Background: Recent studies indicate a rise in the prevalence of obesity in children of various age groups. Obesity was officially recognized as a disease by the American Medical Association (AMA) in June 2013. It has been acknowledged as a progressive epidemic public health crisis in the United States for the past 20 years. This is a health care concern that needs examination and the development of new and more effective prevention and treatment modalities for obesity in children. Environmental, hereditary, behavioral, and socioeconomic factors play a significant role in the prevalence of obesity (Rooney, Mathiason, & Schauberger, 2011). Childhood obesity can generate serious emotional and physical consequences, thereby compromising the quality of life among children. Purpose: The purpose of this capstone project was to assess health care providers’ cultural competency by assessing the management of Hispanic parents with children diagnosed with obesity. A culturally diverse survey was developed to evaluate pediatric health care providers’ daily practice and management of Hispanic parents of children with obesity. Theoretical Framework: Madeleine Leininger’s Theory of Culture Care Diversity and Universality and the Health Belief Model constitute the theoretical framework of this capstone project. Methods: The research project gained support from the private pediatric primary care office for the completion of a questionnaire to assess health care providers’ knowledge of childhood obesity. Results: The data analysis revealed that the health care providers surveyed had at times omitted the evaluation of parameters that were vital in managing the health care of obese or overweight children. Certain parameters, such as weight, were always considered. The data analysis revealed gaps in the care of Hispanic pediatric overweight or obese patients and Hispanic caregivers. As a result of the findings, a better understanding of the importance of providing culturally competent health care was gained. Conclusion: This survey increased health care providers’ awareness of the importance of taking culture into consideration. It identified the gaps, and measures are now being evaluated to improve the quality of care provided to these children.

No description available.

Research shows that healthcare providers (HCPs) are not adequately prepared to provide comfort care for patients who are at the end of life. Since the 1990s, numerous legislative, research, and clinical initiatives have addressed concerns about improving care at the end of life. The purpose of this study was to describe the experiences of HCPs providing comfort for patients in the nursing home who are at the end of life. This study focused on physicians, nurse practitioners, nurses and nurses' aides at a central Florida nursing home. A descriptive qualitative design was done utilizing a focus group discussion, individual interviews, and a self-administered questionnaire. The findings indicated that a lack of facility support, inadequate staffing, inadequate end of life care education, family and patient denial of prognosis, as well as decreased primary care physician involvement affect the delivery of comfort care for patients at the end of life in the nursing home. This study supports the need for end of life education to HCPs and the need for adjustments in staffing to meet the complex needs of patients in the nursing home who are at the end of life. A new finding of this study reflects the use of an angel cart to aid in the provision of comfort care for patients at the end of life. Recommendations for future research were made based on study results

No description available.

This thesis explores the implications of democratisation on the regulation of health care providers. It examines the reforms in relation to two regulatory policies in the pharmaceutical market of the National Health Insurance (NHI) in South Korea – the separation of prescribing and dispensing (SPD) and the pharmaceutical pricing policy – conducted in two periods – the 1980s under the authoritarian regime and the 1990s under the democratised regime. The misuse and overuse of drugs had long been recognised as a problem for the NHI, and the tight regulation of the SPD and pharmaceutical pricing as potential solutions. Democratisation seems unlikely to tighten the government’s regulation of the SPD and pharmaceutical prices. On the one hand, the Korean authoritarian regime was known as being capable of conducting top-down regulation of societal groups, and democratisation as having liberalised the government-society relationship. On the other, pharmaceutical regulation is a sophisticated and detached issue, which restricts the ability of laypeople to mobilise and exert bottom-up pressure for regulation. Nevertheless, the authoritarian government failed to tighten, and even loosened these regulations, whereas the democratised government tightened them. This thesis explains this puzzle by focusing on the features of the agenda-setting process and the articulation of policy issues therein. In the 1980s, the SPD and the pharmaceutical reimbursement pricing policy were administrative issues, discussed exclusively between bureaucrats and the central associations of health care providers, which resulted in loose regulation. In contrast, in the 1990s, reform-oriented professionals and NGOs raised these issues and put them on the political agenda, which motivated the government to conduct tighter regulation. This thesis suggests some general implications of democratisation on the politics of regulation. The hierarchical and exclusive authoritarian policy network aims to realise policy goals set by ruling elites; however, for other policy issues, societal partners can utilise this network to promote their preferred policies. Democratisation, which promotes competitive elections and political rights, allows previously excluded policy actors to participate in policy-making networks. These new actors include professionals and activists who are able to understand regulatory issues and articulate them in ways that are salient to politicians and the general public, which will motivate the government to tighten the regulation governing its traditional policy partners.

