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Executive Summary During 2010-2012, a Leonardo da Vinci-funded EU project focused on enhancing the language skills of Deaf people, interpreters and Health Care Professionals. Project partners from Cyprus, Ireland, Poland, Scotland and Sweden reviewed current knowledge of policy and practice, and embedded the resulting analysis into a programme of materials to support reflection, knowledge and skills development internationally. This report presents the project's initial 'state-of-the-art' review, with particular reference to the partner countries. Sign languages are now widely recognised, for theoretical and practical purposes, as full, natural languages, and sign language interpreting has consequently been established as a respected profession. Sign language interpreters mediate between hearing and deaf people: this entails a complex transfer of meaning between languages, cultural domains and linguistic modalities, and between members of highly literate communities and those whose languages have no written form. Decades of development in understanding of the most effective part to be played by interpreters in small-group dialogue have concluded that communication is best facilitated with recognition of the interpreter as a linguistic partner, and an active participant in the joint creation of meaning. Good practice in interpreting rarely entails a passive role whereby the interpreter acts as a mere conduit for others' words.   In respect of healthcare interpreting, the situation in the partner countries (and beyond) varies widely, from minimal recognition of the need for dedicated provision for deaf patients, to relatively explicit and well-resourced entitlement to services. In none of the partner countries do services address all identified requirements, despite recognition that inadequate provision can lead to damaging and indeed life-threatening consequences. Training and associated resources for all three key groups – interpreters, healthcare staff and deaf people – are insufficient or non-existent across the board. No-one has a stable, clear set of expectations about how communication can most effectively proceed in these situations. In this context, it is predictable that regulation of quality can be highly problematic. Comparison with North America and Australia highlights a range of adoptable best practices, requiring investment over time in order to generate and implement more effective approaches. It must be recognised that the mere provision of sign language interpreters is only the beginning of true access to healthcare for deaf people. In order to maximise positive outcomes, members of all three key groups must become familiar with a common set of assumptions and practices to reinforce the need to operate as a collaborating triad in the co-constructing of effective interaction. Consistent, high-quality outcomes need to be assured through empowered regulatory mechanisms, for which models exist internationally. / MEDISIGNS

Made available in DSpace on 2014-06-11T19:29:33Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-05-18Bitstream added on 2014-06-13T20:19:25Z : No. of bitstreams: 1 parenti_lc_me_botfm.pdf: 889983 bytes, checksum: 9b942deb3651dda20748f3d9da672a87 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A concepção que tradicionalmente orienta a organização de serviços está fundamentada no saber técnico caracterizado pela centralização de sua formulação e por um caráter autoritário, no qual o paciente é reconhecido a partir de sua doença e dos órgãos nos quais está localizada, cabendo ao paciente um papel restrito no seu tratamento. A inadequação desta perspectiva pode ser percebida dentre outros motivos por sua incapacidade de responder a complexidade das prevalentes condições de cronicidade, como a hipertensão arterial e o diabetes mellitus. Tais morbidades só alcançam um efetivo controle quando seus portadores desenvolvem uma efetiva competência para realizar seu autocuidado de modo a adaptar a norma médica ao seu cotidiano, com autonomia e preservação de sua qualidade de vida. O desafio contemporâneo posto aos serviços de saúde é o de fornecer a seus usuários os instrumentos adequados para que possam desenvolver criativamente suas habilidades para o cuidado-de-si. Tal empreita pode ser mais bem sucedida quando indivíduos e grupos interagem e, desta forma, partilham, utilizam e produzem conhecimentos, conformando uma Inteligência Coletiva. Com esta concepção o presente estudo buscou desenvolver processo de formulação de propostas de reorientação da assistência ao diabetes mellitus mediante a mútua cooperação entre profissionais de saúde e usuários de serviço de atenção primária à saúde. Para tanto, estruturou-se pesquisa-ação de caráter exploratório sobre os obstáculos ao autocuidado no diabetes mellitus tipo 2 produzidos por características de organização do serviço: o intervalo longo entre as consultas, a descontinuidade do cuidado e a dificuldade de comunicação entre profissional - paciente. Tais campos problemáticos foram mais bem explorados mediante a análise de banco de dados obtido por meio de entrevista estruturada... / The conceptualization that traditionally orients service organization is based on technical knowledge characterized by the centralization of its formulation and by an authoritarian character in which the patient is recognized from his disease and from the organs where it is located, with the patient playing a restricted role in therapy. The inadequacy of this perspective can be perceived, among other reasons, from its incapacity to respond to the complexity of prevalent chronic conditions, such as arterial hypertension and diabetes mellitus. Such morbidities can only be effectively controlled when patients develop effective competence to engage in self-care so as to adapt the medical norm to their daily lives with autonomy and preservation of their quality of life. The contemporary challenge posed to health care services is that of providing users with suitable instruments so that they can creatively develop self-care skills. Such undertaking can be successful when individuals and groups interact and thus share, use and produce knowledge, hence forming a Collective Intelligence. With this conceptualization, the present study aimed at developing a process for formulating proposals to reorient diabetes mellitus care provision based on mutual cooperation between health care professionals and primary health care service users. To that end, an exploratory action study was designed concerning the obstacles to self-care in type-2 diabetes mellitus which are caused by characteristics of service organization: the long interval between consultations, care discontinuity and the difficulty of communication between professionals and patients. Such problematic fields were better explored by analyzing a database obtained from structured interviews with 275 diabetic individuals. Based on that information, focal groups were performed so that the diabetic individuals could discuss the problematic... (Complete abstract click electronic access below)

