<p><strong>Introduction</strong></p> <p>Despite increasing global interest in regional palliative care networks (PCN) to integrate care, little explicit direction exists to guide their evaluation. The first step of this research was to develop a comprehensive conceptual framework using a systems approach for evaluating integrated palliative care. This framework was then used to guide a rigorous examination of a selected PCN.</p> <p><strong>Methods</strong></p> <p>The conceptual framework was derived from the empirical literature, incorporating principal features of network integration. A case study methodology was used to assess structure (administration) and process (provider) levels in the framework through document review, a PCN executive interview, and surveys with organizational administrators and health professionals who provide palliative care in the community catchment of the PCN.</p> <p><strong>Results</strong></p> <p>Key features to efficient palliative care delivery are currently lacking across this PCN area. Still, the 20 responding administrators (90% response rate) largely viewed Network accomplishments positively and the resulting partnerships as beneficial and collaborative. Additional efforts were seen as required in ensuring palliative care patient identification, reducing silos between organizations, and greater by-in from regional authorities. Relative to processes, the 86 health care providers (85% response rate) reported valuing collaboration and reflected positively on many of the framework elements measured. Insufficiencies were perceived in support for case conferencing and evaluative activities, as well as in informational access.</p> <p><strong> </strong></p> <p><strong>Conclusion</strong></p> <p>This study enabled us to test both the utility of the framework and the capacity of the selected PCN for providing quality, integrated palliative care. This study represents an important initial attempt at examining network-integrated palliative care.</p> / Doctor of Philosophy (PhD)

<p><strong>Purpose</strong></p> <p>Colorectal cancer (CRC) is the fourth most common cancer and the second leading cause of cancer death among Canadians. Little is known about the types of supportive care needs (SCNs) that patients with colon cancer experience during the diagnostic phase or whether these needs are met. To inform the development of population specific healthcare services, a needs assessment of patients with newly diagnosed advanced colon cancer was conducted to identify the types, prevalence, severity, and importance of unmet SCNs, as well as to identify any gaps between patient priority needs and their use of supportive care services.</p> <p><strong>Patients and Methods </strong></p> <p>A descriptive cross-sectional survey was conducted. Over one year, all newly diagnosed patients with colon cancer at the Juravinski Cancer Centre were screened for eligibility. Sixty-two of 80 eligible patients completed a self-report written questionnaire prior to starting treatment (response rate = 77.5%). The questionnaire included the Supportive Care Needs Survey-Short Form, Functional Assessment of Cancer Therapy-Colorectal and Health Service Utilization Questionnaire.</p> <p><strong>Results</strong></p> <p>‘Fears about the cancer spreading’ was the most prevalent unmet SCN (n = 52/62 or 84%). Unmet SCNs experienced by 65% or more of participants related to lack of control about treatment outcomes, the uncertain future, and concerns about family member well-being. Patients also rated these needs as being most severe.</p> <p>The two most severe CRC-specific concerns were related to ‘body appearance’ (Mean = 1.77, SD = 1.37) and ‘bowel control’ (Mean = 2.28, SD = 1.37). The most important or priority unmet needs were related to uncertainty about the future (43.5%), fatigue (24.2%), and information (22.6%). Less than 12% of participants had used existing supportive care services in the community.</p> <p><strong>Conclusion </strong></p> <p>Prevalent and priority unmet needs were related to psychosocial support and information. Recommendations for designing colon cancer-specific services are provided along with strategies to improve patient use of existing resources.</p> <p><strong> </strong></p> / Master of Science (MSc)

