Zugl.: München, Universiẗat, Diss., 2008.

Diplomarbeit Hochschule für Angewandte Psychologie Zürich, 2005.

Infectious disease management system area is considered as an emerging field of modern healthcare in the Gulf region. Significant technical and clinical progress and advanced technologies can be utilized to enhance the performance and ubiquity of such systems. Effective infectious disease management (IDM) can be achieved by analysing the disease management issues from the perspectives of healthcare personnel and patients. Hence, it is necessary to identify the needs and requirements of both healthcare personnel and patients for managing the infectious disease. The basic idea behind the proposed mobile IDM system in this thesis is to improve the healthcare processes in managing infectious diseases more effectively. For this purpose, internet and mobile technologies are integrated with social networking, mapping and IDM applications to improve the processes efficiency. Hence, the patients submit their health related data through their devices remotely using our application to our system database (so-called SAIF). The main objective of this PhD project was the design and development of a novel web based architecture of next-generation infectious disease management system embedding the concept of social networking tailored for Saudi patients. Following a detailed literature review which identifies the current status and potential impact of using infectious diseases management system in KSA, this thesis conducts a feasibility user perspective study for identifying the needs and the requirements of healthcare personnel and the patients for managing infectious diseases. Moreover, this thesis proposes a design and development of a novel architecture of next-generation web based infectious disease management system tailored for Saudi patients (i.e., called SAIF – infectious diseases management framework for Saudi Arabia). Further, this thesis introduces a usability study for the SAIF system to validate the acceptability of using mobile technologies amongst infected patient in KSA and Gulf region. The preliminary results of the study indicated general acceptance of the patients in using the system with higher usability rating in high affected patients. In general, the study concluded that the concept of SAIF system is considered acceptable tool in particularly with infected patients.

The topic of this diploma thesis is ?The Nurse?s Contribution to the Management of Pain Treatment of Patients with a Malignant Disease?. The first objective is to ascertain whether nurses know the specifics of care of patients suffering from a cancer pain. The second objective is to ascertain whether nurses use an analogue score to assess the cancer pain. The third objective is to ascertain whether nurses document the pain intensity. The fourth objective is to ascertain whether nurses use non-pharmacological techniques to relieve cancer pains. The fifth objective is to ascertain whether nurses know the strategy of the WHO?s pain relief ladder. The research was conducted in the form of questioning while using the technique of anonymous structured questionnaires completed by the research set consisting of nurses in selected clinical wards with a high probability of occurrence of patients with an oncologic diagnosis. The total of 360 questionnaires was distributed, of which 198 completed questionnaires were returned. 105 questionnaires (53 %) came from the regional hospital in České Budějovice, 51 (26 %) from the St. Anne?s University Hospital in Brno and 42 (21 %) from the district hospital in Tábor. The research took place in March 2012. The results were assessed under the criteria preset by the author of the thesis. Hypothesis 1: Nurses are able to provide specific nursing care to patients suffering from a cancer pain, was confirmed. Hypothesis 2: Nurses assess the pain under the available analogue scores, was confirmed. Hypothesis 3: Nurses document the pain intensity, was disconfirmed. Hypothesis 4: Nurses use non-pharmacological techniques, especially physical ones, was confirmed. Hypothesis 5: Nurses know the strategy of the WHO?s pain relief ladder, was confirmed. In connection with the addressed issue, an educational leaflet about pain monitoring was drawn up for non-medical healthcare workers. This material describes the most frequently used methods of pain assessment and will serve as an overview of individual procedures including their specifics and application possibilities. The diploma thesis may serve for extending the knowledge of nurses in the field of pain treatment management.

