Patient safety culture (PSC) is a critical factor in creating high reliability healthcare organizations. However, few studies to date have correlated PSC measures with actual safety outcomes. In particular, nursing home studies have only recently appeared in the literature. Nursing homes differ from hospitals in that the vast majority of direct care is provided by certified nursing assistants (CNAs), not licensed nurses. Thus nursing home PSC could differ in important ways from PSC in acute care institutions. This dissertation was a secondary data analysis that examined whether CNAs’ perceptions of patient safety culture were correlated with clinical outcomes in a random sample of 74 nursing homes in five randomly selected states. This study matched CNA PSC survey data using the Hospital Survey of Patient Safety Culture (HSOPSC) with Minimum Data Set (MDS), Area Resource File (ARF) and Online Survey Certification and Reporting (OSCAR) data from those same homes during the first two quarters of 2005. In the original study, 1579 nurse aides out of 2872 completed the survey, for a 55% response rate. In addition to clinical outcomes, this study examined the relationship between CNA PSC scores and staff turnover. The relationship between certain demographic variables, such as level of education, tenure as a CNA, and PSC scores was evaluated. The relationship between certain facility characteristics, such as profit status and bed occupancy was also assessed. An exploratory factor analysis of the original HSOPSC instrument was re-run for this nursing home CNA sample. Data were analyzed using Poisson regression and multilevel techniques; descriptive statistics were compiled for demographic data. Major findings from the regression analyses and combined GEE models suggest that certain factors, such as CNA turnover and LPN staffing may predict CNA PSC scores. CNA PSC scores were associated with rates of falls and restraint use, but were not associated with differences in pressure ulcer rates in this sample. Few associations for CNA PSC with individual subscales were identified. The exploratory factor analysis revealed some potential differences in how items and subscales factored in this nursing home CNA population. This dissertation represents an important step in the evaluation of CNA PSC in nursing homes and the relationship of PSC to safety outcomes. Future work on nursing home PSC and clinical and workforce outcomes is described.

The purpose of this study was to address the aggressive marketing of commercial formula and breastfeeding cessation in Indonesia using an evaluation of a counter-marketing continuing education module. Using a convenience sample (N = 99) of breastfeeding educators and/or counselors, paired t-tests showed a significant increase in participants’ knowledge about counter-marketing after they participated in the training. Findings also showed significant increases post-training for stage of changes, self-efficacy, knowledge, and motivation to perform four key talking behaviors: i.e., involving talking to new and pregnant mothers about corporations’ inappropriate and aggressive marketing of formula, and the risks of becoming dependent on expensive formula and losing the ability to produce their own breast milk. These findings suggested that exposure to the counter-marketing continuing education training served as a brief intervention associated with significant improvements in level of knowledge about counter-marketing among participants and in stage of change self-efficacy, knowledge, and motivation for performing key behaviors of interest. Backward-stepwise regression revealed that higher level of motivation for taking an active role in the proposed campaign (i.e., A Campaign to Expose the Truth about Becoming Dependent on Commercial Formula and Breastfeeding Cessation) was significantly predicted by: (1) higher pre-training self-efficacy for talking to expectant and new mothers about the reasons to breastfeed their infant (β = .327, SEB = .118, p = .007); (2) lower pre-training knowledge for talking to expectant and new mothers about corporations’ inappropriate and aggressive marketing of commercial infant formula (β = -.270, SEB = .092, p = .004); and, (3) higher level of knowledge for taking an active role in the proposed campaign (β = .392, SEB = .083, p = .000). Participants rated the training as very good (74.7%, n = 74). Qualitative data showed that the training provided new knowledge and a new approach in addressing aggressive formula marketing by corporations. Further, participants found that the training has made them more confident and motivated to work with mothers and the community to advocate and educate about negative impacts from commercial formula.

Background: Good oral health is fundamental to general health and well-being. Being in a dependent situation can result in lack of managing your own self-care which can lead to impaired oral health. Patients seem to be quite satisfied with their oral health but the assessment tool ROAG (Revised oral assessment guide) shows the opposite: that the oral standard is more inferior than the patients estimate. To ensure patients need of care, it is important to problematize and discuss oral health in the daily nursing care. Health personnel face dependent people in all kinds of health care. Registered nurses have the responsibility for nursing care and a role in leading the health personnel staff. Aim: The aim of this study is to describe health personnel's experience of working with oral health. Method: A literature-based study was performed with the analysis of seven qualitative articles. Results: The result consists of two main themes and six subthemes. The first main theme describes conditions to provide oral health. The second main theme describe barriers to provide oral health. The subthemes of the first main theme describe knowledge and earlier experiences. The subthemes of the second main theme describe the different barriers; insufficient knowledge, lack of time and resources, lack of support and routines, intrusion on someone's private sphere. These themes describe the health personnel's experience, working with oral health. Conclusion: The result shows that the health personnel need continuous education, clear routines and satisfactory resources. The oral cavity is seen as something private and it is easy to violate the patient's integrity.

