Backround. Based of my personal observations when employed as a pharmacist in a Saudi hospital it was clear that there were problems with medicine supply to outpatients. This thesis was designed to scientifically investigate the types of shortages, the reason(s) for such problems and potential solutions to the problem. Methods . This study was undertaken using a variety of experimental techniques to determine the views and perceptions of patients, pharmacists, physicians and administrative staff of the hospital under examination. To establish the scale of the problem: focus groups (n=25), structured questionnaires, structured interviews/meetings for health care professionals and a national survey (n=650) were the research tools used to objectively determine the relevant data. The data were analyzed by appropriate statistical methods. Results and Discussion That there was a real problem was quickly established in the data obtained from patients. A similar finding was made for each of the 'professional groups'. The central problem was one of shortages of medicines for prescriptions presented by outpatients. It was not a case the medicines were simply not available because they were never stocked but rather a simple shortage in the dispensary stock. It was established the lack of medicines was not due to central budget arrangements but involved prescribing quantities outside of the hospital guidelines which no degree of planning could accommodate. There was also the very unexpected finding that a prescription could be filled in a variety of hospital dispensaries as individuals could access more than one hospital or they could consult more than one physician for the same condition and obtain effectively double the supplies. Communications between the hospital and patients and the health care professionals could all be improved by perhaps increasing the knowledge of the patient about the correct use of medicines. Recommendations. A series of recommendations for future work is provided

This study sought to establish some ofthe problems that occur during a consultation process between a healthcare worker and a patient, such as intangible and tangible verbal/nonverbal communication problems. Tangible nonverbal problems refer to eye contact, gestures, body posture and facial expression. Tangible verbal problems refer to voice tone/attitude and language and intangible to race, age, gender, education and culture. It was made clear that the problems involved in the consultation process were, in the main, common to other fonns of communication such as that between a reference librarian and a client, customer, visitor or user. The factors that hindered communication were investigated by means of semi-structured interviews and questionnaires. The sample population was made up of 100 black isiZulu speaking females and seven healthcare workers of a heterogeneous background. The perception ofthe respondents in relation to the above-named factors (language, age, gender, attitude, culture, education, gestures and postures) was sought. The analysis of the results obtained showed that some of the significant factors that are a problem in communication include voice tone/attitude, eye contact, sitting position, gestures, facial expression and language. Patients, for the sake ofeffective concentration and free flow ofinfonnation, preferred healthcare workers who were polite, had a cheerful demeanour and who sat still and straight up (not looking around or standing). This is noted because the majority of the patients acknowledged such healthcare workers and were not satisfied with those who behaved otherwise. For example, in relation to previous consultations (irrespective of the Clinics), out of the 70 respondents who encountered problems, 61 (87%) in despair cited cases of rudeness, of which the majority of such cases related to African healthcare workers. Culture also mattered, when seen in terms of people being able to speak the same language and understand one another, with respect to the contextual meaning of words. As far as eye contact was concerned, it was apparent that adjustments had been made. For example, it was discovered that although it is the Zulu culture to avoid eye contact, especially between the young and the old, Zulu people have come to accept eye contact in a crosscultural South Africa. Their acceptance was also seen as due to the advantages ofeye contact. This was made clear by the fact that ofthe 90 (91%) respondents who acknowledged the fact that the healthcare workers maintained eye contact during the consultation process, 87 (97%) said it was polite as it gave them the assurance that the healthcare workers were paying attention to what they were saying. Among the socio-demographic variables investigated, the gender of the healthcare worker emerged as one ofthe important predictors of effective communication. This is because the majority of the respondents indicated feeling freer with someone of the same gender groupmg. Certain recommendations were made which were considered vital in improving not only the consultation process but any other form of communication, including that between a reference librarian and a client. The main recommendations were that the healthcare workers be polite and endeavour to speak the main language as the patients. Due to the fact that some healthcare workers hurry during consultation, it was recommended that more staff be employed. / Thesis (M.I.S.)-University of Natal, Pietermaritzburg, 2000.

