ABSTRACT Title: The environment as a tool in nursing - School nurses experiences from using the physical environment in their office supporting schoolchildren Author: Egnell, Maria Department: School of Health and Education, University of Skövde Course: Master Degree project in Nursing, OM854A, 15 ECTs Supervisor: Thorstensson, Stina Examiner: Larsson, Margareta Pages: 28 Keywords: School nurses, environment, health environment, nursing, children       Background: According to research, the physical environment effects children’s well-being. School nurses offer a range of nursing activities promoting health to schoolchildren and to support school performances. The nursing activities occur at school in a psychosocial as well as a physical environment. The school nurses office as a health environment, affects meetings and schoolchildren that occur within it. School nurses take support in the physical environment in their work with schoolchildren. The field has not yet been researched as an important part of nursing at school.   Aim: The aim of this study was to elucidate the school nurses perceptions of using the ward atmosphere at their office, as a tool in nursing.   Method: A qualitative research method was selected for the study. The result emerged through qualitative content analysis. Five school nurses from various schools in Gothenburg were interviewed, using semi structured interviews.   Results: Three major categories and six subcategories emerged during the analysis. Major categories were: offering a health environment for well-being, to be present in the environment for the children and to use the environment for health education.   Conclusion: The school nurses strived to make the office a place for well-being. They also used it for health information, as a sanctuary and as a connection point that considers children’s need for integrity. How the school nurses used the environment depended on who they were as individuals, as the field until now, not has gone through research. Obstacles depended on all those around, with too little knowledge in what school nurses work consist of and also from a complexity in being available to the children.

Medical service institutions and medical service types of Taiwan have experienced fundamental changes since the implementation of national health insurance. Therefore, the organizational vision and culture of a hospital and the professional commitment of doctors are critical in the hospital¡¦s ability to survive in the existing health environment. Among these factors, organizational human resources play the most important role, and doctors constitute the foremost human resources in a hospital. In recent years, armed forces hospitals have implemented programs to trim organization, leading to the further reduction of medical physicians. Moreover, the health environment external to armed forces hospitals has changed and wooed more medical officers from these hospitals. Therefore, it is the major purpose of this research to understand how to increase organizational loyalty of military physicians. This research examined factors that influence organizational commitment from dimensions including vision of organization, culture of organization, and career development and personal characteristics of doctors, and investigated the relationships of these dimensions with organizational commitment. Members on the military physicians at Armed Forces Tsoying General Hospital were targeted the population, and the research has resulted in findings as follows: (1) Among personal characteristics (of military physicians), only the variables of age and seniority made significant differences to the commitment to retention in organizational commitment; only unit of work made significant differences to effort commitment; and others made no significant differences to retention and effort commitment. (2) There existed a significant positive correlation between organizational vision and commitment to organization. (3) There existed a significant positive correlation between organizational culture and organizational commitment. (4) There existed a significant positive correlation between career development of employees and commitment to organization. This research has come up with two suggestions that follow: I. To high-level manager of armed forces hospitals: 1. Strengthen commitment to retention of junior military physicians. 2. Enhance military physicians¡¦ participation in planning for organizational vision. 3. Assist military physicians in job and personal development planning. II. To follow-up researchers: 1. Select different research variables. 2. Increase variable factors. 3. Draw samples from different populations. Keyword: Vision, commitment, health environment, personal characteristics, military physician

