Thesis (MPH.) -- University of Limpopo, 2021 / Background: South Africa’s poor maternal health indicators have resulted from weak maternal health services delivery, including access to quality family planning, skilled birth attendance, emergency obstetric care, and postnatal care for mothers and new-borns. Maternal deaths and disabilities remain a major public health problem in developing countries and maternal mortality is the health indicator which shows the greatest gap between the rich and poor countries. There are global achievements which are substantial reduction in global maternal mortality and an increase in the proportion of childbirths occurring in health facilities. On annual basis there are maternal health outcomes which occurs and these include an estimated 139 million births, an estimated 289 000 women die during pregnancy, childbirth or soon after and lastly an estimate 2.6 million will have stillbirths and 2.9 million infants will die in the first month of life. The purpose of the study was to determine the factors driving maternal health services utilization in rural areas of Limpopo Province. Methodology: The current study was done at Hlogotlou area in Sekhukhune district of Limpopo province and it used a quantitative research approach, that was descriptive cross-sectional study to determine the factors driving maternal health services utilization. The structured questionnaire was used to describe the knowledge levels of pregnant women on utilizing the antenatal services and to describe the utilization of prenatal services by pregnant women. The sampling method was random. The total number of 450 pregnant women participated in the study and all of them were analysed. Data were analysed using STATA version 12 and descriptive statistics were used to describe the data wherein categorical variables, frequencies and percentages were reported. Differences between groups (teenagers, adolescents, adults) were analysed using univariate logistic regression. Results: A total of 450 pregnant women were interviewed majority of women were in the age group 21-25 years, single, unemployed had a secondary educational level. Socio-economic status was assessed using a household wealth index and majority of the pregnant women in the current study were in the medium socio-economic status at 66.4% and majority of the women were using social grants 67.8%. Majority of women get information pertaining to antenatal care from televisions followed by those who v received information from leaflets, radio and those who did not receive information from anywhere at 37.1%, 23.1%, 22.7% and 16.9% respectively. There was a statistical significance difference between those who initiated first antenatal care visit before 12 weeks and after 12 weeks at p-value=0.007. Majority of pregnant women who used televisions as source of information for maternal health care, majority of them were found to be initiating antenatal care after 12 weeks at as compared to those who used radio and leaflets or newspapers as they initiated antenatal care before 12 weeks. Majority of pregnant women in the current study were aware of the antenatal care services rendered at the clinics and they were aware of the fact that antenatal care services rendered at the clinics could assist in detecting the complications related to pregnancies and also reported that these services could reduce the maternal and neonatal morbidity including maternal mortality. There was an understanding of the importance of antenatal care amongst the pregnant women. The predictors of utilization of maternal health services were young age, lower educational level pregnant women who were not married were pregnant women who were in the low socio-economic status. The young pregnant women were 2.2 times more likely to plan their pregnancies and 1.8 times more likely to discuss their pregnancies with their partners or spouses. Pregnant women who were married at a young age were 0.4 times less likely to lack the knowledge about existing for antenatal care at the clinics. Pregnant women with lower educational level were 6.8 times more likely to lack the knowledge about existing for antenatal care at the clinics. Pregnant women who were not married were 2.1 times more likely to go for the first antenatal care booking in the first trimester (1-12 weeks). Pregnant women who were in the low socio-economic status were 1.4 times more likely to lack the knowledge about existing for antenatal care at the clinics and 1.3 times more likely to report that barriers to accessing antenatal care services was either culture, religion or language barrier. Conclusion: The findings of this study highlight the need to address the structural socio-economic drivers of maternal health care utilizations in rural areas of Limpopo Province, South Africa. Timely entry to antenatal care was low in the study area. In order to improve the situation, it is important to provide community-based information, education and vi communication on antenatal care and its right time of commencement. In addition, empowering women and implementing the proclamation designed for the age at marriage should be mandatory up to the local level. Our findings suggested that policies enhancing improved education could benefit health awareness. Key concepts Antenatal care, maternal health care services, pregnant women, utilization.

