The development and the utility of high-tech medical equipments are increasing relative to the health expenditure growth. These high-tech equipments do not necessary benefit the quality of patient care but increase the service utilization for hospitals. This study aims to describe the difference of equipments distribution between academic medical centers and metropolitan hospitals and to examine the association between the change of the kinds, number, and utility of high-tech medical equipments and the health service utilization. Two databases were used in this study. First, a secondary data from the annual hospital survey published in 2003 and 2004 by Taiwan Hospital Association was used. The data contained information on 8 health service volumes, kinds, number and utility of 17 kinds of high-tech medical equipments, 4 hospital characteristics, and 3 kinds of staff ratio. Second, Statistical Yearbook of Department of Social Affairs, Ministry of Interior provided data on Tthe percentage of 65+ years old population in every location. The 8 kinds of health service volumes varience were designed as dependent variables and the 3 independent variables were separately change of kinds, number and utility of high-tech medical equipments. There were 59 samples, 8 academic medical centers and 51 metropolitan hospitals, included. The t-test showed differences between academic medical centers and metropolitan hospitals in change of kinds, number, utility of high-tech medical equipments and health service volumes varience. Person correlation presented how these variables correlated to each other. Regression analyses predicted the health service utilization from those variables. Generally speaking, the academic medical centers only had significant higher varience of average daily emergency roomvisits¡]t = 3.59, p = 0.01¡^than metropolitan hospitals did but there was no significant difference in 3 independent variables. Besides, correlation among medical equipments, health service utilization and themselves shows that the change of total high-tech medical equipment kinds was significant positive correlated with the change of total number of high-tech medical equipments¡]r = 0.44¡^; the change of total number of high-tech medical equipment was significant positive correlated with average daily emergency roomvisits varience¡]r = 0.28¡^and average daily physical examination of outpatient department visits variance¡]r = 0.30¡^; the average utility of high-tech medical equipment was significant positive correlated with average daily outpatient department visits varience¡]r = 0.27¡^. However, the 3 independent variables have no overall significant effect on change of health service utilization. Based on the above findings, although literature indicated that the kinds and number of high-tech medical equipments somehow might stimulate the demand for health service, we did not find the same results. It could be concluded that hospitals¡¦ purchasing of equipment do not impose a significant impact on raising the medical service utilization. Thus, acquisition of high-tech medical equipment might make a hospital a technological leader or give the public a more professional image whether it can help a hospital raise the service quantity is still left to its management.

Western governments face increasing demands to achieve both cost efficiency and responsiveness in their public services leading to radical and challenging transformations. Following the imposition of New Public Management (NPM) approaches within England, it is argued that similar elements of NPM can be also seen within Scottish healthcare, despite policy divergences following devolution. This thesis considers the influence of NPM on Scottish hospital frontline nursing staff in their work. It explores the ways in which managerial practices (specifically professional management; discipline & parsimony; standard setting & performance measurement; and consumerism) have shaped the working relationships, interactions, and knowledge-exchange between managers, staff and patients and the ability of staff to carry out nursing duties within an acute hospital setting. The study is a qualitative interpretivist study grounded in the methodology of adaptive theory and draws upon the works of Lipsky (1980) in order to explore how the front-line nurses cope with and resist the demands of the workplace. Based on thirty-one qualitative interviews with front-line nursing staff in an inner city hospital in Scotland, this thesis presents the findings resulting from nurses’ views of management, finances, policies, targets, audits and consumerism. The findings show that these nurses believe there has been a proliferation of targets, audits and policies, an increasing emphasis on cost efficiency and effectiveness, a drive for professional management and a greater focus on consumerism in NHS Scotland. These are all closely linked to the ethos of NPM. From the findings it can be seen that many elements influence the working relationships of the frontline hospital nursing staff. The study suggests that the main reason for conflict between managers and nursing staff is due to their differing foci. Managers are seen to concentrate on issues of targets, audits and budgets with little thought given to the impact these decisions will have on patient care or nurses’ working conditions. Furthermore the findings highlight high levels of micro-management, self-surveillance, control and the regulation of the frontline nursing staff which has led to tensions both between nursing staff and managers, but also with patients and the public. Finally, although there has supposedly been policy divergence between Scotland and England, this thesis has identified many similarities between Scottish and English polices and NPM approaches continues to influence the working relationships of front-line nursing staff within this study despite the rhetoric that Scotland has moved away from such practices.