The Asian soybean rust (ASR), caused by the fungus Phakopsora pachyrhizi, may promote significant damages in soybean crop. The disease is mainly controlled by sequential applications of fungicides following a calendarbased system. However, this practice disregards the weather favorability to recommend spraying to ASR control. The proposition of fungicide schemes to make the ASR control more efficient can be reached by the use of diseasewarning systems. Thus, the current study aimed to assess the performance of different disease-warning systems to determine better fungicide spraying schemes for the ASR control. The experiment was conducted in Piracicaba, SP, Ponta Grossa, PR, Campo Verde and Pedra Preta, MT, Brazil, over the 2014/2015 and 2015/2016 soybean growing seasons. The treatments were: Unsprayed check treatment; Calendar-based sprays in a 14-day interval from R1 stage (CALEND); Disease warning system based on rainfall data with less conservative threshold (PREC_1 - 80% severity cut-off); and more conservative threshold (PREC_2 - 50% severity cut-off); Disease warning system based on air temperature and leaf wetness duration with less conservative threshold (TLWD_1 - 6 lesions cm-2) and more conservative threshold (TLWD_2 - 9 lesions cm-2). The results confirmed that weather conditions in the field trials were favorable to ASR progress. Among the weather elements correlated to severity leaf wetness duration, cumulative rainfall and air temperature during leaf wetness duration influenced positively the ASR. By testing warning systems to control ASR it ones was evidenced that those based on rainfall data presented highest performances. PREC_2 showed a high performance considering all sowing dates; whereas, PREC_1 was better treatment during sowing dates between October and November. The TLWD diseasewarning systems, with both thresholds, overestimated the ASR, recommending more sprays compared to other treatments. Empirical models were efficient for estimation of LWD in Ponta Grossa, Campo Verde and Pedra Preta. High performances in estimating LWD were identified by using number of hours with relative humidity above 90% (NHRH>=90%), being these able to be use as input in the disease-warning systems (RMSE less than 2.0 h). The profitability of use rainfall based warning systems was conditioned by variations in the rainfalls regimes at the studied sites. PREC_1 and PREC_2 presented the highest relative yield gains in relation to CALEND during the period with the highest rainfalls in Piracicaba, Campo Verde and Pedra Preta. However, in Ponta Grossa, the rainfall based warning systems were not effective to control ASR. / A ferrugem asiática da soja (ASR), causada pelo fungo Phakopsora pachyrhizi, pode ocasionar elevados prejuízos às lavouras de soja. O controle da doença é realizado por meio de aplicações sequenciais de fungicidas em sistema calendarizado. Este, por sua vez, não considera a favorabilidade climática para recomendar pulverizações. A proposição de esquemas de pulverização mais eficientes pode ser obtida pelo uso de sistemas de alerta fitossanitário. Assim, objetivou-se avaliar o desempenho de diferentes sistemas de alerta fitossanitário, visando à determinação de esquemas de pulverização de defensivos químicos para o controle de ASR nos estados de São Paulo, Paraná e Mato Grosso, Brasil. O experimento foi conduzido em Piracicaba, SP, Ponta Grossa, PR, Campo Verde e Pedra Preta, MT, Brasil ao longo das safras de 2014/2015 e 2015/2016. Os tratamentos foram: Testemunha (sem aplicação); Aplicações calendarizadas a partir de R1, espaçadas em 14 dias (CALEND); Sistema de alerta baseado em dados de chuva limiar menos conservador (PREC_1 - 80% de severidade) e mais conservador (PREC_2 - 50% de severidade); Sistema de alerta baseado em dados de temperatura do ar e a duração do período de molhamento foliar com limiar menos conservador (TDPM_1 - 6 lesões cm2) e com limiar menos conservador (TDPM_2 - 9 lesões cm2). Os resultados obtidos confirmaram que as condições meteorológicas nas localidades estudadas foram favoráveis para o progresso da ASR. Verificou-se que a duração do período de molhamento foliar (DPM), temperatura do ar durante o molhamento e chuva acumulada influenciaram positivamente a ASR. Ao testar os sistemas de alerta no controle de ASR verificou-se que aqueles baseados em dados de chuva apresentaram os melhores desempenhos. O PREC_2 apresentou melhor desempenho em análise geral considerando todas as épocas de semeadura, ao passo que PREC_1 foi melhor quando em semeadura de outubro a novembro. Os sistemas TDPM, com ambos os limiares de ação, superestimaram os valores de ASR acusando um número maior de pulverizações comparada aos demais tratamentos. Modelos empíricos mostraram ser eficientes na estimação da DPM em Ponta Grossa, Campo Verde e Pedra Preta. Estimações pelo método de número de horas com umidade relativa acima de 90% (NHUR>=90%) apresentaram RMSE menor que 2,0 h viabilizando o uso da DPM estimada como variável de entrada de sistema de alerta. A rentabilidade do uso dos sistemas de alerta baseado em dados de chuva foi condicionada às variações no regime dessa variável nas localidades estudadas. PREC_1 e PREC_2 apresentaram maior ganho de produtividade em relação à CALEND durante o período com maior índice pluviométrico nas localidades de Piracicaba, Campo Verde e Pedra Preta. Em contrapartida os sistemas de alerta não foram efetivos no controle de ASR em Ponta Grossa.