My dissertation examines the depression prevalence, symptom patterns and dimension, and mental health service use among Chinese Americans. The purpose of this research is to, 1) provide epidemiological data on the prevalence of depression among Chinese Americans, 2) examine sociocultural impacts on the prevalence and specific symptoms patterns of depression, and 3) generate implications for more culturally-sensitive approaches in psychiatric diagnosis and treatment. I use secondary data from the Collaborative Psychiatric Epidemiology Studies (CPES). The CPES consists of three nationally representative surveys conducted between 2001 and 2003. Each of three substantive chapters attempts to a set of issues, and together they contribute to the literature on generational differences in mental health status and help-seeking behaviors among Chinese Americans. The first substantive chapter examines depression prevalence and correlates among different generations of Chinese Americans, using non-Hispanic whites as a comparison group, using weighted multinomial logistic regression. Results of the study indicate that Chinese Americans in general have a lower risk of depression than do non-Hispanic whites. Moreover, the prevalence and correlates of depression do not show a linear trend of difference from first to second to third-or-higher generation Chinese Americans, and then to non-Hispanic whites; rather, the risk of depression and its associated with social relational factors present distinct patterns for first and second generation Chinese Americans, compared to third-or-higher generation Chinese Americans and non-Hispanic whites. Specifically, friend network and extended family network play different roles in their influence on depression risk for different generations of Chinese Americans. In the Chapter Four, I conduct exploratory factor analysis to examine two subgroups of Chinese Americans, the foreign-born and the US-born, and compare them to the non-Hispanic whites. I also conduct weighted binary logistic regression to examine the patterns of depressive symptoms for Chinese Americans (separate by nativity status) and compare the two groups to non-Hispanic whites. I also examine how demographic characteristics and social factors are related to different dimensions of depressive symptoms for each group. I also find very similar factors structures of DSM-IV depressive symptoms among foreign-born Chinese Americans, US-born Chinese Americans, and non-Hispanic whites. For all three groups, suicidal ideation or attempt is a construct that is distinct from the rest of the symptoms items. The three groups have different social correlates, yet there are only minor differences in the social correlates for each one of the four depression dimensions within each group. Chronic physical condition is the most consistently significant predictor, for the negative affect, somatic symptoms, and cognitive symptoms among the two Chinese groups, and for all four dimensions of depression among non-Hispanic whites. Finally, in Chapter Five, I find significant heterogeneity of exclusive complementary and alternative medicine (CAM) use by race/ethnicity and generational status, as well as English proficiency, gender, age, marital status, education, employment status, having insurance, and having any probably psychiatric disorder. Specifically, first generation Chinese immigrants lag behind second, third-or-higher generation Chinese Americans, and non-Hispanic whites in the likelihood of using exclusive CAM services, as well as any services in general. In addition, this chapter finds that exclusive CAM service use was more popular than the use of only conventional Western medicine or a combination of both, among all Chinese Americans except for the second generations. The findings provide a more nuanced understanding of the pattern of mental health service use among Chinese Americans. / Sociology

No / Purpose The purpose of this paper is to determine those factors perceived by users to influence the successful on-going use of e-commerce systems in business-to-business (B2B) buying and selling transactions through examination of the views of individuals acting in both purchasing and selling roles within the UK National Health Service (NHS) pharmaceutical supply chain. Design/methodology/approach Literature from the fields of operations and supply chain management (SCM) and information systems (IS) is used to determine candidate factors that might influence the success of the use of e¿commerce. A questionnaire based on these is used for primary data collection in the UK NHS pharmaceutical supply chain. Factor analysis is used to analyse the data. Findings The paper yields five composite factors that are perceived by users to influence successful e-commerce use. "System quality," "information quality," "management and use," "world wide web - assurance and empathy," and "trust" are proposed as potential critical success factors. Of these, all respondents ranked information quality, system quality, and trust as being of most importance, but differences in the rankings between purchasing and selling respondents are evident. Research limitations/implications The empirical study is limited to a single supply network, and although the findings seem intuitively to be of relevance to other sectors and supply contexts, there remains an opportunity to test this through further research. There is also an opportunity to extend the survey research, particularly into the wholesaler organisations that operate in the sector of study. Practical implications The managerial implications that result from this research provide practical guidance to organisations in this sector on how to ensure that e¿commerce systems for B2B buying and selling are used successfully. Originality/value This paper furthers knowledge and understanding in the fields of operations management, IS, and SCM, by suggesting potential determinants of successful e¿commerce use in both buying and selling organisations within supply networks.

No / The National Health Service (NHS) in England must improve productivity by 6% per annum if projected savings of £21 billion are to be attained by 2014, while simultaneously improving or at least maintaining the quality of care (Department of Health (DH), 2009; 2010a). Given that staff costs represent 60% of the current NHS budget, it is likely that both the number and composition of the 1.7 million strong workforce will need to be changed to meet these targets. In the Department of Health's draft Structural Reform Plan (2010b), the emphasis is on shifting resources to promote better healthcare outcomes, to which end a review of working practices and role relationship must take place, with increased delivery of services by community nurses.