Summary: The subject of this paper is providing of lege artis health care in the system of public health insurance. The aim of the thesis is to analyse the basic terminology, current legislation and its application in practice. Lex artis is in law an uncertain term, difficult to define, therefore its frequent usage should be restricted in the future. Due to the personal experience of the author there are many practical examples from the Czech health care system used in the paper. Related case law is taken into account continuously with the exception of the separately stated recent court judgment of the Constitutional Court of the Czech Republic. The study is divided into four main chapters, introduction and conclusion. The first chapter is dedicated to the concept of lege artis in detail, its terminology and relation to the current legislation. Further subchapters deal with available health care standards and their obligation. The final parts analyze the lege artis restrictions and way of its assessment. The second chapter is dedicated to the concept of public health insurance. First, the term is defined and the current law is considered. The following parts examine the issue of health insurance companies and the network of health care facilities. Chapter three presents the labor law aspects of lege artis...

Submitted by Nara Lays Domingues Viana Oliveira (naradv) on 2015-06-11T13:31:13Z No. of bitstreams: 1 carolineLimadeACosta.pdf: 537155 bytes, checksum: 199e3b5b634a0aeaaad09bc4fbf206f7 (MD5) / Made available in DSpace on 2015-06-11T13:31:13Z (GMT). No. of bitstreams: 1 carolineLimadeACosta.pdf: 537155 bytes, checksum: 199e3b5b634a0aeaaad09bc4fbf206f7 (MD5) Previous issue date: 2013-02-22 / UNISINOS - Universidade do Vale do Rio dos Sinos / A regulamentação dos planos de saúde no Brasil trouxe avanços significativos em relação ao funcionamento das operadoras de planos de saúde, impondo normas de funcionamento e fiscalização. As operadoras, por sua vez, enfrentam pressões crescentes causadas pelo aumento dos seus custos operacionais. Os serviços da operadora são fornecidos por meio de uma rede de fornecedores a ela credenciados, que oferecem o cuidado aos beneficiários em todos os níveis de atenção à saúde. A partir do credenciamento, o fornecedor passa a representar a operadora na execução do atendimento ao beneficiário. Esta pesquisa tem por objetivo investigar os elementos que induzem os fornecedores ao credenciamento junto aos planos de saúde, e propor um conjunto de diretrizes para o desenvolvimento da gestão da cadeia de fornecedores de serviços na saúde suplementar. Dois estudos de caso foram executados e apresentados em artigos distintos. No primeiro estudo de caso, que investigou os elementos indutores ao credenciamento, foram entrevistados 12 fornecedores. No segundo estudo de caso, focado em propor diretrizes para o desenvolvimento da rede credenciada, foram entrevistados 10 fornecedores e 10 gestores atuantes junto a operadoras de planos de saúde. Os achados indicam que os principais elementos indutores ao credenciamento estão relacionados a garantia de demanda, garantia de pagamento e captação de novos clientes. A pesquisa também propôs um conjunto de diretrizes para o desenvolvimento da gestão da cadeia, considerando elementos como seleção e avaliação do fornecedor, orientações da operadora, remuneração, incentivo da operadora e indicadores. Os resultados apontam que assim como as operadoras, os fornecedores de serviços de saúde e as operadoras ainda carecem de desenvolvimento no que diz respeito à gestão da cadeia e aos serviços prestados. / The government regulation of health plan operators in Brazil, with its operating and inspection standards, has brought about significantadvancements as regards the way health plans serve their customers. The health plan operators, however, are faced with the increasing pressure from soaring operating costs. The health plan operators use the services of a chain of accredited health care providers to serve their beneficiaries with a full range of health care services. When these health care providers join up with the health plan operators, they start acting as their representatives in providing the services beneficiaries require. This research work looks into the elements that induce the suppliers to join up with the health plan operators and proposes a set of guidelines for the development of a management system for the chain of non-governmental health service providers. Two casestudies were carried out and presented in distinct articles. In the first case study, which looks into the elements that lead health care providers to join the health plan operators, 12 health care providers were interviewed. In the second case study, aimed at proposing guidelines for the development of the chain of health care providers, 10 health care providers and 10 managers were interviewed who work closely with health plan operators. The findings indicate that the major elements that induce health care providers to join up are the prospect of an assured demand, assurance of payment and an increased customer base. The research proposed a set of guidelines for the development of a management system for the chain of providers, taking into account elements such as provider selection and evaluation, operator guidance, compensation, operator incentive and indicators. The results show that the health care providers andthe health plan operators still lack development as regards the management of the chain and the services rendered.