The resurgence of the polio virus in Nigeria following vaccine rejections poses a severe threat to the total worldwide eradication of polio. Vaccine refusals are a huge problem in Nigeria, especially in the North, which accounts for about 60 percent of polio cases in 2013. These refusals were informed by claims that polio vaccines contained anti-fertility properties that were designed by the ‘West’ to reduce the Muslim population. These claims and subsequent vaccine rejections culminated in the killing of health workers during an immunisation exercise in February 2013. This study is an analysis of the coverage of the polio eradication controversy by two newspapers- Punch and Daily Trust, following the killings of the health workers. Daily Trust is situated in Northern Nigeria, while Punch is situated in the South. The choice of these newspapers is based on the argument by Ayodele (1988) and Omenugha (2004) that the Nigerian press has been accused of escalating tension in the country because they view many aspects of the Nigerian reality from the lenses of religious, political and cultural prejudices. Because it is a text-based study, the chosen research method is Fairclough’s (1995) model of Critical Discourse Analysis (CDA), following a preliminary thematic content analysis. In addition to Fairclough’s model, the study employs textual analytic tools such as narrative analysis and rhetoric/argumentative analysis. The selected texts, which comprise editorials and news stories are analysed based on the themes identified during the thematic content analysis. The study concludes that while the two newspapers differ in their locations and stylistic approach to news, they are similar in their coverage of the polio eradication crisis. They both side with the Federal Government and help perpetuate the South versus North animosity thereby ignoring the intricacies involved in the polio eradication controversy.

Background: In a part of Wales where over 50% of the population were bilingual, one community physical rehabilitation services had no Welsh speaking therapists. This research attempts to find whether Welsh speakers had the same access to health and social care services and whether their outcomes were similar to non-Welsh speaking patients; and what the service users' opinion were on Welsh language services. Methodology: 1 - Therapy inputs and outcomes of service users who spoke Welsh were compared to service users who did not speak Welsh with a rehabilitation team where no therapists spoke Welsh. 2 - The ratio of Welsh speakers referred to the rehabilitation services and accepted for services were compared with the ratio of Welsh speakers in the general population. 3 - 201 service users were asked for their opinion on services and their language choice, and the possible effect on their ability to effectively receive a rehabilitation service. Results: Significantly fewer Welsh speakers were referred to the rehabilitation service than the anticipated percentage (p < 0.001). Wales' social services do not document individuals' language preference consistently. A significant difference was found in the therapy outcomes measured by outcome measures according to the patients' language if the practitioners could not speak Welsh. Welsh speaking patients had significantly lower results following rehabilitation than non-Welsh speakers (p < 0.05). The vast majority of Welsh speaking patients who were asked believed they would have preferred receiving services in Welsh. Conclusion: Awareness raising training for practitioners and carers, as well as language training, including 'little words' training, would support availability of Welsh language services. Consideration should be given to creating a specialist national agency to maintain a database of Welsh speaking practitioners, from which health boards and local authorities could buy their services when appropriate.

CAPES / Este trabalho apresenta a adaptação do código Geant4 para conversão de imagens DICOM (Digital Imaging and Communications in Medicine) de crânio, obtidas em tomografia convencional (CT), em um phantom antropomórfico virtual. O trabalho foi baseado no exemplo médico denominado “Código Dicom”, disponibilizado pelos desenvolvedores do código Geant4. Durante a execução do trabalho foram feitas reestruturações no exemplo “Código Dicom” para a conversão direta de imagens tomográficas em um phantom virtual. Foram retirados do código todos os passos referentes aos eventos físicos nucleares. Foi reformulado o arquivo DicomHandler.cc para não realizar a compressão dos pixels da imagem de CT. Em seguida foi realizada a conversão direta de imagens tomográficas, de um phantom físico de polietileno (PEAD) com núcleo central de acrílico e de um crânio real humano, em phantoms virtuais para o código Geant4. Os resultados demonstraram que com este código é possível a reconstrução de áreas anatômicas com geometrias complexas, partindo do uso de imagens tomográficas reais. / This work presents the adaptation of the Geant4 code for converting DICOM (Digital Imaging and Communications in Medicine) images of a skull, obtained in conventional tomography (CT), into a virtual anthropomorphic phantom. The work was based on the medical example named "Dicom Code" provided by the developers of the code Geant4. During the execution, restructurings using the "Dicom Code" example were made to achieve the direct conversion of tomographic images into a virtual phantom. All the steps referring to nuclear physical events were removed. The file DicomHandler.cc was reformulated in order to avoid the pixels compression of the CT image. The CT images of a physical polyethylene (PEAD) phantom with acrylic core and a real human skull were then converted into virtual phantoms for the code Geant4. The results showed that with this code, it may be possible the reconstruction of anatomical areas with complex geometries, based on the use of real tomographic images.