Integrated behavioral health care within primary care has become a popular style of health care delivery within the United States. However, individuals with a behavioral health concern face several barriers in using these services. The purpose of this quantitative study was to identify key factors accounting for individuals' utilization and intensity of behavioral health services. Andersen's behavioral model of health care use and the integrated theory of health behavior change served as the theoretical framework. It was hypothesized that gender, age, race, ethnicity, family size, payer type, poverty level, and certain preexisting medical conditions (obesity, diabetes, hypertension, and tobacco use) would determine behavioral health care utilization and intensity. A secondary data analysis of 315 individuals who used behavioral health services within primary care was performed; the study setting was at the Center for Health, Education, Medicine, and Dentistry, located in Lakewood, New Jersey. Among the individual variables examined, only a preexisting condition of hypertension reached statistical significance, showing that those individuals were more likely to attend multiple sessions, Ï?2 (1) = 5.77, p = .02. Payer type was also found to be predictive of behavioral health care intensity. Medicare recipients were more likely to attend multiple behavioral health care sessions (74%) than were Medicaid recipients (59%) and those who were uninsured (25%). By providing insights about the barriers faced by individuals, study findings may help patient advocates and health care professionals to provide individuals with better health care. This study has implications for positive social change, as study findings may assist the United States health care system in its shift toward an integrated behavioral health care style of health care delivery.

Abstract:Aims: Due to large inconsistencies in previous studies, it remains unclear how alcohol use is related to health care utilization. The aim of this study was to examine associations between alcohol drinking status with utilization of outpatient and inpatient health care services in Germany. Methodology: Survey data of the GEDA 2014/2015-EHIS study with n = 23,561 German adults were analyzed (response rate: 27 %). Respondents were categorized as lifetime abstainers, former drinkers, and non-weekly drinkers, as well as weekly low-risk drinkers and risky drinkers. Outpatient services included GP, specialist, and hospital visits; inpatient services included hospital overnight stays in the last 12 months. For both settings, binary logistic regression models were applied, adjusted for possible confounders. Results: For specialist visits, elevated odds were found among former drinkers (odds ratio (OR) = 1.93, 95 % confidence interval (95 % CI) = 1.50-2.49), non-weekly drinkers (OR = 1.24, 95 % CI = 1.05-1.47), weekly low-risk drinkers (OR = 1.39, 95 % CI = 1.17-1.67), and risky drinkers (OR = 1.28, 95 % CI = 1.04-1.57) compared to lifetime abstainers. In contrast, lower odds for inpatient service use were found among non-weekly drinkers (OR = 0.76, 95 % CI = 0.62-0.93), low-risk drinkers (OR = 0.66, 95 % CI = 0.53-0.81), and risky drinkers (OR = 0.65, 95 % CI = 0.51-0.84). No differences were observed for GP and outpatient hospital visits. Conclusions: While the increased odds of consulting a specialist are consistent with higher health care needs among former and current drinkers, the lower use of inpatient care among current drinkers is contrary to known health risks associated with alcohol consumption and evidence from hospitalized populations. The findings also highlight the need to differentiate between lifetime abstainers and former drinkers in their use of health services.

Company health care services Abstract The thesis is focused on the company health care services and its legal regulation. It aims to describe and analyse particular duties of an employer, an employee and a company health care services provider, hence the subjects which are of an imminent closeness to the company health services issues. The thesis is composed of five chapters. The first chapter is dedicated to the legislation, as the primary law source in the Czech Republic and further to the European and international law. The chapter also comprises basic definition of the term company health care services and its position in relation to the occupational medicine. Second chapter draws attention to the subjects, whose duties the thesis deals with, including their part in the labour law system. They are the company healthcare services provider, the employer, and the employee. Furthermore, the chapter reflects the exceptions based on the agency employment, providing the company health care services by employee's registering health care provider, and providing the health care services by employer's own staff. Third chapter depicts the analysis of the duties of the company healthcare services provider, especially the analysis of the duties set by the Act on the Special Medical Services. Beside the provider's...

