Aim: The aim of this retrospective study was to record the number and demographics of patients presenting with maxillofacial fractures at the Garankuwa Hospital, University of Limpopo, Medunsa Campus. In addition, the nature of these injuries and the aetiological factors involved were recorded and analysed. Materials and methods: The approach to this study was collection of data from records of patients who were treated at the Maxillofacial and Oral Surgery Department for injuries (fractures) to facial bones. All the records for the period January 2002 to December 2005 were analysed. Results: For the period (2002-2005) under review 4000 patient files were retrieved and analysed. These consisted of 1755 (43,88%) patients with mandibular or middle or upper third cranio-facial fractures who were included in this study and 2245 (56,13%) patients who had been treated as in or out patients for other oral and maxillo-facial procedures or pathology, who were excluded. The 1755 patients consisted of 232 (13.22%) females and 1519 (86.55%) males giving a male to female ratio of 6.55:1. Seventy percent of all the patients were in the age group 20-39 years with a peak frequency in the 3rd decade. The minimum age was two years and the maximum age was 88 years. A total of 2427 fractures were recorded. Of these 2077 (85.58%) occurred in the mandible where the most common sites were the angle (28.97%), the parasymphisis (17.43%) and the body (14.75%). Nearly 80% of the fractures were caused by personal assaults, 14.87% by motor vehicle accidents, 2.34% by gunshot wounds and 3.93 % by falls. Conclusion: In conclusion this study has shown that in a South African population being studied, the leading cause of fractures to the maxillofacial skeleton were interpersonal violence (assaults and gunshots) followed by motor vehicle accidents.

Bakgrund: I västvärlden har telefonrådgivning utvidgats för att minska onödiga sjukvårdsbesök och kostnader för sjukvården. Syftet med telefonrådgivning är att göra vården effektiv, säker och mer tillgänglig för uppringaren. Ett av de vanligaste problemen mellan uppringare och vårdgivare är bristande kommunikation, det som påverkar är när sjuksköterskan inte lyssnar noga och ställer för få frågor. Dessa faktorer ökar risken för felbehandling och misstag. Syfte: Att observera hur distriktssköterskor kommunicerar med uppringare under rådgivande samtal på vårdcentral. Metod: Studien har en deskriptiv design med kvantitativ ansats och görs i form av en empirisk observationsstudie. I studien används en deduktiv ansats då ett strukturerat observationsformulär används. Resultat: Kategori 1) Bedöma, hänvisa och ge råd användes i 96 av 96 samtal (100%). Kategori 2) Ge stöd och omvårdnad användes i 51 av 96 samtal (53%). Kategori 3) Stärka och bekräfta användes i 64 av 96 samtal (66%). Kategori 4) Undervisa och lära ut användes i 45 av 96 samtal (47%). Kategori 5) Att utgå från uppringarens förståelse av problemet användes i 90 av 96 samtal (94%).Slutsats: Distriktssköterskan har ett aktivt lyssnande med uppringaren som utgångspunkt. Distriktssköterskan kommunicerade genom öppna frågor i större delen av samtalen vilket ledde till att uppringaren fick möjlighet att sätta ord på sin situation och sitt lidande. Egenvårdsråd ges i liten utsträckning likaså guidas sällan uppringaren till annan vårdinrättning. Det rådgivande samtalet inom rekommenderad tidsgräns däremot återstår ofta dokumentation efter avslutat samtal vilket kan orsaka stress. / Background: In the Western world telephone counseling has been expanded to reduce unnecessary health care visits and healthcare costs. The purpose of telephone counseling is to make the care efficient, secure and more accessible to the population. One of the most common problems between callers and caregivers is lack of communication. Aim: Study how district nurses communicate with callers during telephone counseling at a health care center.Method: The study has a descriptive design with a quantitative approach and is done in the form of an empirical observational study of district nurse interviews with callers at a health center. In the study a deductive approach is used with a structured observation form. Result: Category 1) Assessing, referring and giving advice was used in 96 of 96 calls (100%). Category 2) Support and care was used in 51 of 96 calls (53%). Category 3) Strengthen and confirm was used in 64 of 96 calls (66%). Category 4) Teach the caller was used in 45 of 96 calls (47%). Category 5) Based on the caller's understanding of the problem was used in 90 of 96 calls (94%)Conclusion: The district nurse used active listening and communicated through open questions. This led the caller to put words to his situation and suffering. Self-care advice was given in a small extent, the caller was rarely guided to another care facility. The district nurse held the recommended time in telephone counseling, but documentation often remains after the end of the call which can cause stress.