I Sverige finns idag cirka 7000 barn och ungdomar med den kroniska sjukdomen diabetes. Ungdomar med diabetes typ 1 har ibland tendens att experimentera och ta risker genom att testa gränser för att utveckla sin kunskap. Risktagandet vid en kronisk sjukdom kan innebära medicinska konsekvenser för ungdomarna. En god vård är därför av betydande vikt. En systematisk litteraturstudie med deduktiv ansats genomfördes där syftet var att beskriva skolsköterskans stödjande insatser ungdomar med diabetes typ 1, utifrån Orems teori omstödjande och undervisande omvårdnadssystem. De vetenskapliga artiklarna eftersöks i databaserna Cinahl och Pubmed och sammanlagt hittas 16 artiklar som svarade mot syftet. Databearbetningen utfördes i form av temaanalys. Resultatet visade fyra kategorier av stödjande insatser som ungdomar med diabetes typ 1 är i behov av från skolsköterskan. Utifrån Orems teori om stödjande och undervisande omvårdnadssystem delas de in i: stöd – fysiskt och psykiskt, vägledning, undervisning och skapa en utvecklande miljö. Det fysiska stödet bestod av att ha en fysiskt närvarande skolsköterska som befann sig på plats och gav stöd åt ungdomarna när diabetesrelaterade problem uppkom. Det psykiska stödet bestod av att ha en god lyssnare som en som förstod ungdomarnas livssituation och deras känslor. Det vägledande stödet bestod i att ha en skriftlig vårdplan för att kunna hantera ungdomarnas diabetes i skolan. Stöd i form av undervisning till ungdomarna med diabetes, lärarna och övrig skolpersonal ansågs viktigt. För att ungdomar med diabetes ska kunna hantera sin sjukdom och egenvård krävdes en anpassad miljö. I en stödjande miljö fanns behov, tid och tillgänglighet av mat. Det var viktigt för att fler personal på skolan skulle ha kunskap och handlingsberedskap vid eventuella akuta situationer som kunde uppstå. Kunskapen som framkommit är viktig i skolsköterskans kliniska arbete, för att kunna ge ungdomar med diabetes typ 1 en trygg tillvaro under sin skoltid. Vidare kvalitativ forskning behövs för att förbättra skolsköterskans stödjande insatser till ungdomar med kronisk sjukdom. Metoder för att skapa en anpassad och säker miljö för ungdomar med kroniska sjukdomar behöver utarbetas. / In Sweden there are currently 7000 children and young people with the chronic disease diabetes. Young people with type 1 diabetes have sometimes tended to experiment and take risks by testing limits to develop their knowledge. Risk-taking in a chronic disease may involve medical consequences for young people. A good health care is therefore of considerable importance. A systematic literature search with a deductive approach carried out where the purpose was to describe the school nurse support to young people with diabetes type1, based on Orem´s theory of supportive and educational care system. The research articles were searched for in database Cinahl and Pubmed and 16 articles were found who answered the purpose. Dataprocessing was carried out in the form of thematic analysis. The result showed 4 categories of support that young people with diabetes type 1 is in need of. Based on Orems theory of supportive and educational caresystem divided into: support -physically and mentally, guidance, education and create a developed environment. The physical support consisted of having a present school nurse who was situated at school and gave support to young people with diabetes related problems when they needed help. The mental support consisted of having a good listener who understood young people's life situation and feelings. The guidance support consisted in having a written care plan for young people to be able to manage diabetes in school. Educational support for young people with diabetes their teachers and other school staff was considered important. Young people with diabetes should be able to manage their disease and care required a developed environment. A supportive environment was necessary also time and availability of food. It was important that more staff at the school would have knowledge and preparedness in the event of any emergency situations that could arise. The knowledge that was found is important in a school nurse clinical work, to be able to give adolescents with diabetes type 1 safe environment during school time. Further qualitative research is needed to improve the school nurse´s supportive service for young people with chronic illness. Methods to create a customized and secure environment for young people with chronic illnesses need to be developed.

