Thesis (Ph.D. (Nutrition))--North-West University, Potchefstroom Campus, 2009.

Background: Occupational stress is a global and complex phenomenon, and workers in developing countries can be affected by it (International Labour Organisation 2001). Staff within maternity settings have been identified as being at risk of suffering from stress, resulting in adverse health outcomes (Evenden and Sharpe, 2002). However, MWAs’ perceptions of stress have not been captured and are not reflected in the literature. Purpose: The aim of this study was to explore MWAs’ perceptions of occupational stress, possible cause(s), the impact and support available and the coping methods they adopted within maternity care settings (hospital) in Nigeria. Methodology: This study adopted a qualitative methodology. Husserl’s (1962) phenomenological approach was chosen as it enabled the researcher to collect rich, in-depth, descriptive accounts of the MWAs’ perceptions of the phenomenon under study through the use of semi-structured interviews. Findings: The major sources of stress for MWAs included work overload, long working hours, staff shortages, work exploitation and intensification and lack of support from senior staff. The stress levels MWAs experienced impacted on their health and well-being and resulted in related behavioural and physical reactions. Conclusion: This study confirmed that MWAs were exposed to similar stress factors experienced by other health workers and reported in the research literature. Additionally, it demonstrated the need for more qualitative studies to explore the perceptions of occupational stress among under-represented groups of healthcare workers. Importantly, this study created an opportunity to explore the experience of dedicated women facing challenging employment practices in hospital settings in Nigeria. Equally, it gave a voice to these unrecognised, almost invisible women, who were the MWAs that played a key role within the maternity services.

Indiana University-Purdue University Indianapolis (IUPUI) / Background: When a patient is incapacitated and unable to make health care decisions, a surrogate decision maker must be designated to make decisions about the patient’s care in his or her place. Studies show that fewer than 20% of patients in hospitals present with a designated health care representative form. Therefore, the overwhelming majority of surrogates in hospitals are identified via default state statutes. Little is known about the implications of state default surrogate decision making statutes on physicians and patient care in clinical practice. Methods: An evaluation of state surrogate decision making statutes was conducted in order to determine variability among state laws. Additionally, a statewide, quantitative, descriptive, cross-sectional survey of a random sample of 405 physicians working in Indiana hospitals was conducted to determine: 1) physicians’ knowledge of Indiana’s surrogate decision making law; 2) physicians’ approaches to hypothetical cases they might encounter in hospital practice; and 3) any delay in patient care physicians experience as a result of state surrogate decision making laws. Results: There is very little consistency among states regarding who may serve as a surrogate decision maker. In Indiana, less than half of the surveyed physicians (47.90%) were able to correctly identify legally allowable surrogates. When presented with clinica vignettes, nearly all physicians (84.90%) report that they would allow a grandchild to act as a surrogate decision maker, even though grandchildren are not legal surrogates under the law. Additionally, more than half of physicians (53.8%) experienced a delay in patient care due to the inability to identify a legal surrogate. Conclusions: The narrow construction of state laws can leave patients in situations where they either have no qualified surrogate under the law or where they have multiple surrogates. If there are multiple surrogates with competing interests a consensus may not be reached on the patient’s medical care. These situations result in a delay of patient care. The results of this study show that the Indiana Surrogate Decision Making law is flawed as it does not reflect the composition of Indiana families and leads to delays in patient care.

Background: Occupational stress is a global and complex phenomenon, and workers in developing countries can be affected by it (International Labour Organisation 2001). Staff within maternity settings have been identified as being at risk of suffering from stress, resulting in adverse health outcomes (Evenden and Sharpe, 2002). However, MWAs’ perceptions of stress have not been captured and are not reflected in the literature. Purpose: The aim of this study was to explore MWAs’ perceptions of occupational stress, possible cause(s), the impact and support available and the coping methods they adopted within maternity care settings (hospital) in Nigeria. Methodology: This study adopted a qualitative methodology. Husserl’s (1962) phenomenological approach was chosen as it enabled the researcher to collect rich, in-depth, descriptive accounts of the MWAs’ perceptions of the phenomenon under study through the use of semi-structured interviews. Findings: The major sources of stress for MWAs included work overload, long working hours, staff shortages, work exploitation and intensification and lack of support from senior staff. The stress levels MWAs experienced impacted on their health and well-being and resulted in related behavioural and physical reactions. Conclusion: This study confirmed that MWAs were exposed to similar stress factors experienced by other health workers and reported in the research literature. Additionally, it demonstrated the need for more qualitative studies to explore the perceptions of occupational stress among under-represented groups of healthcare workers. Importantly, this study created an opportunity to explore the experience of dedicated women facing challenging employment practices in hospital settings in Nigeria. Equally, it gave a voice to these unrecognised, almost invisible women, who were the MWAs that played a key role within the maternity services.

No description available.

No description available.