Since many adolescents experience the transition to young adulthood in college, the university health environment could play a significant role in addressing the current rise in chronic disease and obesity epidemic. The University Health Index for Nutrition and Physical Activity (UHI) tool, guided by the Center for Disease Control and Prevention (CDC) K-12 School Health Index, was developed to evaluate the associations between the university health environment and student health outcomes related to nutrition, physical activity, and weight. Several studies were conducted to examine what university characteristics are most strongly associated with college student health habits related to weight, nutrition, and physical activity behaviors. These studies culminated in a study to develop and validate the UHI. A request soliciting participation in the completion of the UHI was posted on the American College Health Association (ACHA) listserve. The final dataset used for analysis included 13 universities (N = 19) with a total of 9,460 National College Health Assessment (NCHA) student participants. Data were analyzed using Mixed-effects REML regression model adjusting for clustering effects, with statistical significance set at p < 0.05 and trends set a p < 0.10. Data were analyzed to determine associations between the total UHI score, individual module scores, and individual components of each module with student outcomes from the NCHA data (fruit/vegetable intake per day, days per week of aerobic and strength physical activity, and body mass index: BMI; kg/m² calculated from self-reported height and weight). Total UHI score was not significantly associated with outcome variables related to BMI, nutrition, or physical activity. The total health promotion module, however, was associated with vigorous physical activity (coefficient = 0.095; SE = 0.048; p = 0.046) and the built environment was associated with moderate physical activity (coefficient = 0.029; SE = 0.017; p = 0.096) and with high fruit and vegetable intake (coefficient = 0.021; SE = 0.011; p = 0.061). Individual questions related to recreational sports and fitness and nutrition and/or weight management counseling were associated with outcome variables as well. Measures for physical activity are better developed than for nutrition as there was only one nutrition question available with limited utility in terms of data analysis to test the UHI. Studying the university health environment and college students' health habits related to weight, nutrition, and physical activity is multifaceted and challenging. Unlike the K-12 school system, there is not a central university entity with jurisdiction over health-related student issues. Instead, health-related student issues and services are the responsibility of a variety of departments at a university and it is difficult to realize the complete university health environment. Results of this research can be used to refine future versions of the UHI and to continue to investigate the university characteristics that are most strongly associated with specific student health behaviors and outcomes related to nutrition, physical activity, and weight. / Ph. D.

Aim: To describe factors of significance for a good interaction between nurse and patient in their first meeting at a clinic in South Africa.  Method: This study was conducted as an empirical participant observation study with a qualitative design. The analysis was made with a qualitative inductive content analysis. Findings: The observations were analyzed into three main categories, Relationship, Communication and Healthcare environment with associated subcategories. Subcategories that are related to Relationship are presented as Approach and Consolation. Subcategories related to Communication are presented as Verbal communication and Nonverbal communication. Healthcare environment refers to where and how the interaction of the meeting took place but also contributor factors like Integrity. Conclusion: In order to get a good interaction between nurse and patient in the first meeting it is required that the nurse is engaged, is an active listener and puts the patient in her/his center of attention. A contributing factor that made the interaction between nurse and patient difficult to become good was disturbing factors like to many patients at same time in the same room. Knowledge about these factors can help nurses to improve their interaction with patients and lead to a satisfied care for the patient. / Syfte: Att beskriva faktorer som har betydelse för en god interaktion mellan sjuksköterska och patient i deras första möte på en klinik i Sydafrika. Metod: Studien genomfördes som en empirisk deltagande observationsstudie med en kvalitativ design. Analysen gjordes med en kvalitativ induktiv innehållsanalys. Resultat: Observationerna analyserades till tre huvudkategorier, Relation, Kommunikation och Vårdmiljö med tillhörande underkategorier. Tillhörande underkategorier till Relation presenteras som Bemötande och Tröst. Tillhörande underkategorier till Kommunikation presenteras som Verbal kommunikation och Icke-verbal kommunikation. Vårdmiljön syftar till var och hur interaktionen i mötet skedde men också bidragande faktorer som Integritet. Slutsats: För att få en bra interaktion i första mötet krävs det att sjuksköterskan är engagerad, lyssnar aktivt och sätter patienten i fokus. En bidragande faktor som gjorde det svårt för interaktionen mellan sjuksköterska och patient att bli bra var störande faktorer så som många patienter på samma gång i samma behandlingsrum. Kunskap om dessa faktorer kan hjälpa sjuksköterskor att förbättra deras interaktion med patienter och leda till en tillfredsställande vård för patienten.