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The overall aim of this thesis was to provide better understanding of the underlying factors related to health maintenance in very old people, with a focus on medical conditions, functional outcome and nutritional status. Data were gathered from the ELSA 85 project (Elderly in Linköping Screening Assessment). The ELSA 85 project was started in 2007 with a population-based survey of 85-year-old individuals (n = 650) residing in Linköping municipality, Sweden. During the study period from 2007 to 2010, we conducted surveys by postal questionnaire, home visits, geriatric clinic visits, and reviews of electronic medical records as well as the database of health service consumption. A series of cross-sectional analyses were performed on multimorbidity, health service consumption, activities of daily living (ADLs), physical functioning and nutritional status. Of 650 eligible individuals, 496 (78% of those alive) completed the questionnaire (Paper I). Despite the prevalence of multimorbidity (68%) and frequent use of assistive technology for mobility (40%), the majority managed self-care (85%), usual activities (74%) and had high self-rated health (>60/100, visual analogue scale). Factors associated with in-patient care were an increased number of general practitioner visits, more use of assistive technology, community assistance, multimorbidity (≥2 chronic diseases) and/or heart failure and arrhythmia. Cluster analyses (n = 496, Paper II) revealed five clusters: vascular, cardiopulmonary, cardiac (only for men), somatic–mental (only for men), mental disease (only for women), and three other clusters related to ageing (one for men and two for women). Heart failure in men (odds ratio [OR], 2.4; 95% confidence interval [CI], 1–5.7) and women (OR, 3; 95% CI, 1.3–6.9) as a single morbidity explained more variance than morbidity clusters in models of emergency room visits. Men’s cardiac cluster (OR, 1.6; 95% CI, 1–2.7) and women’s cardiopulmonary cluster (OR, 1.7; 95% CI, 1.2–2.4) were significantly associated with hospitalization. The combination of the cardiopulmonary cluster with the men’s cardiac cluster (OR, 1.6; 95% CI, 1–2.4) and one of the women’s ageing clusters (OR, 0.5; 95% CI, 0.3–0.8) showed interaction effects on hospitalization. In Paper III, overweight (body mass index [BMI], 25–29.9 kg/m2) and obese (BMI, ≥30 kg/m2) individuals (n = 333) perceived more difficulty performing instrumental ADL (IADL) and had more comorbidities than their normal weight counterparts (BMI, 18.5–24.9 kg/m2). After controlling for socio-demographic factors, obese but not overweight individuals were more likely to perceive increased difficulty in performing outdoor activities (OR, 2.1; 95% CI, 1.1–4) and cleaning (OR, 2.2; 95% CI, 1.2–4.2) than their normal weight counterparts. Although obesity was also associated with multimorbidity (OR, 3; 95% CI, 1.2–8), the health service cost of each case of multimorbidity (n = 251) was highest in individuals of normal weight and nearly three times as much as in obese individuals (ratio, 2.9; 95% CI, 1.1–8.1). In Paper IV, 88-year-old obese women (n = 83) had greater absolute waist circumference, fat mass (FM) and fat-free mass (FFM), and lower handgrip strength (HS) corrected for FFM and HS-based ratios (HS/weight (Wt), HS/BMI, HS/FFM and HS/FM) than their normal weight and overweight counterparts. After adjusting for physical activity levels and the number of chronic diseases, the HS-based ratios explained more variance in physical functioning in Short Form-36 (R2, 0.52–0.54) than other single anthropometric or body composition parameters (R2, 0.45–0.51). Waist circumference, HS, and two HS-based ratios (HS/Wt and HS/FFM) were also associated with the number of IADL with no difficulty. In conclusion, the ELSA 85 population showed a fairly positive image of healthy perception, good functional ability as well as low use of