their body while the description of overweight is more based on their lived experience and less restrictive than the pure medical definition of health. Nevertheless, the social pressure of the ideal masculine body is felt by many men and makes them often dissatisfied with their body depending on the masculinity that is valued and the stigmatisation that they encounter. Men’s health concerns are predominant in the 30-45 age group and legitimize their desire for weight loss although given reasons may vary: health, appearance or well-being. Expression of emotional pain in weight issues is difficult for a lot of men and very often the traditional masculine values constitute a serious barrier to consulting for these kinds of problems. Health professionals in the future will therefore need to recognize the different characteristics of this masculinity and integrate them in their approach and communication with overweight men.

La recherche économique considère le médecin généraliste comme un agent offrant à l’échange information et services intellectuels en santé à des principaux. L’imparfaite convergence entre leurs objectifs, comme la présence d’incertitudes et d’asymétries d’information, conduisent le médecin à « fixer » les quantités, l’effort fourni et la qualité des soins et services rendus. Cette thèse vise à identifier le rôle des caractéristiques des généralistes, de leur mode d’exercice ou d’organisation, sur la performance de leur activité, en s’appuyant sur trois articles. Le premier analyse les déterminants de la variabilité de prescription d’antibiotiques pour rhinopharyngite aiguë, le second évalue l’impact du travail en équipe avec des infirmières sur la qualité et l’efficience des soins pour les patients diabétiques, et le troisième évalue l’impact de l’exercice regroupé pluriprofessionnel sur l’activité et l’efficience productive des généralistes et l’efficience des recours aux soins ambulatoires de leurs patients. Ces travaux de recherche permettent d’interroger la faiblesse relative de la régulation de l’offre de soins ambulatoire en France en matière de politique de maîtrise de l’évolution des dépenses de santé en comparaison de celle portant sur la demande. / According to economic research, the general practitioner is considered as an agent that offered information and intellectual services in health to principals. Imperfect convergence between their objectives, like the presence of uncertainties and information asymmetries, lead the physician “to fix” the quantities, the effort and the quality of the care and services delivered. Based on three articles, this thesis aims at identifying the role of the characteristics of the general practitioners and of their practice organization, on activity performance. The first articles analyzes the determinants of the antibiotic prescription for acute rhinopharyngitis variability, the second evaluates the impact of team working with nurses on the quality and the efficiency of the care for diabetic patients, and the third evaluates the impact of multi-professional group practices on the activity and the productive efficiency of GPs and on the utilization of ambulatory health care and by their patients. These researches question the relative weakness of the ambulatory health care regulation in France in terms of health care expenditure containment policies in comparison with that bearing on demand.

This study explored and described the experiences of Eritrean immigrants regarding utilisation of healthcare services in Indianapolis. Qualitative descriptive phenomenological design was utilised. Data were collected using a semi-structured interview format, on eight conveniently selected Eritrean immigrants, living in Indianapolis. Data were analysed using Interpretive Phenomenological Analysis Framework for data analysis. Three superordinate themes emerged from data analysis: Healthcare financing system, Positive side of healthcare services and Challenges related to utilisation of healthcare service. All these factors have an impact on the utilisation of the Healthcare services by Eritrean immigrants. Recommendations have been put forward to advocate for policy change regarding financing of healthcare services for immigrants and improved healthcare services to accommodate cultural diversity. Further research should be conducted on ways of improving utilisation of healthcare services by Eritrean immigrants in Indianapolis. / Public Health / M.A. (Health Studies)

No description available.