O presente estudo desenvolve-se numa perspectiva prática, visando à integração de conhecimentos gerados pela pesquisa a atividades assistenciais no hospital geral universitário, dirigindo-se, especificamente, à questão da detecção da depressão. A depressão é um problema de saúde pública no mundo inteiro, transtorno mental de alta prevalência, com elevado custo para os sistemas de saúde. Entre pacientes clínicos e cirúrgicos, hospitalizados, aumenta a complexidade dos tratamentos, implica maior morbidade e mortalidade, importando também no aumento do tempo e dos custos das internações. Por outro lado, a depressão é subdiagnosticada. Este estudo, originado de um projeto cujo objetivo foi criar um instrumento para a detecção de depressão, utilizável na rotina assistencial, a partir da avaliação do desempenho de escalas de rastreamento já existentes, desdobra-se em três artigos. O primeiro, já aceito para publicação em revista indexada internacionalmente, é a retomada de estudos anteriores, realizados no final da década de 1980. É apresentada a comparação da detecção de depressão, realizada por médicos não-psiquiatras e por enfermeiros, no Hospital de Clínicas de Porto Alegre (HCPA), em 1987 e em 2002. O segundo artigo apresenta o processo de construção da nova escala, a partir da seleção de itens de outras escalas já validadas, utilizando modelos logísticos de Rasch. A nova escala, composta por apenas seis itens, exige menos tempo para sua aplicação. O terceiro artigo é um estudo de avaliação de desempenho da nova escala, denominada Escala de Depressão em Hospital Geral (EDHG), realizado em uma outra amostra de pacientes adultos clínicos e cirúrgicos internados no HCPA. O segundo e terceiro artigos já foram encaminhados para publicação internacional. Esses estudos, realizados em unidades de internação clínicas e cirúrgicas do Hospital de Clínicas de Porto Alegre, permitiram as seguintes conclusões: a) comparando-se os achados de 1987 com os de 2002, a prevalência de depressão e o seu diagnóstico, em pacientes adultos clínicos e cirúrgicos internados, mantêm-se nos mesmos níveis; b) foi possível selecionar um conjunto de seis itens, que constituíram a nova Escala de Depressão em Hospital Geral (EDHG), baseando-se no desempenho individual de cada um dos 48 itens componentes de outras três escalas (BDI, CESD e HADS); c) a EDHG apresentou desempenho semelhante aos das escalas que lhe deram origem, usando o PRIME-MD como padrão-ouro, com a vantagem de ter um pequeno número de itens, podendo constituir-se num dispositivo de alerta para detecção de depressão na rotina de hospital geral. / This study unfolds from a practical perspective. Its purpose is to integrate knowledge generated by research into care provided in general hospitals, specifically to detecting depression. Depression is a public health problem all over the world. It is a highly prevalent mental disorder that generates high costs to the health system. Depression increases treatment’s complexity, morbidity and mortality rates, time and costs of clinical and surgical hospitalizations. On the other hand, depression is under diagnosed. This study was originated from a project to develop an instrument for the detection of depression in general hospitals inpatients. This instrument was based on the evaluation of the performance of other already existing rating scales and was designed to be integrated in clinical routine. This study was developed as three papers. The first paper, accepted for publication in an international indexed journal, compares depression detection carried out by non-psychiatric physicians and nurses of Hospital de Clínicas de Porto Alegre (HCPA) between 1987 andandand 2002. The second paper describes the developing process of a new depression scale by Rasch models using items from other previously validated scales. The new scale, with only six items, requires less time for its use. The third paper is the performance evaluation of the new scale, General Hospital Depression Scale (GHDS). This evaluation was conducted in a sample of clinical and surgical adult inpatients at HCPA. The second and third papers have already been submitted to international journals for publication. The conclusions from these studies are: a) comparing the findings of 1987 and 2002, the prevalence rates and the diagnosis of depression in clinical and surgical adult inpatients have not significantly changed; b) it was possible to select a subset of six items to create the new General Hospital Depression Scale (GHDS); these items were selected by individual performance analysis of 48 items from three other scales (BDI, CESD and HADS); c) GHDS has similar performance, using PRIME-MD as gold-standard, to the three other scales from which the items were selected. GHDS has the advantage of a smaller number of items, and may serve as an alert instrument to depression in general hospitals routine.