Telehealth has great potential for providing timely and comprehensive care to community-dwelling older adults while reducing their barriers to healthcare access. The purpose of this study is to understand how older adults with chronic diseases access healthcare services in their community and evaluate the impact of telehealth on access to care from a self-reported survey conducted in British Columbia. About a quarter of older adult participants reported barriers to healthcare access in their community. Participants frequently reported financial barriers to healthcare access regardless of telehealth use. In addition, telehealth users more frequently reported a lack of necessary healthcare services in their community and physical barriers to access to care. Although the findings did not demonstrate a significant difference in access to care between telehealth users and nonusers, telehealth was identified as a meaningful care delivery tool for older adults with barriers to healthcare access. Further efforts are needed to implement a valid tool for ongoing evaluation and optimization of telehealth and integrate telehealth into clinical and community programs to reduce physical and financial barriers to healthcare access for community-dwelling older adults with chronic illnesses. / Graduate

Full service family physicians in British Columbia (BC) are claiming financial incentives in return for providing enhanced care for patients with chronic diseases. These same physicians are also being actively encouraged to adopt electronic medical record systems (EMRs) with an expectation that their adoption will, among other things, aid in improved chronic disease management (CDM). Indeed, both incentives and clinical information systems have been demonstrated in the literature to be crucial components in effective CDM programs. However, within BC little evidence is available that demonstrates whether EMR adoption is in fact associated with improved provision of CDM services. Furthermore, it is not well understood how the CDM incentive program affects a family practice’s adoption of CDM-related EMR functionality. Through a mixed methods study the relationship between EMR adoption and CDM incentives in a small family practice is explored. Additionally, an audit and feedback intervention is used to test the hypothesis that both incentive use and EMR adoption can simultaneously be improved. Results of the study suggest that the presence of an EMR may not guarantee improvements in delivery of incentivized CDM services; that the incentive program has limits in its ability to promote adoption of CDM-related EMR features; and, that a program of audit and feedback may promote improvements in aspects of EMR adoption and incentive utilization. / Graduate / 0723 / 0769

Cardiovascular disease is the number one cause of death for women in the United States. Acute myocardial infarction (AMI) carries a more negative prognosis for women than men. Women with AMI have both increased mortality and disability. All researchers who have documented a difference in delay times between men and women note that women delay longer in seeking treatment. In the case of an evolving AMI, women who delay in seeking medical attention will often place themselves outside the limits of reperfusion therapies such as angioplasty and thrombolysis, thereby increasing their risk of an out-of-hospital sudden cardiac death. Several investigators have reported that reasons for delay to treatment may include the presence or absence of “somatic awareness”, that is, how a woman perceives body activity and physiological functioning. The inability of women to disregard social roles and place primacy of caring over their own health issues may limit them from seeking formal care. Social roles and obligations in a women’s life are often influenced by everyday, ordinary happenings which may have a negative impact on decision making. These everyday, ordinary happenings have been defined as “daily hassles”. The Leventhal self-regulatory model of illness behavior, which has been used to study treatment seeking behavior in response to symptoms, provides a coherent framework for interpreting the problem of delayed treatment of myocardial infarction. The Leventhal model proposes that the patients’ belief about their health is structured in a hierarchical fashion and that these structures are based on previous illness experiences and information presented in the social environment. Utilizing a descriptive design, this study examined the relationship between somatic awareness and daily hassles and how these variables influenced a women’s treatment seeking behavior in AMI. The Modified Somatic Perception Questionnaire (MSPQ) was used to measure somatic awareness; and daily hassles were measured through the Daily Hassles and Uplift Scale (DHUS). The questionnaires were administered at least 24 hours post admission to women with AMI. Though there were no significant relationships found between somatic awareness, daily hassles and time to treatment for AMI, the study revealed other pertinent findings. A significant relationship was found between daily hassles and age; revealing that younger participants revealed a higher daily hassle score. Also, a significant relationship was found between total MSPQ and prior cardiac events; indicating infrequent occurrence of intense symptoms experienced by women with a positive cardiac history. Though it is unknown what impact this new knowledge will have on treatment of women with AMI, these findings hold promise for clarifying these areas of research. Keywords: somatic awareness, daily hassles, treatment seeking behavior, women with acute myocardial infarction (AMI).

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