Bakgrund: Studier har visat att hälso- och sjukvårdspersonal har ett stigmatiserande förhållningssätt gentemot personer med schizofreni. Syfte: Att beskriva hur personer med schizofreni upplever relationen till hälso- och sjukvårdspersonal inom den psykiatriska vården. Metod: Arbetet har en beskrivande design med litteraturöversikt med systematisk ansats och baseras på åtta kvalitativa originalartiklar. Resultat: Det framkom sex kategorier: Kommunikation, diskriminering och stigmatisering, närvaro och tillgänglighet, tvång och ofrihet, delaktighet och meningsfullhet, och säkerhet och trygghet. Resultatet visar att patienterna upplevde goda och dåliga relationer till hälso-och sjukvårdspersonalen. De beskrev att en god relation upplevdes då det fanns god kommunikation, förtroende, delaktighet och trygghet. Dåliga relation upplevdes vid tvång, hot och dålig kommunikation mellan patient och hälso- och sjukvårdspersonal.   Slutsats: En god relation är fundamentalt viktig för patientens välbefinnande och vård. Det behövs mer undervisning till hälso- och sjukvårdspersonal om hur de bör bemöta personer med schizofreni. Vidare forsknings behövs dock då det var svårt att finna artiklar inom samma ämne som var från de närmsta tio åren. / Background: Studies have shown that health personnel have a stigmatizing approach towards people with schizophrenia. Aim: To describe how people with schizophrenia experience the relation to health personnel within psychiatric care. Method: This study has a descriptive design with a literature review with a systematic approach, and is based on eight qualitative original articles. Results: Six categories were identified: Communication, discrimination, presence and availability, coercion and lack of freedom, participation and meaningfulness and safety and security. The results show that patients experience both good and bad relations to health personnel. Good relations took place when patients experienced good communication, trust, participation and security. Bad relations took place when patients experienced coercion, threats and bad communication. Conclusion: A good relation is fundamentally important for the patient’s wellbeing and care. More education on how health personnel establish a good relation with patients with schizophrenia is necessary. However, further research is needed on the subject, since articles published within the past ten years were difficult to find.

How contract learning may be used in the introduction to clinical medicine is described, with the goal to develop and enhance self‐directed learning skills and attitudes of first‐ and second‐year medical students. Essential tasks associated with successful self‐directed learning are cited, and the contract method is described as a means for providing medical students with the opportunity to practise these tasks in the study of gerontology. The procedures followed in the implementation of the contract learning method are described, and its impacts on both need and motivation to continue learning about ageing and skills in directing independent learning projects are analysed and discussed. In addition, the implications of early preparation for doctor's lifelong learning are discussed.

We report severe acute respiratory syndrome coronavirus 2 antibody positivity among market and city bus depot workers in Lima, Peru. Among 1285 vendors from 8 markets, prevalence ranged from 27% to 73%. Among 488 workers from 3 city bus depots, prevalence ranged from 11% to 47%. Self-reported symptoms were infrequent. / National Institute of Allergy and Infectious Diseases / Revisión por pares

El objetivo de este estudio es realizar un análisis bibliométrico de sobre las publicaciones científicas en la base de datos Scielo-Perú relacionados al Síndrome de Burnout en personal de la salud entre los años 2009 y 2019. Se encontró un total de 17 artículos, de los cuales quedaron seleccionados 7 artículos relacionados a la muestra del estudio. Luego, se prosiguió con la organización y análisis correspondiente de los artículos obtenidos. En cuanto a los resultados, se destaca la gran cantidad de estudios cuantitativos, los cuales, como parte de su estructura, presentan en un 100% resumen, abstract, palabras claves, introducción y objetivos. Asimismo, coinciden en su totalidad en cuanto a la presencia de método, resultados, discusión, conclusiones y referencias. No obstante, se encontró que la mayoría de las investigaciones no incluye hipótesis ni recomendaciones en su estudio. Finalmente se concluye que, la bibliometría es el método por excelencia que permite evaluar objetivamente la calidad y estructura de estudios científicos de manera sistematizada. De este modo, posibilita identificar que la producción científica en relación con el síndrome de burnout en el país aún es escasa. Por lo que resulta necesario promover la investigación científica peruana. / The objective of this study is to carry out a bibliometric analysis of the scientific publications in the Scielo-Peru database related to Burnout Syndrome in health personnel between 2009 and 2019. A total of 17 articles were found, of the 7 articles related to the study, samples were selected. Then, the corresponding organization and analysis of the articles obtained continued. As for the results, the large number of quantitative studies stands out, which, as part of their structure, present 100% abstract, abstract, keywords, introduction, and objectives. Likewise, they coincide in terms of the presence of the method, results, discussion, conclusions, and references. However, it was found that most investigations do not include hypotheses or recommendations in their study. Finally, it is concluded that bibliometrics is the method par excellence that allows objectively evaluating the quality and structure of scientific studies systematically. In this way, it makes it possible to identify that scientific production concerning burnout syndrome in the country is still scarce. Therefore, it is necessary to promote Peruvian scientific research. / Trabajo de investigación