abstract: Most studies on refugee populations tend to focus on mental health issues and communicable diseases. Yet, reproductive health remains a major aspect of refugee women's health needs. African refugee women in the United States continue to experience some difficulties in accessing reproductive health services despite having health insurance coverage. The purpose of this study was to understand the reproductive health journey of African refugee women resettled in Phoenix, Arizona. This study also explored how African refugee women's pre-migration and post-migration experiences affect their relationships with health care providers. The study was qualitative consisting of field observations at the Refugee Women's Health Clinic (RWHC) in Phoenix, verbally administered demographic questionnaires, and semi-structured one-on-one interviews with twenty African refugee women (between the ages of 18 and 55) and ten health care providers. The findings were divided into three major categories: pre-migration and post migration experiences, reproductive health experiences, and perspectives of health care providers. The themes that emerged from these categories include social isolation, living between two cultures, racial and religious discrimination, language/interpretation issues and lack of continuity of care. Postcolonial feminism, intersectionality, and human rights provided the theoretical frameworks that helped me to analyze the data that emerged from the interviews, questionnaire and fieldnotes. The findings revealed some contrasts from the refugee women's accounts and the accounts of health care providers. While refugee women spoke from their own specific social location leading to more nuanced perspectives, health care providers were more uniform in their responses leading to a rethink of the concept of cultural competency. As I argue in the dissertation and contrary to conventional wisdom, culture per se does not necessarily translate to resistance to the American health care system for many African refugee women. Rather, their utilization (or lack thereof) of health services are better conceived within a broader and complex context that recognizes intersectional factors such as gender, racialization, language, displacement, and class which have a huge impact on the reproductive health seeking patterns of refugee women. / Dissertation/Thesis / Ph.D. Gender Studies 2011