CAPES / Este trabalho apresenta a adaptação do código Geant4 para conversão de imagens DICOM (Digital Imaging and Communications in Medicine) de crânio, obtidas em tomografia convencional (CT), em um phantom antropomórfico virtual. O trabalho foi baseado no exemplo médico denominado “Código Dicom”, disponibilizado pelos desenvolvedores do código Geant4. Durante a execução do trabalho foram feitas reestruturações no exemplo “Código Dicom” para a conversão direta de imagens tomográficas em um phantom virtual. Foram retirados do código todos os passos referentes aos eventos físicos nucleares. Foi reformulado o arquivo DicomHandler.cc para não realizar a compressão dos pixels da imagem de CT. Em seguida foi realizada a conversão direta de imagens tomográficas, de um phantom físico de polietileno (PEAD) com núcleo central de acrílico e de um crânio real humano, em phantoms virtuais para o código Geant4. Os resultados demonstraram que com este código é possível a reconstrução de áreas anatômicas com geometrias complexas, partindo do uso de imagens tomográficas reais. / This work presents the adaptation of the Geant4 code for converting DICOM (Digital Imaging and Communications in Medicine) images of a skull, obtained in conventional tomography (CT), into a virtual anthropomorphic phantom. The work was based on the medical example named "Dicom Code" provided by the developers of the code Geant4. During the execution, restructurings using the "Dicom Code" example were made to achieve the direct conversion of tomographic images into a virtual phantom. All the steps referring to nuclear physical events were removed. The file DicomHandler.cc was reformulated in order to avoid the pixels compression of the CT image. The CT images of a physical polyethylene (PEAD) phantom with acrylic core and a real human skull were then converted into virtual phantoms for the code Geant4. The results showed that with this code, it may be possible the reconstruction of anatomical areas with complex geometries, based on the use of real tomographic images.

M.Cur.(Medical & Surgical Nursing: Critical Care General) / The majority of Africans use traditional medicine, but do not divulge this information to the nurses and doctors when admitted to critical care units. For this reason, patients develop complications, and these makes it difficult for nurses and medical doctors in critical care units to assess and to provide comprehensive quality care, as they treat only the visible clinical manifestations. The purpose of this study was to explore and describe the factors leading to non- divulgence by patients who used traditional medicines in critical care units of a Westrand mine hospital, in order to describe strategies to facilitate divulgence. The researcher used a qualitative, exploratory, descriptive and contextual research design. The population was composed of the patients who were envisaged to have used traditional medicines in the critical care unit of a Westrand mine hospital. Twelve participants were purposively selected from the critical care unit register because these patients displayed the symptoms of having used traditional medicine. Semi-structured individual interviews were conducted. Ethical principles were adhered to. Trustworthiness was ensured by using namely; credibility, transferability, dependability and confirmability. A qualitative open coding method of data analysis was used according to Tesch’s protocol. The following theme and subthemes emerged from the data analysis: Fear and anxiety as the main theme. Subthemes were 1. Fear to divulge secrets. 2. Fear of negative attitudes from nurses and 3. Fear to lose rights, norms and values. It is recommended that the strategies described be used in clinical practice, nursing education and for further research regarding divulgence of the use of traditional medicine to the nurses and doctors, in order to provide a comprehensive assessment and treatment of the patients in critical care units.

This thesis analyses the state of health care in South Africa with particular reference to a clinic and the Provincial Hospital in Port Elizabeth, Eastern Cape. The complexities of health care provision in a diverse sociolinguistic environment where certain languages are emphasized over others, forms the cornerstone of the research. The research focuses on health care in a complex multi-cultural environment. The goal of the research is to present a coherent and robust translation framework for the development of suitable materials to enhance communication across language and cultural barriers in the health care sector. A model (based on research completed in the USA) is presented as a possible alternative in the final chapter of the thesis.