health care among the majority of participants. Patterns of cardiac and pulmonary conditions were better associated than any single morbidity with hospitalization. Heart failure as a single morbidity was better associated than multimorbidity patterns with emergency room visits. For 85-year-olds, being obese, as opposed to overweight, was associated with self-reported activity limitations and comorbidities. Overweight elderly living in their own homes in this population had similar well-being to those of normal weight. In the cohort of 88-year-olds, obese women had high waist circumference, but their HS was relatively low in relation to their Wt and FFM. These parameters were better than BMI for predicting physical function and independent daily living. / Att åldras innebär inte bara en utveckling över tid utan också en förändring av människans fysiologi och funktion. Vi har många olika bilder av åldrandet. Ofta överväger de negativa bilderna som betonar sjuklighet och höga samhällskostnader för vård och omsorg. ELSA 85, en förkortning av the Elderly in Linköping Screening Assessment, påbörjades 2007 med avsikt att kartlägga 85-åringars hälsotillstånd och funktion. Syftet med denna avhandling var att fördjupa kunskapen om faktorer med betydelse för bevarande av hälsa hos dessa 85-åringar. Populationsstudien genomfördes via enkätutskick (bl.a. livssituation, livskvalitet), hembesök (bl.a. aktiviteter i dagliga livet (ADL), kognitiva funktioner) och mottagningsbesök (bl.a. nutritionsstatus, rörelseförmåga, kroppslig undersökning, blodprover, läkemedel) under perioden mars 2007 till mars 2008. Vi kartlade även deltagarnas sjukvårdsbesök samt sjukvårdskostnader. Tre år senare, när individerna var 88 år, analyserades även kroppssammansättningen hos delar av populationen. Totalt 496 Linköpingsbor födda 1922, deltog i studien. Andelen som svarade på enkäten var 78 % av alla då levande 85-åringar. Resultaten visar att majoriteten av 85-åringarna klarade att sköta sin hygien (85%) samt huvudsakliga aktiviteter (74%). Sextio procent skattade sin hälsorelaterade livskvalitet som hög trots förekomst av flera kroniska sjukdomar och frekvent användning av hjälpmedel för att förbättra rörligheten. Oberoende riskfaktorer för slutenvård var multipla besök hos distriktsläkare, användande av flera hjälpmedel, förekomst av minst två sjukdomar eller förekomst av hjärtsvikt och arytmi. Multimorbiditet (förekomst av minst två kroniska sjukdomar) var vanligt hos 85-åringarna (68%). Olika kombinationer av sjukdomar hade varierande betydelse för behovet av sjukvård. I clusteranalys, där man försöker gruppera diagnoser med hög sannolikhet att förekomma hos en enskild individ, fann vi några cluster som var starkare relaterade till inläggning i slutenvård än andra. Clustren såg dessutom olika ut mellan män och kvinnor. För män var t.ex. kardiella och för kvinnor t.ex. hjärt-lung-cluster starkare relaterade till slutenvård än enskilda diagnoser. Personer med fetma (body mass index (BMI) ≥30 kg/m2) hade mer problem med rörlighet och instrumentell ADL (IADL) jämfört med de med normal- eller övervikt. Trots ett klart samband mellan fetma och multimorbiditet hade de normalviktiga individerna nästan tre gånger så höga hälso-sjukvårds kostnader som personer med fetma. Bland 88-åriga kvinnor, hade personer med fetma högre bukomfång, mer fettmassa (FM) och mer fettfri massa (FFM) men lägre handstyrka (HS) än de normal- eller överviktiga. Relativ HS, handstyrka i form av kvoter (HS/Vikt, HS/BMI, HS/FFM and HS/FM) hade starkare samband med fysisk funktion (Short Form-36, SF-36PF) än andra enskilda parametrar. Två enskilda parametrar (bukomfång och HS) samt HS/Vikt och HS/FFM var associerade med antal aktiviteter utan svårighet i IADL. Sammanfattningsvis är 85-åringarna inte så skröpliga som de ofta beskrivs. Studien ELSA 85 visar en övervägande positiv bild med bevarad hälsa och funktion för en övervägande del av populationen. De flesta 