Thesis (MBA (Business Management))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: Purpose – The health care industry is faced with numerous challenges ranging from rising medical costs, poor state of hospitals, deteriorating health care services and an increasing number of hospital deaths. All these disparities present tremendous challenges for the health care managers in charge of the health care services. As a result, they are forced to try new management methods that will assist their organizations to remain cost effective and efficient. Total Quality Management (TQM) constitutes an appropriate response to these challenges and it has become the strategy of choice to improve organization’s performance and patient satisfaction. However, in practice the implementation of TQM is often unsuccessful. Certain barriers have been identified which prevent the successful implementation of TQM in other industries as well as in the health care industry. The main aim of this research is to investigate the barriers to the successful implementation of Total Quality Management in Kraaifontein health care service organization in the Western Cape Province, 2008. Design/methodology/approach – The study employed a quasi-qualitative and quantitative case study. For the quantitative section a questionnaire with a 5–point Likert style scale was used to quantify the response (strongly disagree=1; strongly agree=5). For the qualitative section a focus group discussion was conducted to verify the results obtained from the questionnaire which addressed the challenges of TQM implementation. The statistical population of this research consisted of all health care workers working the pharmacy department who were involved in the implementation of TQM in their organization. Data was analyzed using appropriate statistical procedures. The mean score of each of the dimensions was used as a representative performance indicator and the coefficient of variation (CV) was used as a general measure of standardized skewness on the performance of each dimension. A high means score indicated desired outcomes while low scores indicated poor outcomes. Findings – Major barriers that were encountered during the implementation of TQM in this case study included the lack of top management active involvement and full commitment in the initiative, rigid organizational structure, culture towards quality changes that inhibited communication between management and employees which in turn hindered employee empowerment. Other obstacles that were encountered were lack of continuous improvement processes and initiative, improper evaluation, the lack of a recognition and reward system for team work, poor collection and analysis of data that resulted in difficulty to convert this data into meaningful information to improve quality. The absence of an integrated performance measurement system also exhibited a problem as employees were not aware what was being assessed during performance appraisals. Lack of evidence based decision making, poor communication and inflexible organizational structure and culture were also viewed as barriers. Research limitations/implications – Although conducted in Kraaifontein health care facility, it is expected that the results of the study may be relevant on a broader scale to other health care departments and facilities. The results could assist the health care managers to develop a plan that addresses the barriers and challenges faced during the implementation of TQM, yielding fruitful results which allow TQM to be implemented easily, effectively, efficiently and successfully in health care facilities. / AFRIKAANSE OPSOMMING: Doel – Die gesondheidsorg sektor het vele uitdagings wat wissel van stygende mediese kostes, lae standaarde in hospitale, die agteruitgang van gesondheidsorg dienste, en die toename in sterftes in hospitale. Hierdie en ander probleme stel groot uitdagings aan diegene verantwoordelik vir die lewering van gesondheidsorg, met die gevolg dat diesulkes nuwe bestuursmetodes moet vind om te verseker dat hulle organisasies steeds koste-effektief en doeltreffend funksioneer. Totale Gehalte Bestuur (TGB) is ‘n geskikte en toepaslike alternatief om genoemde probleme aan te spreek, en word toenemend as oplossing gesien om organisasies se dienslewering te verbeter, en pasiënt-tevredenheid te verseker. Die implementering van TGB blyk egter nie altyd suksesvol te wees nie. Daar is spesifieke struikelblokke geidentifiseer wat as redes aangevoer word vir die onsuksesvolle implementering van TGB in verskeie sektore, insluitend die van gesondheidsorg. Die hoof doel van hierdie navorsing was om die struikelblokke te ondersoek wat verhoed dat TGB suskesvol toegepas word in Kraaifontein gesondheidsdienste in die Weskaap, 2008. Ontwerp/Metode/Benadering – Die studie was ‘n kwasi kwalitatiewe en kwantitatiewe gevallestudie; vir die kwantitatiewe komponent is ‘n 5 punt Likert tipe skaal gebruik om die response (verskil beslis = 1; stem beslis saam = 5) te kwantifiseer. Die kwalitatiewe komponent het ‘n fokusgroep bespreking behels, waartydends die resultate van die vraelys geverifiëer is, wat die uitdagings van die implementering van TGB uitgewys het. Die statistiese populasie vir hierdie navorsing was al die gesondheidsorg werknemers in diens van die aptekers-departement, wat betrokke was in die implemetering van TGB in hulle organisasie. Die data is geanaliseer met toepaslike statistiese metodes. Die gemiddelde telling van elkeen van die dimensies was gebruik