Orientador: Antonio de Pádua Pithon Cyrino / Banca: Elen Rose Lodeiro Castanheira / Banca: Luiz Carlos de Oliveira Cecilio / Resumo: A concepção que tradicionalmente orienta a organização de serviços está fundamentada no saber técnico caracterizado pela centralização de sua formulação e por um caráter autoritário, no qual o paciente é reconhecido a partir de sua doença e dos órgãos nos quais está localizada, cabendo ao paciente um papel restrito no seu tratamento. A inadequação desta perspectiva pode ser percebida dentre outros motivos por sua incapacidade de responder a complexidade das prevalentes condições de cronicidade, como a hipertensão arterial e o diabetes mellitus. Tais morbidades só alcançam um efetivo controle quando seus portadores desenvolvem uma efetiva competência para realizar seu autocuidado de modo a adaptar a norma médica ao seu cotidiano, com autonomia e preservação de sua qualidade de vida. O desafio contemporâneo posto aos serviços de saúde é o de fornecer a seus usuários os instrumentos adequados para que possam desenvolver criativamente suas habilidades para o cuidado-de-si. Tal empreita pode ser mais bem sucedida quando indivíduos e grupos interagem e, desta forma, partilham, utilizam e produzem conhecimentos, conformando uma Inteligência Coletiva. Com esta concepção o presente estudo buscou desenvolver processo de formulação de propostas de reorientação da assistência ao diabetes mellitus mediante a mútua cooperação entre profissionais de saúde e usuários de serviço de atenção primária à saúde. Para tanto, estruturou-se pesquisa-ação de caráter exploratório sobre os obstáculos ao autocuidado no diabetes mellitus tipo 2 produzidos por características de organização do serviço: o intervalo longo entre as consultas, a descontinuidade do cuidado e a dificuldade de comunicação entre profissional - paciente. Tais campos problemáticos foram mais bem explorados mediante a análise de banco de dados obtido por meio de entrevista estruturada... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The conceptualization that traditionally orients service organization is based on technical knowledge characterized by the centralization of its formulation and by an authoritarian character in which the patient is recognized from his disease and from the organs where it is located, with the patient playing a restricted role in therapy. The inadequacy of this perspective can be perceived, among other reasons, from its incapacity to respond to the complexity of prevalent chronic conditions, such as arterial hypertension and diabetes mellitus. Such morbidities can only be effectively controlled when patients develop effective competence to engage in self-care so as to adapt the medical norm to their daily lives with autonomy and preservation of their quality of life. The contemporary challenge posed to health care services is that of providing users with suitable instruments so that they can creatively develop self-care skills. Such undertaking can be successful when individuals and groups interact and thus share, use and produce knowledge, hence forming a Collective Intelligence. With this conceptualization, the present study aimed at developing a process for formulating proposals to reorient diabetes mellitus care provision based on mutual cooperation between health care professionals and primary health care service users. To that end, an exploratory action study was designed concerning the obstacles to self-care in type-2 diabetes mellitus which are caused by characteristics of service organization: the long interval between consultations, care discontinuity and the difficulty of communication between professionals and patients. Such problematic fields were better explored by analyzing a database obtained from structured interviews with 275 diabetic individuals. Based on that information, focal groups were performed so that the diabetic individuals could discuss the problematic... (Complete abstract click electronic access below) / Mestre