O presente estudo desenvolve-se numa perspectiva prática, visando à integração de conhecimentos gerados pela pesquisa a atividades assistenciais no hospital geral universitário, dirigindo-se, especificamente, à questão da detecção da depressão. A depressão é um problema de saúde pública no mundo inteiro, transtorno mental de alta prevalência, com elevado custo para os sistemas de saúde. Entre pacientes clínicos e cirúrgicos, hospitalizados, aumenta a complexidade dos tratamentos, implica maior morbidade e mortalidade, importando também no aumento do tempo e dos custos das internações. Por outro lado, a depressão é subdiagnosticada. Este estudo, originado de um projeto cujo objetivo foi criar um instrumento para a detecção de depressão, utilizável na rotina assistencial, a partir da avaliação do desempenho de escalas de rastreamento já existentes, desdobra-se em três artigos. O primeiro, já aceito para publicação em revista indexada internacionalmente, é a retomada de estudos anteriores, realizados no final da década de 1980. É apresentada a comparação da detecção de depressão, realizada por médicos não-psiquiatras e por enfermeiros, no Hospital de Clínicas de Porto Alegre (HCPA), em 1987 e em 2002. O segundo artigo apresenta o processo de construção da nova escala, a partir da seleção de itens de outras escalas já validadas, utilizando modelos logísticos de Rasch. A nova escala, composta por apenas seis itens, exige menos tempo para sua aplicação. O terceiro artigo é um estudo de avaliação de desempenho da nova escala, denominada Escala de Depressão em Hospital Geral (EDHG), realizado em uma outra amostra de pacientes adultos clínicos e cirúrgicos internados no HCPA. O segundo e terceiro artigos já foram encaminhados para publicação internacional. Esses estudos, realizados em unidades de internação clínicas e cirúrgicas do Hospital de Clínicas de Porto Alegre, permitiram as seguintes conclusões: a) comparando-se os achados de 1987 com os de 2002, a prevalência de depressão e o seu diagnóstico, em pacientes adultos clínicos e cirúrgicos internados, mantêm-se nos mesmos níveis; b) foi possível selecionar um conjunto de seis itens, que constituíram a nova Escala de Depressão em Hospital Geral (EDHG), baseando-se no desempenho individual de cada um dos 48 itens componentes de outras três escalas (BDI, CESD e HADS); c) a EDHG apresentou desempenho semelhante aos das escalas que lhe deram origem, usando o PRIME-MD como padrão-ouro, com a vantagem de ter um pequeno número de itens, podendo constituir-se num dispositivo de alerta para detecção de depressão na rotina de hospital geral. / This study unfolds from a practical perspective. Its purpose is to integrate knowledge generated by research into care provided in general hospitals, specifically to detecting depression. Depression is a public health problem all over the world. It is a highly prevalent mental disorder that generates high costs to the health system. Depression increases treatment’s complexity, morbidity and mortality rates, time and costs of clinical and surgical hospitalizations. On the other hand, depression is under diagnosed. This study was originated from a project to develop an instrument for the detection of depression in general hospitals inpatients. This instrument was based on the evaluation of the performance of other already existing rating scales and was designed to be integrated in clinical routine. This study was developed as three papers. The first paper, accepted for publication in an international indexed journal, compares depression detection carried out by non-psychiatric physicians and nurses of Hospital de Clínicas de Porto Alegre (HCPA) between 1987 andandand 2002. The second paper describes the developing process of a new depression scale by Rasch models using items from other previously validated scales. The new scale, with only six items, requires less time for its use. The third paper is the performance evaluation of the new scale, General Hospital Depression Scale (GHDS). This evaluation was conducted in a sample of clinical and surgical adult inpatients at HCPA. The second and third papers have already been submitted to international journals for publication. The conclusions from these studies are: a) comparing the findings of 1987 and 2002, the prevalence rates and the diagnosis of depression in clinical and surgical adult inpatients have not significantly changed; b) it was possible to select a subset of six items to create the new General Hospital Depression Scale (GHDS); these items were selected by individual performance analysis of 48 items from three other scales (BDI, CESD and HADS); c) GHDS has similar performance, using PRIME-MD as gold-standard, to the three other scales from which the items were selected. GHDS has the advantage of a smaller number of items, and may serve as an alert instrument to depression in general hospitals routine.