as ‘n verteenwoordigende aanduiding van prestasie, en die koëfisiënt van veranderlikheid was gebruik as ‘n algemene maatstaf van die gestandardiseerde skeefheid soos gemeet op elkeen van die dimensies. ‘n Hoë gemiddelde telling was ‘n aanduiding van die beoogde uitkomste, en lae tellings aanduidend van swak uitkomste. Bevindinge – Belangrike uitdagings wat ondervind is tydens die implementering van die TGB in hierdie gevallestudie sluit in, die gebrek aan aktiewe betrokkenheid en toewyding van die topbestuur vir hierdie inisiatief, rigiede organisatoriese strukture, die kultuur teenoor gehalte veranderinge wat kommunikasie tussen bestuur en werknemers belemmer, wat op sy beurt werknemer-bemagtiging verhoed. Ander struikelblokke wat geidentifiseer is, was ‘n afwesigheid van voortdurende verbeteringsprosesse en inisiatief, swak evaluering, ‘n gebrek aan ‘n sisteem vir erkenning en vergoeding vir spanwerk, swak data insameling en ontleding, wat tot probleme gelei het om die data in betekenisvolle inligting te verwerk wat kon lei tot ‘n verbetering in gehalte. Die afwesigheid van ‘n geintegreerde prestasie-beoordeling sisteem is ook as probleem geidentifiseer omdat werknemers nie ingelig was oor wat die prestasie-beoordelings behels nie. Die gebrek aan navorsingsgesteunde besluitneming, swak kommunikasie, en onbuigsame organisatoriese strukture en kultuur, was ook gesien as struikelblokke. Navorsing-beperkinge/implikasies – Alhoewel die studie in Kraaifontein gesondheidsorgfasiliteit gedoen is, word dit aanvaar dat die bevindinge van hierdie studie ook van toepassing is op ander gesondheidsorg departmente en fasiliteite. Die resultate kan gesondheidsorgbestuurders help om die uitdagings en struikelblokke te identifiseer in die implementering van TGB. Hierdie identifikasie kan lei tot ’n meer effektiewe en suksesvolle implementering van TGB in gesondheidsorgfasiliteite.

Syfte: Att studera bvc-sjuksköterskors erfarenheter av familjer med förekomst av nedstämdhet efter förlossning. Bakgrund: Nyblivna föräldrar kan drabbas av förlossningsdepression och nedstämdhet efter förlossning. Detta kan störa den viktiga anknytningen till barnet och ge långsiktiga negativa konsekvenser för barnets fortsatta kognitiva och känslomässiga utveckling. Barnhälsovårdens uppdrag är att förebygga ohälsa hos barnet, bedriva hälsofrämjande och föräldrastödjande samtal, samt bidra till hälsosamma relationer inom familjen. Enligt familjefokuserad omvårdnad ses familjen som en enhet och om en familjemedlem drabbas av ohälsa påverkar det hela familjen. Design: En kvalitativ design valdes för studien. Metod: Sju bvc-sjuksköterskor intervjuades våren 2017 och den insamlade datan analyserades med kvalitativ innehållsanalys. Resultat: Bvc- sjuksköterskornas erfarenhet är att föräldrarollen påverkas vid nedstämdhet vilket i sin tur kan påverkar anknytningen till barnet och relationerna inom familjen. Bvc-sjuksköterskornas erfarenheter visar också att det finns fördelar med att involvera hela familjen, men att bvc- sjuksköterskorna inte alltid känner sig trygga i att erbjuda stöd till familjen relaterat till brist på utbildning och erfarenhet. Bvc-sjuksköterskor erfar också att det är en utmanande arbetssituation med nedstämda familjer och att det kan vara svårt att upptäcka dem. Slutsats: Bvc-sjuksköterskors erfarenheter är att hela familjen påverkas vid en nedstämdhet. Det skulle vara betydelsefullt att inom bvc-verksamhet se hela familjen som en enhet eftersom alla i en familj påverkar varandra, men också för att familjemedlemmarnas mående kan vara avgörande för barnets framtida hälsa och utveckling. / Aim: To study child health care nurses’ experiences of families with prevalence of depression after childbirth. Background: New parents may suffer from maternity and paternity postpartum depression ranging from mild to severe. This can interfere with the important bonding to the child and give long-term negative consequences for the child's continued cognitive and emotional development. The child health service’s mission is to prevent childhood illness, to promote health and support parents, and contribute to healthy relationships within the family. According to family-centered care, the family is seen as a unit and if one family member suffers from ill health, it affects the whole family. Design: A qualitative design was chosen for the study. Method: Seven child health care nurses were interviewed in spring 2017 and the collected data was analyzed with qualitative content analysis. Findings: The child health care nurses’ experiences show that parental influence is affected by depression, which in turn can affect the relationship with the child and the relationships within the family. The experiences of the child health care nurses also show that there are benefits of involving the whole family, but the child health care nurses do not always feel confident in providing support to the family due to lack of education and experiences. The child health care nurses also experience that working with depressed families is a challenging work situation and that they can be hard to detect. Conclusion: The child health care nurses’ experience is that the whole family is affected at a postpartum depression. It would be beneficial for the child health care nurses to tend to the whole family as a single unit, partly because everyone inside the family affect each other but also because the overall well-being of the family as a whole can be crucial to the child’s future health and progress.