Introduktion: Teknikutvecklingen och digitaliseringen i samhället sker i en hög hastighet. Äldre vuxna är en grupp som ofta saknar den kompetens, kunskap och de färdigheter som är nödvändiga för att kunna nyttja de hälsoresurser och hälsoinformation som finns tillgängliga online. För att kunna engagera sig i e-hälsa och söka hälsoinformation online krävs det att de äldre vuxna har en viss nivå av eHealth literacy. eHealth literacy är förmågan att söka, hitta, förstå och värdera hälsoinformation från elektroniska källor, och tillämpa den kunskap som erhålls för att lösa ett hälsoproblem. Syfte: Syftet med litteraturöversikten var att belysa om det finns ett förhållande mellan eHealth literacy och hälsobeteenden samt hälsoutfall hos äldre vuxna, 55 år och äldre. Metod: Metoden som användes var en strukturerad litteraturöversikt. Analysmetoden som användes var en induktiv tematisk analys av 10 kvalitetsgranskade tidskriftsartiklar. Resultat: Den tematiska analysen genererade i 3 teman; Förbättrad livsstil, Engagemang i egenvård och eHealth literacy en mellanliggande faktor till hälsobeteenden och hälsorelaterad livskvalité. Resultatet visade att en ökad nivå av eHealth literacy hos äldre vuxna förbättrade deras hälsobeteenden, hälsobeslut och hälsoutfall i form av välmående och hälsorelaterad livskvalité. eHealth literacy hade både en direkt och en indirekt effekt på de studerade utfallen. Slutsats: Resultatet belyste betydelsen av att arbeta förebyggande och hälsofrämjande med äldres eHealth literacy förmåga för att i sin tur stärka deras hälsa, livskvalité och delaktighet i sin egenvård. eHealth literacy är en central faktor för äldres hälsa och för att de ska kunna nyttja de e-hälsotjänster som finns tillgängliga till sin fulla potential. / Introduction: Older adults often lack the skills and competence necessary to be able to use health resources and health information available online. To be able to get involved in digital health and search for health information online older adults are required to have a certain level of eHealth literacy. eHealth literacy is defined as the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem. Aim: The purpose of the literature review was to shed light on whether there is a relationship between eHealth literacy and health behaviors and health outcomes in older adults. Methods: The method used was a structured literature review. The method of analysis used was an inductive thematic analysis of 10 peer-reviewed journal articles. Results: The thematic analysis generated in 3 themes; Improved lifestyle, Commitment to self-care and eHealth literacy an intermediate factor to health behaviours and health-related quality of life. The results showed that an increased level of eHealth literacy in older adults improved their health behaviours, health decisions and health outcomes in terms of well-being and health-related quality of life. eHealth literacy had both a direct and an indirect effect on the outcomes studied. Conclusion: The results highlighted the importance of working health-promoting with the elderly's eHealth literacy to be able to strengthen their health and participation in their own healthcare. eHealth literacy is a key factor for the health of the elderly and for theme to be able to use the e-health services available to their full potential.

This study explores how socioeconomic status influences lifestyle choices and chronicdiseases in Sweden. It investigates prevalent chronic diseases across different socio economicgroups and assesses policy interventions to address disparities. Theoretical frameworks suchas chronic disease prevention, health lifestyle and fundamental causes theories inform theanalysis. The method of this study is used to gather and analyse sensory data for the study. Itdescribed the systematic search for relevant articles, inclusion and exclusion criteria, dataextraction and thematic analysis. Ethical considerations are also addressed and maintained.The results highlighted socioeconomic disparities in lifestyle and chronic disease burden inSweden and other countries. The results show varying impacts in health behaviours andoutcomes based on socioeconomic status, emphasising on the need for targeted interventionwhich address preventable health conditions. The discussion of the study provides a detailedinterpretation of the results by linking theories and methods used.

This study offers insights into the impact of competition among Managed Care organizations (MCOs) on infant birthing charges and birth outcomes. Kentucky provides one of the nation’s first case studies to determine successes and failures of Medicaid MCOs, and by doing so, provides a prediction of the impact of Patient Protection Affordable Care Act (PPACA) competition on healthcare costs and birth outcomes. An analysis of a natural policy experiment in the state of Kentucky reveals that infants insured by a Medicaid MCO stay longer in hospitals, are less healthy, and cost more than those insured under Traditional Medicaid prior to a policy change. Utilizing a difference-in-difference-in-difference (DDD) estimation, this study found initial evidence in a competitive MCO environment of Traditional Medicaid average birth charges substantially more than births under a Medicaid MCO, while outcomes also revealed the incidence of normal delivery increased almost identical to that of private insurance. However, after a short time, average birth charges for infants born under Medicaid MCO climb higher than other payer-types and infant health begins to decline. Outcomes of this study signal that Managed Care infants are actually less healthy and cost substantially more than anticipated but it is possible that these outcomes can be attributed to insurance selection.

Our modern health care system requires technology that can deal with multidisciplinary and complex processes, operations, and situations. The EHR, by far, is one of the greatest health information technology innovations that satisfy these requirements because of its efficiency and the effectiveness of its features. This study sought to develop an in-depth understanding of how underserved patients' perspectives about their health and illness, can contribute to greater use of the EHR. It also sought to improve their health outcomes and maintain sustainable change in the lives of the underserved. A quantitative non-experimental design study was conducted over a 6-week period outside of three different internal medicine clinics, one in the Northwestern and the two others in the Southeastern regions of Washington, DC. Surveys were distributed directly to patients coming out of these health clinics, and participants sent their responses via mail. Data collection included 215 surveys out of 560, but, only 155 fit the overall study categories. A strong level of significance in the relationships between clinical outcome measures and the EHR was identified at a 95% confidence interval. There were considerable health determinants that demonstrated the essence of patients' perspectives and the need for its incorporation into health outcomes measures for the underserved populations. The study also identified sets of environmental health predictors which acted as facilitators and contributors to a holistic health management model designed to contribute to the needs of the underserved communities. The holistic health model and the individual care plan model derived from the study are applicable at the level of the underserved population. It can help achieve sustainable health outcomes that will save lives and promote better health.