O presente trabalho foi realizado no município de Bananal, uma área endêmica da Esquistossomose mansônica em São Paulo, com persistente prevalência e expansão na transmissão da doença. A presença de endemia evidencia um distanciamento da tríade Educação-Saúde-Ambiente, que se faz perceber pela inabilidade das comunidades atingidas em lidar com as situações de risco de contaminação. Este estudo analisou a influência do conhecimento sobre a Esquistossomose mansônica, dos estudantes da escola formal do município, em relação à suscetibilidade a contaminação, agregando-a aos outros fatores determinantes da expansão na dinâmica de transmissão e persistente prevalência. Foi utilizado um protocolo de avaliação de desempenho, baseado nas três categorias de aprendizagem, Conhecimento, Compreensão e Aplicação, do Domínio Cognitivo da Taxonomia dos Objetivos Educacionais de Bloom (1956), aplicado ao corpo discente do Ensino Fundamental (4ª a 8ª séries) e do Ensino Médio. O desempenho foi analisado no grupo total de alunos e no grupo de alunos doentes, relacionando o grau de conhecimento aos padrões da atividade humana no seu meio social e no inter-relacionamento com o Ambiente. Foram evidenciadas claras dificuldades nas três categorias de aprendizagem, em especial, nas relacionadas à aplicação do conhecimento compreendido no cotidiano, passando a representar assim, um fator determinante importante na suscetibilidade à contaminação da doença, seja no plano individual como no coletivo. Este fato norteou como recomendação a proposta de um Projeto em Educação Ambiental, sugerido a permear na escola formal como instrumento de integração Educação-Saúde-Ambiente, de forma que possa vir a constituir em uma força aliada, tanto ao processo de ensinagem como ao Programa de Controle da Esquistossomose, na intenção de auxiliar a conquista de um modo de vida melhor e mais saudável. / The current work was carried out in the Bananal municipality, an endemic area for schistosomiasis mansoni in São Paulo State, with a persistent prevalence and expansion of the disease transmission. The presence of the endemy highlights the distance between Education-Health-Environment triad, shown by the inability of involved communities in dealing with the contamination risks. This study avaliated the influence of the knowledge on schistosomiasis mansoni by the students of the formal schools in Bananal, concerning on contamination susceptibility aggregated to other determinant factors of the expansion in the transmission dynamic and persistent prevalence. A performance evaluation register, based in the three learning categories - knowledge, understanding and application from the cognitive field of taxonomy of Bloom´s Educational Goals (1956, 2001), was applied on Elementary and Middle School students. The performance was assessed considering the totality of the students as a group vs. the sick students group, associating their knowledge degree with the standard human activities in their social surrounding and inter-relationship with the environment. It was observed a clear difficulty in all three learning categories, particularly in those related to application of everyday knowledge showing as a determinant factor in the contamination susceptibility of the disease, in both individual and collective levels. As a contribution to improve this situation is proposed a recommendation in the form of an Environmental Education Project that percolates the regular school as a tool for integration of the Education-Health-Environment triad, and be a powerful contribution for both teaching process and schistosomiasis control program, intending to help the construction of a better and healthier way of life.

O presente trabalho foi realizado no município de Bananal, uma área endêmica da Esquistossomose mansônica em São Paulo, com persistente prevalência e expansão na transmissão da doença. A presença de endemia evidencia um distanciamento da tríade Educação-Saúde-Ambiente, que se faz perceber pela inabilidade das comunidades atingidas em lidar com as situações de risco de contaminação. Este estudo analisou a influência do conhecimento sobre a Esquistossomose mansônica, dos estudantes da escola formal do município, em relação à suscetibilidade a contaminação, agregando-a aos outros fatores determinantes da expansão na dinâmica de transmissão e persistente prevalência. Foi utilizado um protocolo de avaliação de desempenho, baseado nas três categorias de aprendizagem, Conhecimento, Compreensão e Aplicação, do Domínio Cognitivo da Taxonomia dos Objetivos Educacionais de Bloom (1956), aplicado ao corpo discente do Ensino Fundamental (4ª a 8ª séries) e do Ensino Médio. O desempenho foi analisado no grupo total de alunos e no grupo de alunos doentes, relacionando o grau de conhecimento aos padrões da atividade humana no seu meio social e no inter-relacionamento com o Ambiente. Foram evidenciadas claras dificuldades nas três categorias de aprendizagem, em especial, nas relacionadas à aplicação do conhecimento compreendido no cotidiano, passando a representar assim, um fator determinante importante na suscetibilidade à contaminação da doença, seja no plano individual como no coletivo. Este fato norteou como recomendação a proposta de um Projeto em Educação Ambiental, sugerido a permear na escola formal como instrumento de integração Educação-Saúde-Ambiente, de forma que possa vir a constituir em uma força aliada, tanto ao processo de ensinagem como ao Programa de Controle da Esquistossomose, na intenção de auxiliar a conquista de um modo de vida melhor e mais saudável. / The current work was carried out in the Bananal municipality, an endemic area for schistosomiasis mansoni in São Paulo State, with a persistent prevalence and expansion of the disease transmission. The presence of the endemy highlights the distance between Education-Health-Environment triad, shown by the inability of involved communities in dealing with the contamination risks. This study avaliated the influence of the knowledge on schistosomiasis mansoni by the students of the formal schools in Bananal, concerning on contamination susceptibility aggregated to other determinant factors of the expansion in the transmission dynamic and persistent prevalence. A performance evaluation register, based in the three learning categories - knowledge, understanding and application from the cognitive field of taxonomy of Bloom´s Educational Goals (1956, 2001), was applied on Elementary and Middle School students. The performance was assessed considering the totality of the students as a group vs. the sick students group, associating their knowledge degree with the standard human activities in their social surrounding and inter-relationship with the environment. It was observed a clear difficulty in all three learning categories, particularly in those related to application of everyday knowledge showing as a determinant factor in the contamination susceptibility of the disease, in both individual and collective levels. As a contribution to improve this situation is proposed a recommendation in the form of an Environmental Education Project that percolates the regular school as a tool for integration of the Education-Health-Environment triad, and be a powerful contribution for both teaching process and schistosomiasis control program, intending to help the construction of a better and healthier way of life.