O objetivo desta pesquisa foi descrever e analisar a produção do cuidado através das atividades de arte e cultura nos CAPS que atendem adultos no município de São Paulo, conforme informado pela observação dessas atividades e breves relatos de profissionais envolvidos nesse cuidado. Trata-se de investigação empreendida a partir de parte da base de dados da pesquisa Avaliação dos Centros de Atenção Psicossocial do Município de São Paulo, desenvolvida em 21 CAPS que atendem adultos entre 2007 e 2008. Foram analisados os relatos de observação etnográfica das 126 atividades de arte e cultura que integraram aquela pesquisa. O método empregado foi análise de conteúdo, com referenciais da reabilitação psicossocial; da arte e da cultura; e de meios terapêuticos em Terapia Ocupacional (enquadres, atividades e vínculos). A interpretação dos resultados deu visibilidade a três tendências de cuidado. A primeira foi caracterizada por atividades realizadas exclusivamente dentro do CAPS e voltadas à ampliação de competências pessoais, com vínculos relacionados a interações dentro dos grupos; temas referentes às dificuldades e desafios dos participantes; e produções culturais circunscritas ao ambiente dos serviços. O foco do cuidado foi o processo grupal e as atividades tiveram função predominantemente expressiva. A segunda tendência caracterizou-se por uma perspectiva clínica desenvolvida na interface da arte e da saúde, com desdobramentos em direção ao território. Predominaram as parcerias com espaços culturais, a diversidade de abordagens, a sustentação de experiências criativas e a ampliação dos repertórios culturais dos participantes. A ampliação das relações com os espaços da cidade, a autoria e as produções artísticas e intervenções culturais em âmbito mais amplo do que o CAPS caracterizaram essa tendência, em que arte, cultura e cuidado estiveram relacionados à produção de vida. Uma terceira e minoritária tendência esteve relacionada a dificuldades na condução das atividades; repertórios limitados; desconsideração de necessidades, desejos ou projetos dos participantes; e ausência de oportunidades de experiência estética e cultural. No seu conjunto, as atividades tiveram pouca visibilidade para gestores, com escassez de discussão no âmbito das equipes multiprofissionais e um aproveitamento tímido na articulação de redes de apoio social aos sujeitos da atenção, percepções essas que sugerem uma possível fragmentação do cuidado, tanto em relação ao projeto terapêutico do CAPS quanto aos projetos individuais. Seu pleno desenvolvimento, na perspectiva da reabilitação psicossocial, parece depender: do acesso dos profissionais a bens culturais, processos criativos e recursos de avaliação; da sua visibilidade, para gestores e equipes, enquanto trabalho implicado na instauração de formas de convívio com a diferença; e da consideração de todos os atores envolvidos como produtores de fatos de cultura / The research\'s main goal was to describe and analyse the mental health care through artistic and cultural activities in 21 Psychosocial Health Care Community Services (CAPS) at the city of São Paulo. These facilities are targeted to the treatment of adult people undergoing serious mental ilness. This research was developed using part of the data base of the Avaliação dos Centros de Atenção Psicossocial do Município de São Paulo research, carried out from 2007 to 2008. The ethnographic observation reports related to all 126 artistic and cultural activities and a brief report of the health providers about it were analysed through content analysis. The theoretical framework included the concepts of psychosocial rehabilitation, art and culture and occupational therapy perspectives. It was possible to identify three main trends of mental health care. The first, more common trend, consisted of activities conduced strictly inside the CAPS\'s facilities, aiming to improve personal capacities, to stimulate the self knowledge, to establish bonds among the patients, to share life\'s adversities; the focus of this procedures were the patients group process. The second trend included activities outside the facilities, in public spaces and cultural facilities; aiming artistic and cultural creative experiences and social reinsertion; this trend stood out by using both health and art professionals, with different approaches. The third and smaller trend had difficulties to conduce their activities, lacking of cultural repertory, disregarding of patient\'s needs, desires or projects and lack of aesthetic and cultural experiences. The art and culture activities, in general, had low visibility to managers and healthcare teams and were barely considered in the social support network strength. The results suggest a fragmentation of the care provided, both in institutional terms as in individual therapeutic project. To develop a more comprehensive care with the whole development of art and culture activities would depend on: providers have greater access to creative and cultural experiences and evaluation resources; managers and providers teams to acknowledge these activities; the acceptance of the differences; and everybody start to be considered as facts of culture producers.

