An examination of developments between 1970-1990 demonstrate a substantial restructuring of relations between the state and nonprofit societies within Vancouver's mental health system. While helping to establish and support the growth of nonprofit societies, the state, during the 1970's, maintained a "hands off" relationship with the nonprofit sector. Throughout the 1980's and early 1990's, state intervention into the affairs and aspirations of nonprofit societies dramatically increased, primarily through the establishment of corporatist arrangements. Such arrangements necessitated the establishment of non-aligned intermediary organizations to regulate and monitor activities within the nonprofit sector. The establishment and development of nonprofit societies and the subsequent restructuring of relations between the state and nonprofit societies is explored through an examination of corporatism. This examination includes a detailed case study of two nonprofit societies operating in the city of Vancouver between 1972 to the present, the Coast Foundation Society and The Greater Vancouver Mental Health Services Society. The methodology utilized includes analysis of secondary data, archival and documentary materials, and personal interviews with a number of key informants previously or currently employed within the mental health system. Analytic themes from the literature on pluralism and corporatism, along with Claus Offe's theoretical examination of state-interest group relations, are used to explain the construction of corporatism during this period. While the inquiry provides a detailed account of developments within Vancouver's mental health system through a case study approach, broader issues are also explored. The impact of macro economic changes, especially the effect of the recessionary period during the 1970's, is crucial in understanding changing state priorities and the subsequent construction of corporatism. An understanding, therefore, of the way in which corporatism relates to the broader reconstruction of consensus within late capitalist societies is an important focus of this study.

Multiple transitions between care settings have been reported to affect the quality of life of the older adults and their families. In Canada, there have been no studies that have examined transitions between care settings at the end of life in older adults who are on homecare. The aim of this thesis was to address this gap, and to describe transitions between care settings in older homecare clients towards the end of their life and examine what personal, health system and health service use factors predict these transitions. The sample used in this study was the cohort of individuals 65 years and older(n=7866) who died in Manitoba within the fiscal years 2003-2006, and who received homecare for at least 30 days in the last year of their life. The outcome variables in this study were transitions and independent variables included demographic (e.g., age, sex), health service use (homecare days) and system factors (e.g., hospital bed supply). The study involved secondary data analysis of anonymized administrative data (the hospital, homecare and personal care home (PCH) data), vital statistics data, health insurance registry, census data, and annual provincial statistical reports. Descriptive and inferential data analyses methods were used to analyze the data in the study. It was found in the study that more than half of the homecare clients had one or more transitions between care settings in their last month of life, and more than half of the homecare clients in the study died in hospitals. Homecare clients who were males, in the 75-84 years age group, received more homecare days and lived in regions of high hospital bed supply were more likely to have one or more transitions in the last month of their life, and those who were single, in the lower income quintile groups, lived in regions of high physician and PCH bed supply had lower odds of having one or more transitions. The findings suggest the need for increasing palliative care and homecare services to reduce transitions and hospital deaths at the end of life. Increasing physician supply, particularly in rural areas should also be considered. Future studies should also attempt to classify which of the transitions towards the end of life were essential or burdensome.