This thesis focuses on how reproductive health is made meaningful in the context of a Planned Parenthood clinic in Kentucky. Using ethnographic field methods, including participant observation and semi-structured interviews, the paper explores how staff members negotiate definitions of reproductive health as employees of Planned Parenthood health center. The analysis addresses reproductive health discourse among the clinic staff and how reproductive health is used as a site of intervention. It also explores the sociocultural processes and interactions the staff members engage in at the national and local levels and the role these play in shaping the conceptualization of reproductive health and how it is deployed at the clinic level. This analysis illuminates the fluid nature of reproductive health meanings and the ways in which health care delivery is contextually and socially mediated.

Pražské nemocnice v letech 1948-1968 Ing. Mgr. Kateřina Murtingerová Summary: This work presents a development of Prague hospitals during 1948 and 1968. The first part of my thesis describes theoretical and historical background of health care provision in the first half of the 20st century and it is focused on development of Czech healthcare system. This part of thesis also includes reform plans and concepts proposed during the first republic and the Second World War, with special attention to Albert and Nedvěd's plans playing a key role in setting of healthcare provision after the year 1948. The second part of this thesis is based on legislative and institutional analysis after the Second World War that was developing hand in hand with social, political, and economic changes in Czechoslovakia. Important part of this capture is also an assessment of the results of health care provision during 1948-1968 from the perspective of the whole country, including structure and availability of hospital care, demographic trends and population health trends, expenditure of health care provision and preventive measures etc. Thesis also includes historical overview of academic environment. The issue of Prague hospitals and hospital care is framed in the context of institutional and legal framework of health care system...

The diploma thesis deals with the identification of risks which threaten students in the fields of Radiology Assistant, General Nurse and Paramedic. The aim of the thesis is to map the knowledge of risks during providing health care in students of selected fields at the Faculty of Health and Social Studies at the University of South Bohemia. Four hypotheses were set in the thesis. Hypothesis no. 1 saying that there are statistically significant differences in risk knowledge between students of the first and last year of individual fields of health care. Hypothesis no. 2 that there are statistically significant differences in stress perception as a risk-enhancing factor between paramedics and general nurses. Hypothesis no. 3 states that there is a statistically significant difference in the knowledge of the risk of ionizing radiation between radiological assistants and general nurses and hypothesis no. 4 that paramedics will call their future occupation more risky than general nurses. To achieve the objectives and verify the hypotheses, a questionnaire was prepared, a questionnaire survey was conducted and everything was evaluated using graphic and statistical methods. The questionnaire contained 23 questions and the research sample consisted of 105 respondents from the studied fields. The results show that hypothesis no. 1 was confirmed in the fields of Radiology Assistant and Paramedic and rejected by the General Nurse. Hypothesis no. 2 was also confirmed. Hypothesis no. 3 was rejected and hypothesis no. 4 was also rejected. The contribution of the thesis is a complex picture of the knowledge of risks during providing health care in the studied fields. The results can serve the faculty to further more effective teaching.