85-åringarna klarar sig ganska bra trots förekomst av flera sjukdomar. Vissa mönster av multimorbiditet med hjärt- och lungsjukdomar är mer relaterade till slutenvård medan hjärtsvikt hade hög risk för akutmottagningsbesök. Därför är det viktigt att beakta en komplexitet av sjukdomar, inte bara enskilda diagnoser eller antalet diagnoser, i planeringen av den framtida vården. Personer med normal- eller övervikt klarar sin funktion bättre och lever mer självständigt än de som lider av fetma. Den betydande andelen feta med begränsad rörlighet och funktion bland äldre kan komma att påverka behovet av tyngre omsorgsinsatser för den gruppen och är således en varningssignal inför framtiden. / 【目的】      通过研究高龄老人的医疗情况，躯体功能和营养状态，提高对高龄老人健康维护相关因素的理解。 【方法】      ELSA 85 项目（林雪平老年人普查，Elderly in Linköping Screening Assessment）是一个以瑞典林雪平城市中85岁高龄老人（1922年出生， n = 650）为研究对象的人群研究。(1) 2007/03–2008/03：通过邮寄问卷，家庭访问及门诊检查的三个步骤， 我们搜集的数据包括：个人和家庭的背景信息（居住情况，既往的学历和工作程度，健康相关的生活质量EQ-5D等），身体机能（日常生活活动能力ADL评定，移动性测试等）和营养状态（人体测量等）。我们同时还阅览了所有注册的电子病历和每位老年人的年卫生费用。（2） 2010/06–2010/10: 在3年后的随访中，我们对所有88岁的女性老年人增加了人体组成测定和SF-36健康调查量表之生理功能子量表（SF-36PF）的评估。 ELSA 85 项目还包括了其他医学检查项目以及为期一年的随访（2008–2009）, 但这些数据统计并未列入本论文中。 【结果】      论文1：共496人（参与率78％）回寄并参与了问卷调查。总体而言，虽然慢性多病以及日常生活中频繁使用辅助身体移动的器具在85岁高龄老人中非常普遍，多数老年人仍然能够完成个人卫生自理和常规日常活动。他们在健康相关评价问卷中的评估自身健康状态多为良好 (EQ-5D评估）。与住院相关的风险因素包括：全科医生的年就诊次数，有共患疾病（存在两种或两种以上的慢性病征），或者是心力衰竭和心律失常两个单病种。 论文 2：运用聚类分析和性别分层对共患疾病归类，生成男女组各五个集群：血管性类疾病集群，心肺疾病集群，心源性疾病集群（只存于男性组内），躯体-精神心理疾病集群（只存于男性组内），精神心理性疾病集群（只存于女性组内），以及三个和老化过程有关的集群（男性组内1组，女性组内2组）。心力衰竭 （男性组内的比值比 OR = 2.4，95% 的可信区间CI = 1–5.7；女性组内 OR = 3，95% CI = 1.3–6.9) 作为单一病种在预测急诊就诊的模型中比任一共患疾病集群都能解释更多的变量值。男性组内的心源性疾病集群 （OR = 1.6，95% CI = 1–2.7） 和女性组内的心肺疾病集群（OR = 1.7，95% CI = 1.2–2.4）与预测是否住院显著有关。在住院模型中， 心肺疾病集群与男性的心源性疾病集群（OR = 1.6，95% CI = 1–2.4）， 或与女性组内的老化相关集群（OR = 0.5，95% CI = 0.3–0.8）具有显著的交互作用。 论文3：超重（体重指数 BMI：25–29.9 kg/m2）和肥胖（BMI ≥30 kg/m2）者在工具性日常生活活动评定（IADL）比正常体重者（BMI: 18.5–24.9 kg/m2）有更多的困难，再者也比正常体重者有更高伴发疾病的风险。但是在控制了混杂变量（社会人口因素）后，对照正常体重组，只有肥胖者而不是超重者的IADL（户外活动：OR= 2.1，95% CI=1.1–4；居室清洁：OR= 2.2，95% CI= 1.2–4.2）存在更大的困难。虽然肥胖与共患疾病相关（OR= 3，95% CI=1.2–8），有共患疾病的正常体重者的卫生服务消费却是共患疾病的肥胖者的近三倍（ratio= 2.9，95% CI= 1.1–8.1）。 论文 4：88岁女性肥胖组相比正常体重和超重组而言，其腰围值、脂肪群值和祛脂肪群值较大。肥胖者的绝对握力值在校正祛脂肪群后以及握力比值（握力/体重，握力/BMI，握力/祛脂肪群，等等）都较其他两组低。在控制个体的体力活动程度和慢性疾病数量后，握力比值对生理功能（SF-36PF）的解释度（R2：0.52–0.54）高于任何单一人体测量指标或人体组成成分的测定值（R2：0.45–0.51）。腰围值、绝对握力值及握力比值（握力/体重和握力/祛脂肪群）与IADL中无困难的活动项目数显著相关。 【结论】      ELSA 85 人群研究显示了一个相对健康的，个体功能良好的，且使用卫生服务较低的高龄老年群体。心源性和肺部疾病的共患与住院风险相关，而心力衰竭作为单一病种与急诊就诊有显著相关。对85岁高龄老人而言，肥胖（但不是超重）与个体的活动限制和伴发疾病有关。居住于自己住所内的超重高龄老人，其健康水平与正常体重者相近。在88岁女性高龄老人中，肥胖者有较大的腰围值和较低的握力比值（握力/体重和握力值/祛脂肪群）。这些指标比体重指数更好地反映了生理功能及高龄老人的日常独立生活能力。 / Elderly in Linköping Screening Assessment, ELSA 85

Pagrindimas: Lietuvoje vykstant sveikatos priežiūros reformai, didelio visuomenės ir mokslininkų dėmesio sulaukia įvairūs sveikatos priežiūros organizavimo, paslaugų kokybės aspektai, kurie dažniausiai vertinami vykdant pacientų apklausas, tačiau svarbus yra ir medicinos personalo nuomonės tyrimas šiais klausimais dėl realaus požiūrio į tam tikras sistemos funkcionavimo galimybes. Darbo tikslas: Išsiaiškinti kaip Vilniaus miesto medikai vertina dabartinę sveikatos priežiūrą ir paslaugas, analizuojant tam tikrus sveikatos priežiūros organizacinius aspektus, atsižvelgiant į medikų specializaciją, darbovietę ir darbo stažą. Metodika: Anoniminės anketinės apklausos būdu apklausti 297 respondentai (gydytojai ir slaugytojai) dirbantys pirminės sveikatos priežiūros centruose, stacionaruose ir privačiose įstaigose. Tyrimo tikslui ir uždaviniams pasiekti naudotas kiekybinis momentinis sociologinis tyrimas. Anketa sudaryta remiantis viešosios nuomonės ir rinkos tyrimų bendrovės ,,Spinter tyrimai“ 2004 m. atlikto tyrimo, kurio metu siekta išsiaiškinti, kaip medikai vetina sveikatos priežiūros įstaigų restruktūrizaciją ir kt. problemas, klausimynu. Duomenų apdorojimas ir analizė atlikta naudojantis statistiniu paketu SPSS. Skirtumai tarp atitinkamų