Partindo de uma abordagem da figura polêmica da loucura como domínio estratégico de inúmeras relações de poder que não majoritariamente orientadas por princípios restritivos, esta dissertação enfoca a produção do sujeito “usuário" em um NAPS (Núcleo de Atenção Psicossocial) – instituição pública de saúde mental vinculada ao movimento da Luta Antimanicomial. Para tanto, transcrições de entrevistas com os usuários foram analisadas segundo o método de análise institucional de discurso. Visou-se, com isso, ao estudo da constituição do sujeito no discurso – o que implica tanto o seu vínculo com a instituição quanto a interlocução que se configura com o entrevistador no ato mesmo da entrevista. Empreendendo uma analítica do discurso do usuário – em detrimento de classificações psiquiátricas ou psicopatológicas impostas aos sujeitos –, realizou-se o delineamento de singularidades por meio da positivação desses discursos. Por fim, confrontando as análises das entrevistas, buscou-se mapear as regularidades discursivas e as diversas correlações de força. Temas como violência, médicos, sexualidade, medicamentos e cotidiano institucional são abordados nesta pesquisa, sempre tendo por base o discurso dos usuários. / Starting with an approach of the controversial image of insanity as a controlling strategy of various power relationships, which are not mostly guided by restrictive principles, this dissertation focuses on the subject’s production, a user in a NAPS (Social and Psychological Attention Centre) – public institution of mental care, which is linked to the “Anti-Mental Hospital" fight. Therefore, transcriptions of users’ interviews were analyzed according to the institutional discourse analysis method. For the objective of studying the subject’s constitution in the discourse – which implies its relation to the institution and the conversation configured with the interviewer during the interview. Applying the user’s discourse analysis – in disregard of psychiatric or psychopathological categories imposed on the subjects – was made the outline of singularities through the assertiveness of those discourses. At last, comparing the interviews’ analyses, we intended to map discourse regularities and various power correlations. Topics like violence, medicals, sexuality, medicine and institutional daily life are always approached in this research, keeping the users’ discourse as support.

O sistema público de saúde brasileiro tem sido convocado a dar resposta a um cenário ao qual se observa transição epidemiológica composta por um emergente aumento de condições crônicas de saúde. Em oposição ao sistema fragmentado, com foco nas condições agudas, voltado para o atendimento individual e isolado, que age de forma reativa e episódica em relação à demanda das pessoas usuárias, surge a Rede de Atenção à Saúde (RAS) com o objetivo de prestar a atenção certa, no lugar certo, com o custo certo e no tempo certo. Para tanto a RAS baseia-se na Atenção Primária à Saúde (APS) como eixo estrutural, esta sendo o centro de comunição das RAS e a porta de entrada do sistema. Assim, cabe a APS a função de coordenação do cuidado e da ordenação da RAS de acordo com as necessidades de saúde das pessoas. Objetivo: Verificar a presença e extensão dos elementos de coordenação do cuidado e de ordenação da rede de atenção pela APS em diferentes tipos de serviços públicos de APS em Porto Alegre. Método: É um estudo transversal de base populacional em adultos adscritos à rede pública de APS de Porto Alegre (Unidade Básica de Saúde, Estratégia Saúde da Família, Centro de Saúde Escola Murialdo e Serviço de Saúde do Grupo Hospitalar Conceição). A análise consiste em questões do PCATool-Brasil, as quais, segundo os autores relacionam-se com as funções de coordenação e ordenação. Resultados: Observa-se que o escore médio de Coordenação e Ordenação pela APS geral é de 5,7 (5,5: 5,9). Quanto aos tipos de serviço, o GHC com escore médio de 6,78 (0,12) foi o único que ficou com valor ligeiramente superior ao valor do ponto de corte (6,6) da escala arbitrária para Coordenação e Ordenação. Os escores médios de coordenação e ordenação da UBS foi 4,85 (0,17); do CSEM 5,48 (0,17) e do ESF foi 5,95 (0,09). Conclusões: Observase que, na experiência dos usuários entrevistados, os serviços públicos de APS de Porto Alegre ainda são incipientes quanto ao desempenho das funções de Coordenação do Cuidado e Ordenação das RAS. / The Brazilian public health system has been