Health communication has gained worldwide recognition as one of the most effective methods for tackling global health challenges; a conclusion that is supported by a range of studies showing generally positive results. Literature in the field has tended to focus on one of two perspectives: either individual behaviour change or a cultural/critical approach. This dissertation, which falls into the latter category, extends previous work on health communication and culture into a new context, namely Saudi Arabia. The thesis is motivated by two main research questions. First, how has culture influenced health communication in Saudi Arabia specifically in initiatives against illicit drug use and alcohol abuse? Second, how has this communication developed? At the heart of this study is the role of Saudi culture in health communication in an increasingly interdependent and connected world. The dissertation makes use of mixed qualitative data collection methods. Principally, it utilised semi-structured interviews with key officials and focus groups with young Saudis and health promoters in Saudi Arabia as well as attendance at and observation of health-communication events and permanent exhibitions as a subordinate method. The study reveals promising findings supporting the growing scholarly interest in the cultural dimension of health communication. It concludes that the key influence of the Saudi culture on health communication against substance abuse is Islamic beliefs about health, in particular those about substance abuse. These beliefs created a rejection of illicit drug abuse in Saudi society, thereby shaping a supportive environment for promotion activities against risky health behaviour. In addition, Islamic influence inspired the related regulations and laws in the kingdom. Islamic and local influences exert a powerful influence on the practical side of health communication in Saudi Arabia, including the content of messages, the appeal used to attract the specific audience, and the communication channels used to promote the campaigns. The study engages with four concepts constituting the Islamic model of health and illicit drug abuse: prohibition (haram), promotion (Da’wah), repentance and inclusiveness (Tawbah), and treatment and rehabilitation (Elaj). The study also examines controversial issues about health communication in the country, such as the predominance of top-down communication, the absence of participatory communication and cultural diversity. In short, a lack of innovation and creativity in delivering health communication messages. The study illustrates the major role the Saudi government has played in communicating health and substance abuse since the 1980s, when officials realised the need to modernise the means of communicating health and drug issues from mosque-based only to include modern methods such as televised campaigns, school-based programmes and hospital-based health education. Since then, government-led health communication initiatives have been well established in the kingdom. The dissertation is able to demonstrate a critical understanding of the reality of health communication against substance abuse in Saudi Arabia and make a range of recommendations to improve the efficacy of current policies and suggest new avenues for future research.

Background: Effective information exchange is an asset to effective lung cancer care. Although a considerable body of evidence informs the approaches to ‘diagnostic bad news delivery’, the exchange of information that takes place between patients with cancer and professionals with whom they interact thereafter is less well documented. Information exchange has an influential role throughout the lung cancer care continuum, providing patients and professionals with details relative to the cancer diagnosis and the subsequent choices to be made in its management. Information on disease extent, treatment and related side-effects, rehabilitation and prognosis are judged by patients as the most prominent for them. Despite awareness of the specific categories relevant to information exchange needs, there is little evidence available exploring the information exchange process, per se, within cancer generally and even less within the lung cancer context. Aim: To investigate information exchange processes during lung cancer consultations, specifically exploring information content which is both exchanged and not exchanged. Design: Qualitative, multiple case study design. Methods: A case centred on a patient with lung cancer. Within the case were the patients, the health professionals they consulted with and accompanying companions. Seven cases were recruited, which included 12 companions. Data were collected in outpatient clinics between 2010 and 2011. Data were digital recordings of consultations; debrief interviews immediately post-consultation and later in-depth patient interviews. All interviews were transcribed and analysed for pattern matching and coding. Findings: Analysis of categorical data indicated cases were typical of the Scottish lung cancer population across all demographic domains, accept age and performance status. The preliminary analysis showed across cases, almost universal satisfaction with the level and content of information exchange for the main a priori categories of diagnosis, treatment and treatment outcome. Substantive analysis revealed that information content across the a priori categories was influenced by the presence of the accompanying companion. Within the clinical consultation, companion influence on information exchange was shown to be mediating, moderating or neutral. A key finding which emerged showed companion accompaniment to be a negotiated process, with three identifying levels of accompaniment. Non-negotiated companion presence at the clinic was associated with influential and expert companions who significantly moderated the content, direction and flow of information exchange, using the constructs of companion control, companion agenda and companion as expert. Persuasive influences further shaped non-negotiated accompaniment and were identified as demographic characteristics and relationship alliances. Patient and professional perspective regarding companion accompaniment was shown to be discordant. Conclusions: The level of negotiated companion presence at lung cancer clinics has direct implications for clinical care. There needs to be greater understanding among professionals of ways in which information exchange can be influenced by companions.