rodiklių laikomi patikimais, kai klaidos tikimybė p ≤ 0,05. Šią reikšmę programa ieškant ryšio tarp kintamųjų, suskaičiuoja automatiškai. χ2 statistinis kriterijus taikomas tikrinant kokybinių požymių ryšio hipotezes. Taip pat... [toliau žr. visą tekstą] / Background: While the Lithuanian health service reform is being implemented, major attention of the public and of the scienctists is drawn to different health service organization, service quality aspects, which often are being evaluated by implementing polls of the patients. However also is important poll of the medical personnel about these questions regarding the real opinion of particular functional abilities of the system. Purpose of the work: to find out how medics of the Vilnius city treat current health supervision and the services by analyzing particular organizational aspect of the health service, considering specialization, workplace and probation of the medics. Methodology: in the way of the anonymous questionnaire 297 respondents have been questioned (medic doctors and caregivers), working at primary health service centres, stationeries and private institutions. For reaching the purpose and the goal of this survey quantitative instantaneous sociological survey was used. The questionnaire was compounded using questionnaire of public opinion and market survey company ,,Spinter tyrimai“ of year 2004 intended to find out how the medics treat restructurizing of the health service institutions and other problems. Processing of data and analysis was completed using statistical packet SPSS. Differences between appropriate rates are treated as reliable when likelihood of mistake is p ≤ 0,05. The programme figures this value automatically when finds connection... [to full text]

Tuberculosis (TB) is a major public health problem in many low- and middle-income countries, including Indonesia. To accelerate TB case detection, and to improve the quality of diagnosis and treatment provided by all providers, the Public-Private Mix for implementing Directly Observed Treatment Short-course (PPM DOTS) was introduced in 2000. However, previous studies on PPM DOTS have focused on private practitioners and there has been a scarcity of research on PPM DOTS in the hospital setting. This dissertation aims to capture the potential of the PPM DOTS strategy, and identify the barriers to its implementation in hospitals in Indonesia. This dissertation is based on four separate but interrelated studies: 1. A costeffectiveness analysis, comparing incremental cost per additional number of TB cases successfully treated under three strategies of PPM DOTS in four provinces. 2. An evaluation of the access to TB services by a cross-sectional study among 62 hospitals, by estimating the proportion of TB cases receiving standardised diagnosis and treatment according to the DOTS strategy. The data were analysed using poststratification analysis. 3. The quality aspect was explored in a multiple-case study, including eight selected hospitals. The data were analysed using cross-case analysis. 4. The process of partnership was explored through a qualitative study. In-depth interviews were conducted with 33 informants, who were actors involved in PPM DOTS in hospitals in Yogyakarta province. Content analysis was applied to the qualitative data. PPM DOTS in hospitals was shown to be a cost-effective intervention in this particular context. However, the quality of the implementation was commonly suboptimal. In addition, a substantial number of TB cases did not get standardised diagnosis and treatment as per the DOTS strategy. The process of creating partnership among hospitals and National TB Programme was shown to be complex and dynamic. Process factors, such as commitment to collaboration and interaction and trust among the actors, were shown to be important. The rapid scaling-up of PPM DOTS in hospitals at the national level in Indonesia should be revisited. Indeed, considering the importance of hospitals in TB control, the implementation should be continued and expanded. However, more attention needs to be given to process, context and governance.