The last few years have seen an increase in the infection rate not only of HIV but also TB. The HIV/AIDS pandemic is increasing rapidly mainly in developing countries with 71 % of infections in the Sub-Saharan region of Africa. South Africa, which forms part of the Sub- Saharan region, has the highest infection rate in the world with 3.2 to 3.4 million people living with HIV/AIDS. People with HIV are especially vulnerable to TB, and HIV pandemic is fuelling an explosive growth in TB cases. The increase in the infection rate of TB and HIV exert increased pressure on health service delivery thus reflecting the serious problem in the country with regard to health service delivery to people co-infected with TB and HlV/AlDS. Health service delivery is also hindered by negative attitudes of health workers that have been reported towards people living with HIV/AIDS. They entertain a biased view of their own risk, considering risk only from occupational exposure and denying the possibility of infection in their private life. These attitudes of health workers decreases the quality of care and support delivered to patient co-infected with TB and HIV. This result in people not disclosing their illness even in cases were treatment is available like TB for the fear of stigmatisation. Hence the problem of stigmatisation escalates into a dilemma for the patient co-infected with TB and HIV. Therefore these patients tend to shy away from health services and isolate themselves due to fear of being stigmatised twice. The need to address TB and HIV together in the light of this dimension is urgent so as to improve the utilization of the health services by people co-infected with Ti3 and HIV. The purpose of this research was to explore and describe the experiences of patients co-infected with TB and HIV regarding stigmatisation by the health workers, to explore and describe the attitudes of health workers towards patients co-infected with TB and HIV, and to formulate guidelines for health workers that will facilitate the health service utilization by patients co-infected with TB and HIV in the Potchefstroom district. The research was conducted in the Potchefstroom district in the North West province of South Africa. A qualitative research design was used to explore and describe the experiences of patients co-infected with TB and HIV regarding stigmatisation by the health workers, and to explore and describe the attitudes of health workers toward co-infected patients. A purposive voluntary sampling method was used to select participants who met the set criteria. Two populations were used, that is the patients co-infected with TB and HIV, and the health workers who were involved in their care. In depth unstructured interviews were conducted with the patient population and semi structured interviews with the health worker population using an interview schedule that was formulated from the background literature. Data was captured on an audiotape, and transcribed verbatim. Field notes were taken immediately after each interview. The researcher and a co-coder did data analysis after data saturation was reached and a consensus was reached on the categories that emerged. From the findings of this research it appeared that there were general perceptions by the patients co-infected with TB and HIV that indicated stigmatisation by the health workers. This perceived stigmatisation was reported as being perpetrated by all categories of health workers. Negative behaviours such as the health workers not having time for the patients and being impatient were reported. Lack of sufficient knowledge was related to these behaviours especially amongst lower categories or non-professional health workers. In spite of the above, the researcher also observed that there was a limited number of health workers who were still being perceived as committed and caring by the patients co-infected with TB and HIV. The researcher concluded that the relationship between the health workers and the patients co-infected with TB and HIV was characterised by conflict. The health workers seemed to perceive the patients co-infected with TB and HIV as stubborn, harsh, abuse alcohol, manipulative and not taking responsibility of their illness. These perceptions lead the health workers to have a negative attitude towards these patients and occasionally came across as unsympathetic towards them. On the other hand the researcher observed that there were other health workers who did not present with negative behaviours towards these patients and tried to understand the reasons for their sometimes-unacceptable behaviours. Recommendations are made for the field of nursing education, community health nursing practice and nursing research with the formulation of guidelines for health workers so as to facilitate the utilization of the health services by the patients co-infected with TB and HIV. The guidelines are discussed under three main categories, namely guidelines for the health workers to facilitate the utilization of the health services by the patients co-infected with TB and HIV, guidelines to improve the utilization of the health services more efficiently and adequately by the patients co-infected with TB and HIV, and guidelines to improve the attitudes of the health workers towards the patients co-infected with TB and HIV with the intention of improving the utilization of the health services by these patients. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2006.

The productivity and well-being of the SANDF are dependent on the effective functioning of its individual members, positive relationships amongst various groups of members and between members and the organization. Military social work, based on occupational social work, was established in order to support the well-being of the organization. Supervisors within the South African National Defence Force play a fundamental role in the management and assistance of employees and organizational units whose performance is affected by a range of problems. These supervisors are the key role players in the identification and effective referral of 'employees whose performance is affected by problem situations. The Supervisory Training Course was developed and implemented by military social workers as a training aid to equip supervisors in appropriate ways of managing and assisting employees and organizational units. The Supervisory Training Course (a very comprehensive package) is currently presented on a small scale amongst SANDF supervisors. These supervisors are not using acquired knowledge and skills effectively regarding the management of their subordinates. This situation motivated the researcher to undertake this study. / Thesis (M.A. (MW))--North-West University, Potchefstroom Campus, 2006.