No / There are 353 NHS hospitals in the United Kingdom, and within these hospitals there is wide variation in the electronic prescribing systems applied. Indeed, only one hospital uses a single system in all of its clinical areas. Medication error is the biggest issue in the health care profession in respect to patient safety—

Yes / This article presents midwives' views and experiences of flexible working and work-life balance. Both flexible working and work-life balance are important contemporary agendas within midwifery and can have both positive and negative consequences for midwives. Full-time midwives and those without caring commitments feel disadvantaged by flexible working and work-life balance policies as they have to fit when they work around part-time midwives and are increasingly expected to cover extra work. They feel their work-life balance is marginalised and this is fuelling discontent and resentment among midwives and leading to divisions between full and part-time staff that reinforce flexibility stigma. Although flexible working and work-life balance are important for recruiting and retaining midwives they are part of the ongoing tensions and challenges for midwives and the midwifery profession. Keywords flexibility stigma, flexible working, full-time work, marginalisation, midwives, National Health Service,

Yes / Even prior to the conclusion of the European Union (EU) referendum (Brexit), the NHS was showing tremendous signs of strain. Immediately after the outcome was announced, promises of major re-investment of funds saved from payments to the EU were retracted. Since then, hospital closures, cuts and changes to health and social care have been revealed, with regular news broadcasts highlighting the crisis facing the NHS. The uncertainties about post-Brexit relationships, economy, politics and security are likely to further significantly impact the NHS and its sustainability. Higher Education Institutions (HEIs) and the NHS are inextricably linked through research and education of health and social care professionals – changes therefore having implications for both.