The purpose of this study was to ascertain the current status of healthcare delivery on American Indian reservations. In particular, the study sought to determine if the Indian Health Service was actually meeting its goals in delivering healthcare to American Indians, and if not, were there alternatives to public medicine for healthcare? The Indian Health Service has not met its own goals in delivering healthcare, and private medicine in the form of private practicing physicians and other medical personnel have filled the void left by the Indian Health Service. The study also discusses the possibility of private medicine being the only realistic alternative in the future for Indian healthcare delivery.

The purpose of the study was to examine the career paths of women managers in the service area of higher education and women managers in the hospital industry service area. A secondary purpose was to identify factors that influence the advancement of women managers in those areas.This research outlined the career paths of women managers in the service industry in educational and in non-educational organizations. It identified encouragements and impediments to the promotion of qualified women in the areas of management within the service industry.Findings from the study show that there is no significant difference between the career paths of women managers in higher education and women managers in the hospital industry. There are no differences between the education, training, length of tenure, motivation for employment, mentoring, emotional support or career impediments of women managers in service area of both higher education and the hospital industry.The following conclusions were drawn from the study:1. Women in the service field of higher education and the hospital industry face very similar histories.2. Entry into the profession can be found through a variety of sources and it is through the investigation of these sources that a woman will find entry into this field.3. Very few women reported career impediments and many reported having the emotional support of family and friends.4. The true reason why the experienced, educated, trained woman manager has not progressed up the career and salary ladder until the past several years has not been found. Both groups are being motivated by opportunity for advancement and salary.5. Most women managers in the service have been the determinants of their own career advancement. The women desiring to become managers in the service field must realize that the future of her career and its advancement lies with her own decisions and her own initiative. The woman manager must be responsible for her own future. / Department of Educational Leadership

Official-language minorities in Canada may face specific issues in accessing health care services that can lead to negative consequences on their health, utilization of health care services and satisfaction with the health care system. A secondary data analysis of the 2006 Survey on the Vitality of Official-Language Minorities revealed significant differences between the Anglophone minority (n=5,161) and the Francophone minority (n=12,029) with regards to general health, and access to and use of health care services. Important predictors of these outcomes included age, education level, household income, marital status and place of residence (urban/rural). Access to health care services in the minority language was associated with self-perceived health in the Anglophone minority only. Health policy recommendations elaborated in light of the findings include working on both the supply and the demand of health care services offered in the two official languages, while taking into consideration important contextual differences between regions.