Bakgrund: Amningen i dagens samhälle har minskat. Ett bra stöd från barnmorskor och distriktssköterskor kan främja amningen. Stöd behövs även till de mammor som inte kan eller som inte vill amma. Syfte: Syftet med studien var att undersöka distriktssköterskors erfarenheter av att erbjuda professionellt stöd vid amning. Metod: Kvalitativ metod med induktiv ansats användes i studien. Intervjuerna analyserades enligt kvalitativ innehållsanalys. Sex distriktssköterskor som arbetar på BVC deltog i studien. Resultat: Analysen resulterade i tre kategorier; Kontinuitet i stöd och information, Individanpassat stöd och Förutsättningar för att ge stöd. Dessa resulterade i sju underkategorier; Amning från BB till hemmet, Hembesök av distriktssköterska, Broschyrer och Amningshjälpen, Kulturella skillnader, Val och begränsningar vid amning, Att kunna ta sig tid och Fortbildning och egenansvar. I resultatet framkom att det finns behov av mer utbildning om amning för att kunna ge bra stöd. Konklusion: Det är viktigt att mammor får stöd om amning redan från personalen på BB. Distriktssköterskan på BVC träffar sedan familjen regelbundet och fortsätter ge stöd efter deras önskemål. Det är viktigt att distriktssköterskorna ger ett bra stöd även till kvinnor som inte kan eller som inte vill amma. / Background: In society today there’s a reduce of breastfeeding. A good support from midwives and district nurse’s can promote breastfeeding. Support is important even for mothers who can’t or have decided that they don’t want to breastfeed. Aim: District nurse’s experiences of offering professional support to women about breastfeeding. Method: Qualitative method with inductive approach. The interviews were analyzed according to qualitative content analysis. Six district nurse’s working in the child health care centre participated in the study. Results: The analysis resulted in three categories; Continuity of support and information, Individually adapted support and Conditions to give support. These resulted in seven subcategories; Breastfeeding from BB to home, Homevisit from distric nurse, Brochures and Amningshjälpen, Cultural differences, Choises and limitations about breastfeeding, Being able to give time and Continuing education and self-responsibility. The result shows that there is a need for more education about breastfeeding. Conclusion: It’s important for mothers to get support about breastfeeding already on BB. Then the district nurse at the child health care centre meets the family regularly and keep giving support after theirs wishes. It’s important for district nurse’s to give a good support both to women who can’t or have decided not to breastfeed.

This paper examines the plight of the incarcerated mentally ill. After a consideration of the historical factors which have contributed to the current philosophy and pattern of services throughout North America, and specifically in British Columbia, the paper reports on a qualitative study using participant observation, informal and formal interviews, and Strauss' Constant Comparative Methods which was undertaken to identify the needs of the mentally ill individuals who are serving a term of imprisonment in the Health Care Centre of the Lower Mainland Regional Correctional Centre. Altogether there were eighteen formal participants. They included six mentally ill offenders, six correctional personnel, and six health care professionals. A critical analysis of the major findings -alienation, lack of organizational commitment, and the incongruencies between our social policies and practices - provided the basis for program recommendations. The challenge lies in the building of a vision that values humane treatment for the marginal members of our society. / Arts, Faculty of / Social Work, School of / Graduate