Hintergrund: Anorexia nervosa (AN) und Bulimia nervosa (BN) sind schwere Erkrankungen, die vorwiegend junge Frauen betreffen und häufig mit gravierenden psychischen, somatischen und sozialen Folgen einhergehen. Behandlungsstandard beider Erkrankungen ist eine Richtlinienpsychotherapie. Ziel der Arbeit: Zielsetzung dieser Studie ist es, die Behandlungsprävalenzen und Versorgungssituation von Patienten mit AN oder BN in Sachsen abzubilden sowie aufzuzeigen, welche Fachrichtungen die Erstdiagnose dieser Krankheiten stellen, und welche Faktoren die Vermittlung in eine psychotherapeutische Behandlung beeinflussen. Material und Methoden: Basierend auf Routinedaten der gesetzlichen Krankenkasse AOK PLUS wurde unter allen Versicherten in Sachsen die Prävalenz von ambulant behandelten Patienten mit AN und BN im Zeitraum von 2009 bis 2014 ermittelt sowie nach Alter, Geschlecht und Wohnort des Patienten untersucht. Weiterhin wurden die Fachärzte, die die Diagnosen erstmalig kodierten, sowie die Inanspruchnahme einer ambulanten Psychotherapie nach ambulanter Erstdiagnose betrachtet. Ergebnisse und Diskussion: Die Behandlungsprävalenzen der AN und BN zeigen für Patientinnen von 2009 bis 2014 einen signifikanten Anstieg, während die deutlich niedrigeren Behandlungsprävalenzen für Patienten stabil blieben. In den Großstädten waren die Behandlungsprävalenzen für beide Diagnosen signifikant höher als in den übrigen Regionen. Fast die Hälfte der Essstörungen wurde von Fachärzten für Allgemeinmedizin diagnostiziert, weitere 20–25 % von Fachärzten für psychosomatische Medizin und Psychotherapie. Lediglich 25 % der AN-Patienten und 33 % der BN-Patienten nahmen im ersten Jahr nach der Diagnosestellung eine Richtlinienpsychotherapie wahr. / Background: Anorexia nervosa (AN) and bulimia nervosa (BN) are severe diseases that predominantly affect young women and are often associated with severe psychological, somatic and social consequences. The standard treatment for both disorders is guideline psychotherapy. Objective: The aim of this study is to present the treatment prevalence and care situation of patients with AN or BN in Saxony, to show which specialist disciplines make the initial diagnosis of these diseases and which factors influence the referral to psychotherapeutic treatment. Material and methods: Based on routine data of the statutory health insurance fund AOK PLUS, the prevalence of outpatients with AN and BN was determined among all insured persons treated in Saxony in the period from 2009 to 2014 and examined according to age, gender and place of residence of the patient. Furthermore, the medical specialists who made the diagnoses for the first time and the utilization of outpatient psychotherapy after initial outpatient diagnosis were investigated. Results and conclusion: The treatment prevalence of AN and BN showed a significant increase for female patients from 2009 to 2014, whereas the much lower treatment prevalence for male patients remained stable. The treatment prevalence for both diagnoses was significantly higher in large cities than in other regions. Almost half of the eating disorders were diagnosed by general practitioners and another 20–25% by specialists for psychosomatic medicine and psychotherapy. Only 25% of the AN patients and 33% of the BN patients underwent guideline psychotherapy within the first year after diagnosis.

Indiana University-Purdue University Indianapolis (IUPUI) / This qualitative study was successful in utilization of grounded theory methodology to ascertain nurses’ decision-making processes following their awareness of having made a medical error, as well as how and/or if they corrected and reported the error. Significant literature documents the existence of medical errors; however, this unique study interviewed thirty nurses from adult intensive care units seeking to discover through a detailed interview process their individual stories and experiences, which were then analyzed for common themes. Common themes led to the development of a theoretical model of thought processes regarding error reporting when nurses made an error. Within this theoretical model are multiple processes that outline a shared, time-orientated sequence of events nurses encounter before, during, and after an error. One common theme was the error occurred during a busy day when they had been doing something unfamiliar. Each nurse expressed personal anguish at the realization she had made an error, she sought to understand why the error happened and what corrective action was needed. Whether the error was reported on or told about depended on each unit’s expectation and what needed to be done to protect the patient. If there was no perceived patient harm, errors were not reported. Even for reported errors, no one followed-up with the nurses in this study. Nurses were left on their own to reflect on what had happened and to consider what could be done to prevent error recurrence. The overall impact of the process of and the recovery from the error led to learning from the error that persisted throughout her nursing career. Findings from this study illuminate the unique viewpoint of licensed nurses’ experiences with errors and have the potential to influence how the prevention of, notification about and resolution of errors are dealt with in the clinical setting. Further research is needed to answer multiple questions that will contribute to nursing knowledge about error reporting activities and the means to continue to improve error-reporting rates