Les nanotubes de carbone (CNT) sont des nanomatériaux (1D<100 nm) présentant des propriétés physico-chimiques uniques, qui ont conduit à des applications déjà nombreuses dans l'industrie. Cette utilisation croissante des CNT soulève la question de leur potentielle toxicité. De nombreuses études ont été réalisées sur les effets de ces nanomatériaux, et il a été montré que les CNT pouvaient être toxiques, entraînant du stress oxydant et de l'inflammation d'intensité variable selon leurs caractéristiques physico-chimiques. Parmi ces caractéristiques, la longueur et la chimie de surface semblent jouer un rôle important. Néanmoins, les mécanismes sous-jacents de cette toxicité n'ont pas été complètement identifiés à ce jour. Il a été montré que l'autophagie pouvait moduler la réponse oxydante et inflammatoire, et que les CNT pouvaient être internalisés par endocytose dans la cellule et se retrouver dans les lysosomes, ce qui pourrait relier l'autophagie à la toxicité des CNT. De plus, le devenir des CNT dans les cellules (localisation, et intégrité de leur structure) a été très peu étudié à ce jour, alors que mieux connaître ce devenir pourrait nous donner des informations supplémentaires sur le mécanisme de toxicité des CNT. L'objectif de ce travail était donc 1) d'évaluer le rôle de l'autophagie dans la réponse de macrophages exposés à différents CNT, et 2) d'étudier le devenir des CNT dans ces cellules. Pour cela, il a été synthétisé quatre CNT de différentes longueurs et chimies de surface : des courts (S-), courts fonctionnalisés (SF-), longs (L-) et longs fonctionnalisés (LF-) CNT, qui ont été caractérisés. Des macrophages murins ont été exposés à ces différents CNT, et leurs effets sur l'autophagie ont été analysés, ainsi que leur devenir dans ces cellules. Nous avons montré que tous les CNT entraînaient une accumulation des autophagosomes avec un blocage du flux autophagique et un dysfonctionnement lysosomal. Ce dysfonctionnement lysosomal était dépendent du type de CNT, tous les CNT sauf les SF-CNT entraînant une basification du pH lysosomal. Il a aussi été démontré que tous les CNT sauf les SF-CNT étaient modifiés au contact des cellules. Ces résultats montrent donc que les CNT peuvent interagir avec l'autophagie, et peuvent être modifiés, selon leurs caractéristiques physico-chimiques. Ceci ouvre de nouvelles possibilités quant à l'interprétation et la compréhension de la toxicité des CNT / Carbon nanotubes (CNT) are fibre-shaped nanomaterials (at least 1D<100 nm). They are widely used in various industries because of their unique properties. As a result, an important literature has been published with the aim to evaluate the impact of CNT on health. It is now understood that CNT can be toxic, and, although inflammation and oxidative stress have been proposed as two mechanisms potentially relevant to CNT toxicity, the exact underlying mechanisms remain to be elucidated. It has been demonstrated that autophagy can repress oxidative stress and inflammation, and that CNT can be internalized in the cells by endocytosis, ending up in the lysosomes, which could link autophagy to CNT toxicity. Moreover, little is known about the fate of CNT inside the cells, where they go and if they are modified, although better knowledge about this fate could help us understand CNT toxicity. The aim of this project was therefore 1) to evaluate the role of autophagy in the response of murin macrophages to CNT, and 2) to elucidate the fate of CNT in these cells. Moreover, and because a large contribution of CNT physico-chemical characteristics has been described in their pathogenic response, we choose to synthesized four CNT varying in length and/or in surface properties: short (S-), short functionalized (SF-), long (L-), and long functionalized (LF-) CNT. Here we demonstrated that exposure to all CNT lead to the accumulation of autophagosomes, with the blockage of the autophagic flux and an impairment of lysosomal activity. Interestingly, lysosomal impairment was dependent on the type of CNT, as we observed a basification of lysosomal pH in response to all but SF-CNT. We also showed that all CNT but SF-CNT are modified when in contact with the cells. These results indicate that CNT can interact with the autophagy pathway, and can be modified, depending on their physic-chemical characteristics. This opens new ways in the interpretation and understanding of CNT toxicity