La démographie médicale est un sujet de préoccupation ancien en France. Les disparités de la répartition des médecins libéraux sont reconnues depuis plusieurs siècles. Des témoignages contemporains et de nombreux travaux de recherche ont largement démontré la persistance de leur attirance pour le milieu urbain. Or, l’urbanisation du pays dès le milieu du XIXème siècle a rendu confuse la lecture de ces liens. Le développement urbain a été particulièrement important en Ile-de-France en raison de la présence de la capitale. Il se poursuit, accéléré par la métropolisation générée par la mondialisation. Grâce à une approche dynamique ignorée en France, l’objectif de cette thèse est de comprendre les déterminants géographiques de l’installation en libéral et leurs adaptations aux dynamiques urbaines. Nous avons utilisé une démarche quantitative à différentes échelles et périodes grâce à l’exploitation d’archives administratives anciennes et de données actuelles. Une recherche qualitative complémentaire a été mise en oeuvre dans deux communes de banlieue. Notre étude révèle que depuis le XIXème siècle, l’installation des médecins libéraux est guidée par la recherche de la centralité dont ils sont des indicateurs. La reconstitution de leur répartition fait apparaître l’ancienneté et la stabilité des déséquilibres fonctionnels de l’espace francilien, accentués par la métropolisation. Le recul temporel permet de constater les spatialisations différenciées de ce groupe professionnel et de la population. Leur démarche ne répond donc pas à de quelconques logiques sanitaires. / The amount of the physicians has been a cause of concern for a long time. The private practitioners uneven distribution is well known since several centuries. Contemporary accounts and numerous research works have demonstrated the persistence of their attraction for urban environment. But, the urbanization of the country since the middle 19th century has muddled up the deciphering of these links. Urban development has been particularly important in Paris area because it includes the french capital. That development still goes on, accelerated by the metropolization generated by globalization. Thanks to a dynamic approach ignored in France, the objective of this thesis is to reveal and explain the private physicians distribution due to their adaptation to the urban dynamics. We have used a quantitative approach by using of historical archives and current data. In addition, the qualitative research was implemented in two suburb towns. Our study demonstrates that since the 19th century, centrality is the determining factor of their distribution. In fact, private doctors are an indicator of that spatial property. The noticed evolutions reveal the oldness and the stability of spatial functional imbalances in Paris area. They are stressed by the metropolization. The benefit of hindsight highlights different spatial logics of population and physicians. There are no sanitary logics in their spatial behavior.

The purpose of this study was to explore and describe the perceptions of health professionals on the changes brought about by health system reforms in Zimbabwe. Qualitative, explorative and descriptive research was conducted to identify concerns of health care provision, as described by health professionals in Zimbabwe, and to provide awareness for future reforms. Data collection was done using semi-structured interviews. Ten health professionals from two study sites participated in the research. The findings revealed that health professionals have an understanding of health system reforms and how these have changed the way health services have been delivered over the years. There is a general outcry among health professionals regarding the deteriorating provision of quality health care amidst the challenges that the health system is facing under a collapsing economic situation. The study recommends inclusion of health professionals in policy making as well as timely dissemination of any information regarding changes in policy. The study also recommends further research on the same topic with a larger diverse group of participants. / Health Studies / M. P. H.

and key words ! Thesis: Constitutional limits of statutory regulation of the provision of health care ! Abstract ! The main goal of this thesis is to characterize and analyse the legal regulation concerning the provision and payment of health care under Czech law. This analysis is based mainly on the Charter of Fundamental Rights and Basic Freedoms as the foundation for the constitutional perspective. The thesis therefore begins with the constitutional limits of the provision and payment of health care. The right to health care is provided by Article 31 of the Charter of Fundamental Rights and Basic Freedoms, which is the basis for its constitutional provision. As the Charter is a complex document, Article 31 must therefore not be seen as isolated, which is why other Articles are taken under consideration. This provides a complex view of the right to health care in the Czech constitution. The thesis then focuses on the characterization of statutes and executive regulations, which provide the basic right to health care. This part of the thesis is focused mainly on the Public Health Insurance Act, as the most important statue in this area and also on executive regulations based on the Act, which imminently regulate the right to health care. Both of these parts of the thesis serve as a precise...