Bakgrund: Vårdrelaterade infektioner är ett globalt problem som orsakar ett onödigt lidande för patienten samt stora kostnader för vården och samhället. Den mest primära åtgärden för att förebygga vårdrelaterade infektioner är basala hygienrutiner där handskar ingår. Sveriges kommuner och regioner utför årligen undersökningar kring följsamheten till basala hygienrutiner. Ytterligare undersökningar behövs dock för att identifiera vad som underlättar eller försvårar användningen av handskar. Syfte: Syftet var att belysa vilka främjande och hindrande faktorer som påverkar hälso- och sjukvårdspersonalens attityder och följsamhet till användningen av handskar inom omvårdnaden i slutenvården. Metod: Examensarbetet utfördes som en allmän litteraturstudie med en induktiv ansats där tio vetenskapliga artiklar granskades och inkluderades i resultatet. Data bearbetades och sammanställdes därefter genom en innehållsanalys. Resultat: Resultatet visade att den mest förekommande främjande faktorn för handskanvändning av hälso- och sjukvårdspersonal inom slutenvården var att skydda sig själva. Den mest förekommande hindrande faktorn var stress som relaterade till tid- och personalbrist. Konklusion: Ytterligare forskning inom området behövs då ämnet är begränsat utforskat de senaste tio åren. / Background: Nosocomial infections is a global issue that causes the patient unnecessary suffering and a major cost to the healthcare. Standard precautions, which includes glove use, are the most essential measure to prevent nosocomial infections. Measurements of the compliance to standard precautions are performed every year in Sweden. However, research is needed to illustrate factors that promote or hinders the use of gloves. Aim: The aim of the study was to illustrate factors affecting health care personnel’s attitudes and compliance to glove use in nursing in the inpatient care. Method: This literature study was conducted as a general literature review with an inductive approach. Ten articles were analysed and included in the result. The data was processed and compiled through a content analysis. Result: The result showed that the most common promotive factor of glove use among health personnel in the inpatient care was to protect themselves. The most common hindering factor was stress caused by lack of time and health personnel. Conclusion: Due to the lack of research of the subject in the past ten years, further research is needed.

京都大学 / 0048 / 新制・論文博士 / 博士(社会健康医学) / 乙第13004号 / 論社医博第8号 / 新制||社医||9(附属図書館) / 32932 / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 中山 健夫, 教授 木原 正博, 教授 黒田 知宏 / 学位規則第4条第2項該当 / Doctor of Public Health / Kyoto University / DFAM

In recent decades, both global migration in general and specifically migration to Sweden have increased. This development compels the need for delivering healthcare to the increasingly diverse populations in Sweden. To support health professionals, for instance occupational therapists, in developing their professional knowledge in encounters with foreign-born clients a self-rating instrument measuring cultural competence is developed. This may contribute to the development of suitable services for foreignborn clients and improve person-centered interventions for these clients. The general aim of this thesis was to develop an instrument for health professionals by examining psychometric properties and utility of the Swedish version of the Cultural Competence Assessment Instrument (CCAI-S) among occupational therapists. The specific aim of study I was to evaluate the content validity and utility of the Swedish version of the Cultural Competence Assessment Instrument (CCAI-S) among occupational therapists. The study had a descriptive and explorative design. Nineteen occupational therapists participated, divided into four focus groups. Qualitative content analysis was used to examine the content validity and utility of the CCAI-S. The specific aim of study II was to examine the clinical relevance, construct validity and reliability of the Swedish version of the Cultural Competence Assessment Instrument (CCAI-S) among Swedish occupational therapists. The study had a cross-sectional design. A web-based questionnaire was e-mailed to a randomised sample of 428 occupational therapists to investigate the construct validity, reliability and utility of the CCAI-S. Factor analysis was performed as well as descriptive statistics. The findings from study I revealed high content validity for all 24 items. However, six items needed reformulations and exemplifications. Regarding utility, the results showed strong support for CCAI-S. The category ‘Interactions with clients’ showed that the CCAI-S could be utilised individually for the health professional and create a higher awareness of cultural questions in practice. The category ‘Workplace and its organisational support’ displayed potential for use in different workplaces regarding CCAI-S and indicated the importance of organisational support for health professionals in the development of cultural competence. The findings from study II regarding construct validity generated a three-factor model with the labels ‘Openness and awareness’, ‘Workplace support’ and ‘Interaction skills’. All three factors showed high factor loadings and contained 12 of the 24 original items. The Cronbach’s Alpha showed high support for the three-factor model. Concerning utility, the participants reported that all 24 items had high clinical relevance. In conclusion, the findings from the two studies indicated good measurement properties and high clinical relevance for the CCAI-S. This may sup-port the utilisation of CCAI-S in the Swedish context for health professionals, for instance occupational therapists. The results of the instrument development show that the upcoming published version of the CCAI-S can be a valuable self-assessment tool for health professionals who strive to improve in person-centred communication in encounters with foreign-born clients. CCAI-S can also be of support for the organisation to serve as a guide for what to focus on to develop cultural competence within the staff. Altogether this presumably influence the effectiveness of the healthcare and enhance the evidence of interventions for foreign-born clients. To develop an instrument is an iterative process requiring several evaluations and tests in various settings and populations. Therefore further psychometric testing and utility studies on the CCAI-S is crucial.