On December 26th, 2004, 280,000 people lost their lives. A massive earthquake struck Indonesia, triggering a tsunami that affected several countries, including Thailand. The disaster had important implications for health status of Thai citizens, as well as health system planning, and thus underscores the need to study its long-term effect. This dissertation examined the patterns, determinants, and spatial analysis of health service utilization following the tsunami in Thailand. The primary aim was to determine whether tsunami-affected status (personal injury or property loss) and distance to a health facility (public health center or hospital) influenced health service utilization. The study population included Thai citizens (aged 14+), living in the tsunami-affected Thai provinces: Phuket, Phang Nga, Krabi, and Ranong. Study participants were randomly selected from the ‘affected’ and ‘unaffected’ populations. One and two years after the tsunami, participants were interviewed in-person on demographic and socio-economic factors, disaster impact, health status, and health service utilization. Five types of health services were examined: outpatient services, inpatient services, home visits, medications, and informal (unpaid) care. Distance to a health facility was calculated using Geographic Information System’s Network Analyst. The Grossman model of the demand for health care and a distance decay concept provided the foundation for this study. A propensity score method and a two-part model were used to examine the study objectives. There were 1,889 participants. One year after the tsunami, individuals affected by property loss were more likely to use medications than unaffected participants. Two years after the tsunami, individuals with personal injury were more likely to use outpatient services, medications, and informal care than unaffected participants. Distance to a health facility was associated with the use of medications and informal care. The results confirmed the long-term effect of a tsunami. This dissertation may assist the decision- and policy-makers in the identification of those most likely to use health services and in the request of health resources to the affected areas. The patterns, determinants, and spatial analysis of health service utilization found in this study may not be specific to a tsunami and may provide insights on post-disaster contexts of other natural disasters.

On December 26th, 2004, 280,000 people lost their lives. A massive earthquake struck Indonesia, triggering a tsunami that affected several countries, including Thailand. The disaster had important implications for health status of Thai citizens, as well as health system planning, and thus underscores the need to study its long-term effect. This dissertation examined the patterns, determinants, and spatial analysis of health service utilization following the tsunami in Thailand. The primary aim was to determine whether tsunami-affected status (personal injury or property loss) and distance to a health facility (public health center or hospital) influenced health service utilization. The study population included Thai citizens (aged 14+), living in the tsunami-affected Thai provinces: Phuket, Phang Nga, Krabi, and Ranong. Study participants were randomly selected from the ‘affected’ and ‘unaffected’ populations. One and two years after the tsunami, participants were interviewed in-person on demographic and socio-economic factors, disaster impact, health status, and health service utilization. Five types of health services were examined: outpatient services, inpatient services, home visits, medications, and informal (unpaid) care. Distance to a health facility was calculated using Geographic Information System’s Network Analyst. The Grossman model of the demand for health care and a distance decay concept provided the foundation for this study. A propensity score method and a two-part model were used to examine the study objectives. There were 1,889 participants. One year after the tsunami, individuals affected by property loss were more likely to use medications than unaffected participants. Two years after the tsunami, individuals with personal injury were more likely to use outpatient services, medications, and informal care than unaffected participants. Distance to a health facility was associated with the use of medications and informal care. The results confirmed the long-term effect of a tsunami. This dissertation may assist the decision- and policy-makers in the identification of those most likely to use health services and in the request of health resources to the affected areas. The patterns, determinants, and spatial analysis of health service utilization found in this study may not be specific to a tsunami and may provide insights on post-disaster contexts of other natural disasters.