This dissertation deals with the contradiction between the situation, in which the development of healthcare, transformation of the political system and the changes in the environment, has had a major influence on the fact that we are now experiencing a higher age than people at the beginning of the period under review (since 1945). This gives us a sense of assurance of longevity, but the contradiction arises in reality, that lies in the perspective of chronic life, which eliminates us from the ordinary life very soon. Despite this fact, a number of countries have succeeded in achieving higher age limits, but a high age is not a reflection of better health, which reflects a main contradiction between expectations and reality, and it is the main research problem of this dissertaiton at the same time. The goal of this disertation was to find out the evolution of conditions of healthy lifestyle of individuals in the Czech society, between years 1945 and 2016. The second goal was to reflect the evolution of the health status of the whole society in the context of health policy focusing on stages divided into "decades". The dissertation used a combination of institutional analysis of public policy and author's own biographical research with seven respondents, using morphological analysis and...

This dissertation analyses public health service delivery at the Sir Seewoosagur Ramgoolam National Hospital (S.S.R.N.H.) in Mauritius. Particular emphasis is laid on the historical development of public health service delivery at S.S.R.N.H. Public health service delivery has been approached from the view points of its nature and scope. The core components of the research survey have been on some major obstacles and flaws in effective public health service delivery at S.S.R.N.H. The measuring instrument used for the research survey was a self­ administered questionnaire. The main findings were discussed especially absenteeism, personnel turnover, stress, burnout, morale, sexual harassment, lethargy and disobedience, nepotism, shirking responsibility, alcohol and drug abuse, active political interference, bribery and corruption, dishonesty and retaliation and neglect of duty. Attention was also devoted on the current national health policy for improving public health service delivery at S.S.R.N.H., inter-alia, the National Policy for Public Heath Act 17 of 2000 and the White Paper on Health Sector Development and Reform of December 2003. The public health environment is constantly altering. Therefore, it is essential to adjust to the changing health environment. This dissertation has addressed the future challenges in the micro health environment and macro health environment of S.S.R.N.H. Ultimately, a holistic instead of a parochial approach to addressing shortcomings identified in public health service delivery at S.S.R.N.H. has been advocated in this dissertation. / Public Administration / M.Admin. (Public Admin)

This dissertation analyses public health service delivery at the Sir Seewoosagur Ramgoolam National Hospital (S.S.R.N.H.) in Mauritius. Particular emphasis is laid on the historical development of public health service delivery at S.S.R.N.H. Public health service delivery has been approached from the view points of its nature and scope. The core components of the research survey have been on some major obstacles and flaws in effective public health service delivery at S.S.R.N.H. The measuring instrument used for the research survey was a self­ administered questionnaire. The main findings were discussed especially absenteeism, personnel turnover, stress, burnout, morale, sexual harassment, lethargy and disobedience, nepotism, shirking responsibility, alcohol and drug abuse, active political interference, bribery and corruption, dishonesty and retaliation and neglect of duty. Attention was also devoted on the current national health policy for improving public health service delivery at S.S.R.N.H., inter-alia, the National Policy for Public Heath Act 17 of 2000 and the White Paper on Health Sector Development and Reform of December 2003. The public health environment is constantly altering. Therefore, it is essential to adjust to the changing health environment. This dissertation has addressed the future challenges in the micro health environment and macro health environment of S.S.R.N.H. Ultimately, a holistic instead of a parochial approach to addressing shortcomings identified in public health service delivery at S.S.R.N.H. has been advocated in this dissertation. / Public Administration and Management / M.Admin. (Public Admin)