Abstract The purpose of this study was to analyze cultural meanings associated with primary health center´s from customers’ point of view. Since 1972 the health center has been the most important place providing public health care. Nationally, customership development has been the main goal of primary health care. The purpose of this study was to determine the cultural meanings associated with the health center from customers’ point of view. The theoretical framework utilized in the study comprised the idea of new public service, the theory of organizational culture and a cultural model that allows understanding the health center, the cultural meanings conceptualized, and the interface between the customer and health care center. A three -phase empirical study was conducted using mixed methods. In the first phase, the cultural significance of the customer point of view was examined in document data (N=605), consisting of health care center -related writings in the Kaleva newspaper during the period 1972–1982. The second phase consisted of virtual anthropological data (N=338), i.e internet chat room writings from around 2010. The third phase was a questionnaire form, which formed part of the Northern Finland Birth Cohort 1966 study. It included a multiple choice questionnaire (N=3237) and open questions (N=200). Qualitative data (the empirical part of phases I, II, and partly III) were analyzed by inductive and deductive content analysis and text analysis. The quantitative data (the partly empirical phase III) were statistically analyzed. In the study, four cultural models were formed pertaining to the visible and hidden cultural meanings related to health centers from customers’ point of view: 1. The Melting Pot of Health Problems Model, highlighting the meanings between the organization and the customer, such as staff incarnation and individual activity associated with meanings, which on the other hand appeared contradictory. 2. The Low-Threshold Model, where the meanings are associated with service. The health center was considered a “rush center”, where the level of care varies, but the service was felt to harmonize with the trust-related meanings and was compared to the bedrock. 3. The Guessing Centre Model, which consisted of the beliefs and meanings associated with a health center waiting room or was described as a lottery, but which was on the other hand regarded as the center of rumors. 4. The Expected Future Model, where the meanings related to expectations concerning the future of the health care center, describing a generative and functional local health care centre with a set of values based on holisticity. The theoretical results provide new insight that helps understand phenomena on the interface between health care services and customers. Health center customers appear to be a cultural phenomenon, organized as cultural models. In health care, the new information generated in the study can be used in customers-oriented planning and development, education, health and applied cultural research. / Tiivistelmä Tutkimuksen tarkoituksena oli analysoida terveyskeskukseen liittyviä kulttuurisia merkityksiä perusterveydenhuoltopalveluiden asiakkaan näkökulmasta. Terveyskeskus on ollut vuodesta 1972 tärkein julkinen terveydenhoitopaikka. Valtakunnallisesti perusterveydenhuollon päätavoitteeksi on nostettu asiakkuuden kehittäminen. Tutkimustehtävänä oli selvittää, millaisia kulttuurisia merkityksiä terveyskeskukseen liittyy asiakkaan näkökulmasta. Tutkimuksen teoreettisessa viitekehyksessä hyödynnettiin hallintoteoreettista näkökulmaa, teoriaa organisaatiokulttuurista sekä kulttuurimallia. Terveyskeskukseen liittyviä kulttuurisia merkityksiä käsitteellistettiin reifikaatioon peilaten terveyskeskuksen ja asiakkaan välisen rajapinnan ymmärtämiseksi. Tutkimus jakautuu teoreettiseen ja empiiriseen osaan. Kulttuurisia merkityksiä asiakkaan näkökulmasta tutkittiin mixed methods -menetelmälähtöisesti kolmivaiheisen empiirisen aineiston pohjalta. Ensimmäinen vaihe koostui dokumenttiaineistosta (N=605), joka muodostui sanomalehti Kalevan julkaisemista terveyskeskukseen liittyvistä kirjoituksista vuosina 1972–1982. Toinen vaihe koostui virtuaaliantropologisesta aineistosta (N=338), joka käsitti internetin keskustelupalstojen kirjoituksia 2010-luvun taitteessa. Kolmas vaihe kerättiin kyselylomakkeella, joka oli osaotos Pohjoissuomen syntymäkohortti 1966:n tutkimusta. Se sisälsi monivalintakyselyn (N=3237) sekä avoimen kysymyksen (N=200). Laadulliset aineistot (empiirisen osan vaiheet I, II, osin III) analysoitiin induktiivisella ja deduktiivisella sisällön- ja tekstianalyysillä. Määrällinen aineisto (osin empiirisen aineiston osa III) analysoitiin tilastollisesti. Tutkimuksessa muodostettiin terveyskeskukseen liittyvistä näkyvistä ja piilotetuista kulttuurisista merkityksistä asiakkaan näkökulmasta neljä kulttuurimallia: 1. Vaivojen sulatusuunimalli, jossa korostuivat organisaation ja asiakkaan väliset merkitykset. Niitä olivat henkilöstöinkarnaatio ja asiakasaktiivisuus, jotka toisaalta näyttäytyivät ristiriitaisina. 