Background. Heart failure (HF) which is a chronic, disabling disorder is mainly found in older people and is one of the leading causes of hospitalisation and readmission around the world. Unfortunately, the mortality and morbidity rates for HF remain high. HF is a complex combination of symptoms which are related to an inadequate perfusion of the body tissues caused by fluid and sodium retention. Hence, enhancing HF patients’ self-efficacy to change their behaviours to perform fluid & sodium control is one of the most important issues for the management of HF. A self-management program has the potential to raise self-efficacy and self-care which is a method to improve health for those with chronic illness and to decrease patients’ health service utilisation and also to enhance these patients’ health status. Aim. The study aims to examine the effectiveness of a self-management program, based on self-efficacy theory, in older people with heart failure in Taiwan. Methods. An experimental design was used to examine the effectiveness of a self-management program on diet and fluid control among HF patients. A total of 93 subjects from two medical centres in Taiwan were randomly assigned to the intervention and control groups. In order to examine the effectiveness of self-management, data were collected at baseline, week 4, and week 12 using the following instruments: self-efficacy for salt and fluid control, HF self-management behaviour, HF related symptoms, and body weight. Moreover, health service utilisation and patient’s evaluation of care received were collected on all patients for the 12 weeks prior to commencing the study and for the 12 week study period. Demographic and disease information was also collected including age, gender, marital state, education, and New York Heart Association (NYHA) functional classification. A structured, individualized self-management training program created by the investigator was implemented for the intervention group through home visits and telephone follow-ups. This program emphasized self-monitoring of diet control and body weight for the self-management of heart failure. The purpose was to improve patients’ self-efficacy in their diet control behaviour. The “diet control” in this study focussed on sodium and fluid restriction. Outcome measures were analysed using the Statistical Package for the Social Sciences (SPSS) 15.0 version, and the level of significance (á) was set at 0.05 for statistical analysis. Results. There were differences for older Taiwanese HF patients’ self-efficacy for salt and fluid control, self-management behaviour, and HF related symptoms for participants who received a self-management intervention compared to those who did not. However, there were no significant differences between the two groups in weight and health serves utilization (p>.001). Conclusion. The self-management program had a positive impact on the improvement of self-efficacy for salt and fluid control, HF related self-management behaviours and symptoms in older Taiwanese with HF. This program may bridge the gap between theory and practice. Health care providers need to provide older people in Taiwan with HF the appropriate skills for self-managing their condition and thereby promoting their health status. These patients with HF and their caregivers have to receive individualized education that emphasizes self-efficacy in the self-management of their disease, thus improving their quality of life.

This thesis presents two studies that form the basis of the Samoan Ministry of Agriculture and Fisheries’ (MAF) recent efforts to enhance its animal disease surveillance capacity. The first study investigated a method of enhancing the surveillance value of veterinary case data collected by the MAF’s Animal Health Service, which provides the only veterinary service for livestock in the country, through temporal analysis of cases and syndromes by species. Threshold levels generated from 3-monthly moving averages combined over 3 years of veterinary case data were used to identify unusually high numbers of cases and the cause of these unusual events were investigated. Further, the analysis of data in the system identified gaps in the coverage of the Animal Health Service which helped identify alternative methods for conducting surveillance in these areas using the Crops Division advisory officers. The objective of the second study was to identify if the veterinary case data collected by the Animal Health Service represented pig health problems in the general population. Reproduction and mortality patterns were compared on a group of 10 holdings that were regularly attended by the veterinary staff and 13 holdings that did not utilise the Animal Health Service. The performance of these holdings, measured in liveborn piglets per sow year and pre-weaning and post-weaning mortality were compared given their status as client or non-client of the service and their exposure to various management factors like confinement, protein supplementation, frequency of feeding, management time per sow per day, the use of improved or exotic breeds, the extent of commercial activity and, in the case of piglets their season of birth (rainy or dry season). The mean number of sows per herd was 6, producing a mean litter size of 6.1 piglets with a mean interfarrowing interval of 235 days. The median pre-weaning mortality per litter was 0 and a median of 1 piglet per litter was used for productive purposes (consumed, gifted or sold) at a median age of 153 days. It was found that the greatest influence on productivity in these holdings was nutrition. Sow productivity (in terms of liveborn piglets per sow year and pre-weaning survival) was best in the non-client, free range herds that did not provide protein supplementation (but whose feeding was unrestricted due to their freedom to roam and scavenge) and worst in client and non-client herds that were confined and not given protein supplementation (due to restricted and underfeeding). The mortality of pigs postweaning was significantly higher if they were free roaming, due to their loss to predation, theft and being hit by car. The study showed that the health status of pigs was better on holdings that did not use the Animal Health Service compared with those that did.