Aim: The overall aim of this thesis is to explore School health nursing through school nurses’ descriptions of school children’s health and to analyse factors influencing the recording of schoolchildren’s health in the School Health Record (SHR). An additional aim is to evaluate family nursing interventions as a tool for the school nurses in the School Health Service (SHS).Methods: The thesis comprises four papers. A combination of qualitative and quantitative methods was used through individual interviews with a strategic sample of school nurses (n=12) (PI), a national survey to a representative sample of school nurses (n=129) (PII, III) and the implementation of family nursing models developed in Canada with girls in their early adolescence with recurrent health complaints and their families (n=4) in co-operation with their school nurses (n=2) (PIV). The Strengths and Difficulties Questionnaire (SDQ) was used as pre and post test. Evaluation interviews were conducted with the families and the nurses separately. Qualitative content analyses were used to analyze the interview text with the school nurses and the families. Manifest content analysis was used to analyze the free text answers of the survey and the evaluation interview with the school nurses. Descriptive statistical analyses were used to describe demographic data in all four papers. The SDQ was hand-scored statistically.Findings: The findings showed that nurses judged the schoolchildren’s mental health as deteriorated, especially in socially disadvantaged areas and more generally among girls expressed as psychosomatic symptoms. Individual factors related to lifestyle affected the schoolchildren’s physical health, and the mental health was, to a large extent, affected by the school environment and family relations. The latter seemed to be the most important factor affecting schoolchildren’s mental health. The basis for the school nurses judgement of the physical health was health check-ups and the health dialogues. Spontaneous visits were more commonly used to judge the mental health. Recording schoolchildren’s mental health was a challenge for school nurses. Difficulties were related to ethical considerations, tradition, lack of time and the improper structure of the SHR. Fears of marking the schoolchild for life related to the schoolchild itself, the parents or to other authorities/successive caregivers were brought up as hinders for recording mental and social health. Family sessions may be useful within the profession when handling recurrent health complaints among adolescence girls. The girls and their families experienced relief, they felt confirmed and that their feelings and reactions were normal in that situation. The families became aware of their own strengths and possibilities and this was supported by the SDQ which showed an increased well-being. The school nurses valued this way of working and meant that the sessions seemed to start a changing process within the families.Conclusions: The results indicate that school nurses have a deep knowledge about schoolchildren’s health which is not used to its full potential in a public health perspective. However, the experienced difficulties recording schoolchildren’s mental health seem obvious, which would demand developing the SHR for the needs of today. Family sessions in SHS with the school nurse as a collaborator with the family seemed useful and may be transferable to other health problems expressed by the schoolchildren. Bronfenbrenner’s ecological systems theory and other models for health determinants are used to illustrate the school nurse as a mediator working on the bridge over different health streams with schoolchildren’s health on an individual and a population level. / Syfte: Avhandlingens övergripande syfte är att undersöka skolsköterskors uppfattning om skolbarns hälsa och att analysera faktorer som påverkar dokumentation av skolbarns hälsa i skolhälsovårdsjournalen. Ett ytterligare syfte är att utvärdera modeller för familjeinterventioner som redskap för skolsköterskor i skolhälsovård.Metoder: Avhandlingen består av fyra delarbeten. En kombination av kvalitativa och kvantitativa metoder användes. I delarbete I genomfördes intervjuer med ett strategiskt urval av skolsköterskor (n=12). Intervjuerna analyserades med kvalitativ innehållsanalys. I delarbeten II och III distribuerades en nationell enkät till ett representativt urval av Sveriges skolsköterskor (n=129). Manifest innehållsanalys användes vid analys av de öppna frågorna. I delarbete IV genomfördes en interventionsstudie med familjesamtal, inspirerad av modeller för familjefokuserad omvårdnad utvecklade i Kanada. Skolflickor i tidig adolescens med återkommande subjektiva hälsoproblem (n=4) och deras föräldrar i samarbete med deras verksamma skolsköterskor (n=2) ingick i studien. Separata utvärderingsintervjuer genomfördes med familjer och skolsköterskor. Intervjuerna analyserades med kvalitativ och manifest innehållsanalys respektive. The Strengths and Difficulties Questionnaire (SDQ) användes som före/efter test vid interventionen och resultatet bearbetades statistiskt manuellt. Deskriptiv statistik användes för analys av demografisk data i samtliga delarbeten.Resultat: Resultatet visade att skolsköterskorna bedömde skolbarnens mentala hälsa som försämrad särskilt bland flickor och i socioekonomiskt utsatta områden. Individuella livsstilsfaktorer påverkade skolbarnens fysiska hälsa och den mentala hälsan var i stor utsträckning påverkad av skolmiljö och familjerelationer. Det sistnämnda verkade vara den mest betydelsefulla påverkansfaktorn för skolbarnens mentala hälsa. Bedömningen av den fysiska hälsan baserades på hälsokontroller och hälsosamtal medan spontana besök var vanligare för bedömning av den mentala hälsan. Dokumentation av mentala hälsa var en utmaning för skolsköterskorna. Svårigheterna kunde relateras till etiska överväganden, tradition och tidsbrist samt till skolhälsovårdsjournalens struktur som inte ansågs uppfylla dagens krav. Skolsköterskorna uttryckte en rädsla för att journalanteckningarna skulle märka skolbarnet för livet. Framtida tolkningar relaterade till skolbarnet själv, föräldrar eller andra/påföljande vårdgivare uttrycktes som hinder för att dokumentera mental och social hälsa. Familjesamtal visade sig vara användbara i skolhälsovården. De medverkande flickorna och deras familjer kände sig bekräftade i att deras känslor och reaktioner var normala. De sade sig bli medvetna om egna styrkor och möjligheter vilket styrktes av SDQ som visade ett ökat välbefinnande efter sammankomsterna, både hos skolbarnen och hos föräldrarna. Skolsköterskorna var positiva till att arbeta med familjesamtal och upplevde sig mer som samverkanspartner än som expert. Samtalen ledde till att en förändringsprocess startade i familjerna enligt skolsköterskorna.Slutsatser: Resultatet indikerar att skolsköterskor har en djup kunskap om skolbarns hälsa som sannolikt kunde tas tillvara på ett bättre sätt ur ett folkhälsoperspektiv på såväl nationell som lokal nivå. Behovet av att utveckla skolhälsovårdsjournalen efter dagens behov och fördjupad kunskap om de upplevda svårigheterna att dokumentera skolbarns mentala hälsa är uppenbar. Familjesamtal, där skolsköterskan intar en roll som samverkanspartner, visade sig användbara och kan sannolikt överföras till andra hälsoproblem bland skolbarn. Bronfenbrenners utvecklingsekologiska systemteori och andra modeller för hälsodeterminanter används för att illustrera skolsköterskans arbete med skolbarns hälsa på såväl en individuell nivå som folkhälsonivå.

Community-Based Health Insurance (CBHI) in Rwanda was promulgated as the best alternative to address the financial barriers for accessibility to health care services for the poor population and the informal sector. The purpose of this study was to investigate whether CBHI reduce Out-of-pocket health expenses for their members as compared to non-members and to what extent CBHI provide financial protection for the poorest population. This research based itself on secondary source of data primarily collected for a prospective quasi-experimental design which evaluated the impact of Performance-Based Financing. The primary study had reported on the Out-Of-Pocket expenses for health by members and non-members of CBHI; residing in a sample of 1961 households; in addition to their demographics and socio-economic characteristics. The findings indicate that insured individuals were about 2.6 times more likely to utilize health care services than respondents without health insurance. It is also worth noting that households with health insurance coverage were less likely to experience a catastrophic health expenditure than households without health insurance (aOR: 0.744; 95% CI:[0.586 - 0.945]), and that the effect of health insurance coverage was higher in people living in poor households than in people living in middle or richer households / Health Studies / M.A. (Public Health)