2. Matalan kynnyksen malli, jossa merkitykset liittyivät palveluun. Terveyskeskus miellettiin ruuhkakeskukseksi, jossa hoidon taso vaihtelee, mutta toisaalta palveluun luotettiin ja sitä verrattiin peruskallioon. 3. Arvauskeskusmalli, joka muodostui uskomuksiin liittyvistä merkityksistä. Terveyskeskusta kuvailtiin odotushuoneeksi tai lottoriviksi, mutta joka toisaalta käsitettiin huhupuheiden keskiöksi. 4. Tulevaisuuden odotemalli, jossa merkitykset liittyivät tulevaisuuden odotuksiin. Terveyskeskus haluttiin nähdä tulevaisuudessa generatiivisena ja toimivana lähiasemana, jonka toimintakulttuurin arvopohja perustuisi holistisuuteen. Tutkimuksen teoreettisilla tuloksilla on uutuusarvoa terveyspalveluiden ja sen asiakkaan rajapinnan ilmiöiden ymmärtämiseksi. Terveyskeskuksessa asiakas on edelleen palvelujen tuottamisen kohde. Asiakkaan roolia tulee kehittää aktiiviseksi ja osallistuvaksi. Terveyskeskus on asiakkaille tärkeä ja se tulisi olla joustavasti lähellä myös tulevaisuudessa. Tutkimuksen tuottamaa tietoa voidaan hyödyntää terveydenhuollon asiakaslähtöisessä suunnittelu- ja kehittämistyössä, koulutuksessa sekä terveydenhuollon ja kulttuurintutkimuksen soveltavassa tutkimuksessa.

The study aimed to explore and described the assessment of patient’s satisfaction with the quality of health care services rendered by the Crossroads Community Health Centre (CHCC). The target population comprised of adult male and female patients who have attended the clinic more than once. One hundred and twenty patients participated in the study. The convenience sampling method was used to select the respondents. A questionnaire was used to collect data. Validity and reliability were ensured. The Chronbach’s alpha reliability test was used to measure the internal consistency of the likert scale questionnaire items and was less than 0.4 for sections B-F, and 0.675 for section E. Descriptive and inferential data analysis was conducted using the Statistical Package for the Social Sciences 16.0 for Windows, release 16.0.1 with the assistance of a statistician. The findings indicated a positive perception of the quality of health care services rendered by the Crossroads CHCC. It was concluded that despite a positive perception of the health care services, there was a percentage of the respondents that rated the quality of the service as poor in relation to environmental cleanliness, staff attitudes, long waiting times, medications shortage, the complaints system reporting and health care service drainage to other CHCC where patient’s resided. The issue of quality improvement in these aspects was noted to be crucial and recommendations were made to improve the quality of the health care service at Crossroads CHCC. / Healh Studies / M.A. (Health Studies)

The study aimed to explore and described the assessment of patient’s satisfaction with the quality of health care services rendered by the Crossroads Community Health Centre (CHCC). The target population comprised of adult male and female patients who have attended the clinic more than once. One hundred and twenty patients participated in the study. The convenience sampling method was used to select the respondents. A questionnaire was used to collect data. Validity and reliability were ensured. The Chronbach’s alpha reliability test was used to measure the internal consistency of the likert scale questionnaire items and was less than 0.4 for sections B-F, and 0.675 for section E. Descriptive and inferential data analysis was conducted using the Statistical Package for the Social Sciences 16.0 for Windows, release 16.0.1 with the assistance of a statistician. The findings indicated a positive perception of the quality of health care services rendered by the Crossroads CHCC. It was concluded that despite a positive perception of the health care services, there was a percentage of the respondents that rated the quality of the service as poor in relation to environmental cleanliness, staff attitudes, long waiting times, medications shortage, the complaints system reporting and health care service drainage to other CHCC where patient’s resided. The issue of quality improvement in these aspects was noted to be crucial and recommendations were made to improve the quality of the health care service at Crossroads CHCC. / Healh Studies / M.A. (Health Studies)