called to respond to a scenario where the observed epidemiological transition consists of an emergent increase in chronic health conditions. In contrast to the fragmented system, focusing on acute conditions facing individual care and isolated, which acts in a reactive and episodic in relation to people's demand users, there is the Health Care Network (HCN) with the objective of providing the right attention at the right place, at the right cost and at the right time. For both the RAS is based on Primary Health Care (PHC) as a structural axis, this being the communication center of the HCN and the gateway system. Thus, it is the function of the PHC care coordination and ordering of HCN according to the health needs of the people. Objective: To determine the presence and extent of the elements of care coordination and ordering of the care network by PHC in different types of public PHC in Porto Alegre. Method: It is a population-based cross-sectional study in adults ascribed to public PHC of Porto Alegre (Basic Health Unit, Family Health Strategy, Health Centre Murialdo and Health Service of the Conceição Hospital). The analysis consists of questions PCATool-Brazil, which, according to the authors relate to the functions of coordination and ordering. Results: It was observed that the mean score for the Coordination and Ordination by PHC overall is 5.7 (5.5: 5.9). As for the types of service, the GHC with a mean score of 6.78 (0.12) was the only one who got slightly higher than the cutoff value (6.6) of arbitrary scale for Coordination and Sorting. Mean scores of coordination and ordenation of UBS was 4.85 (0.17), the CSEM 5.48 (0.17) and FHS was 5.95 (0,09). Conclusions: We observed that, in the opinion of the users interviewed, utilities PHC Porto Alegre are still incipient as the performance of functions of the Care Coordination and Ordination of HCN. / Telemedicina

Thesis (M. Nursing Science) --University of Limpopo, 2018 / Introduction: Diabetes mellitus has become a worldwide problem that is continuing to rise resulting in morbidity and mortality in developing countries.Finland developed the FINDRISC tool. Canada uses the Finnish Diabetes Risk Score (FINDRISC) tool and the Canadian Diabetes Risk Questionnaire (CANRISC), Germany has developed the German Diabetes Risk Score (GDRS). These risk scores are all self-assessment tools meant for assessing the risk of diabetes. They cover variables such as age, waist circumference, height, history of hypertension, physical activity, consumption of alcohol, coffee, whole grains and red meat (Buijsse, Simmons, Griffin & Schulze, 2010). Aim: To determine the feasibility of Home-Based Carers (HBCs) on the use of the FINDRISC tool to assess diabetes mellitus (DM) patients at Ga-Dikgale Village, South Africa. Methodology: A quantitative, descriptive cross–sectional design has been used to describe knowledge and practices of HBCs in using FINDRISC tool to assess the Diabetes Mellitus patient at the Dikgale village. Fifty two (52) HBCs have been assessed and homogeneous purposive convenience sampling has been used. A modified (tool) has been used by the HBCs to assess the risk status of people to determine diabetes risk status while the researcher scored the HBCs on the utilisation of modified FINDRISC tool after they have demonstrated all sections of the risk assessment tool. Data analysis has been done using (Statistical Package for Social Sciences) IBM ABSTRACT vii SPSS version 24 software and Microsoft excel sheet. Results: This study has found that HBCs can play in important role in the assessment of patients at risk of developing diabetes in the communities by using the assessment tool. The knowledge and skills of the HBCs that have been acquired throughout the years can be augmented by strengthening the primary health care re-engineering programme and in-service training that can be tailored for proper functioning of the HBCs within the health care team. Conclusion and recommendation: The burden of DM can be alleviated through the use of FINDRISC tool by determining diabetes risk status and employ necessary precautions to assist people who are at risk. This study recommend that the FINDRISC tool be modified in order to be relevant to the African perspective by validating of the tool through taking blood samples from people who are at risk . Keywords: diabetes mellitus, home-based carers, Finnish diabetes risk score tool, feasibility, assessment of patients at risk.