This thesis presents two studies that form the basis of the Samoan Ministry of Agriculture and Fisheries’ (MAF) recent efforts to enhance its animal disease surveillance capacity. The first study investigated a method of enhancing the surveillance value of veterinary case data collected by the MAF’s Animal Health Service, which provides the only veterinary service for livestock in the country, through temporal analysis of cases and syndromes by species. Threshold levels generated from 3-monthly moving averages combined over 3 years of veterinary case data were used to identify unusually high numbers of cases and the cause of these unusual events were investigated. Further, the analysis of data in the system identified gaps in the coverage of the Animal Health Service which helped identify alternative methods for conducting surveillance in these areas using the Crops Division advisory officers. The objective of the second study was to identify if the veterinary case data collected by the Animal Health Service represented pig health problems in the general population. Reproduction and mortality patterns were compared on a group of 10 holdings that were regularly attended by the veterinary staff and 13 holdings that did not utilise the Animal Health Service. The performance of these holdings, measured in liveborn piglets per sow year and pre-weaning and post-weaning mortality were compared given their status as client or non-client of the service and their exposure to various management factors like confinement, protein supplementation, frequency of feeding, management time per sow per day, the use of improved or exotic breeds, the extent of commercial activity and, in the case of piglets their season of birth (rainy or dry season). The mean number of sows per herd was 6, producing a mean litter size of 6.1 piglets with a mean interfarrowing interval of 235 days. The median pre-weaning mortality per litter was 0 and a median of 1 piglet per litter was used for productive purposes (consumed, gifted or sold) at a median age of 153 days. It was found that the greatest influence on productivity in these holdings was nutrition. Sow productivity (in terms of liveborn piglets per sow year and pre-weaning survival) was best in the non-client, free range herds that did not provide protein supplementation (but whose feeding was unrestricted due to their freedom to roam and scavenge) and worst in client and non-client herds that were confined and not given protein supplementation (due to restricted and underfeeding). The mortality of pigs postweaning was significantly higher if they were free roaming, due to their loss to predation, theft and being hit by car. The study showed that the health status of pigs was better on holdings that did not use the Animal Health Service compared with those that did.

This thesis presents two studies that form the basis of the Samoan Ministry of Agriculture and Fisheries’ (MAF) recent efforts to enhance its animal disease surveillance capacity. The first study investigated a method of enhancing the surveillance value of veterinary case data collected by the MAF’s Animal Health Service, which provides the only veterinary service for livestock in the country, through temporal analysis of cases and syndromes by species. Threshold levels generated from 3-monthly moving averages combined over 3 years of veterinary case data were used to identify unusually high numbers of cases and the cause of these unusual events were investigated. Further, the analysis of data in the system identified gaps in the coverage of the Animal Health Service which helped identify alternative methods for conducting surveillance in these areas using the Crops Division advisory officers. The objective of the second study was to identify if the veterinary case data collected by the Animal Health Service represented pig health problems in the general population. Reproduction and mortality patterns were compared on a group of 10 holdings that were regularly attended by the veterinary staff and 13 holdings that did not utilise the Animal Health Service. The performance of these holdings, measured in liveborn piglets per sow year and pre-weaning and post-weaning mortality were compared given their status as client or non-client of the service and their exposure to various management factors like confinement, protein supplementation, frequency of feeding, management time per sow per day, the use of improved or exotic breeds, the extent of commercial activity and, in the case of piglets their season of birth (rainy or dry season). The mean number of sows per herd was 6, producing a mean litter size of 6.1 piglets with a mean interfarrowing interval of 235 days. The median pre-weaning mortality per litter was 0 and a median of 1 piglet per litter was used for productive purposes (consumed, gifted or sold) at a median age of 153 days. It was found that the greatest influence on productivity in these holdings was nutrition. Sow productivity (in terms of liveborn piglets per sow year and pre-weaning survival) was best in the non-client, free range herds that did not provide protein supplementation (but whose feeding was unrestricted due to their freedom to roam and scavenge) and worst in client and non-client herds that were confined and not given protein supplementation (due to restricted and underfeeding). The mortality of pigs postweaning was significantly higher if they were free roaming, due to their loss to predation, theft and being hit by car. The study showed that the health status of pigs was better on holdings that did not use the Animal Health Service compared with those that did.