There is not sufficient information in the market of medical service. Whether the public has adequate information is the key to the choice of healthcare seeking. Due to the shift of medical environment, rise of consumer¡¦s awareness and respect to patient¡¦s right, the public is concerned about their health and right. Becoming customer-oriented, the industries of medical service start to emphasize the management of customer¡¦s needs and provide appropriate products and service in order to achieve hospital¡¦s sustainable operation and development. This research aims to explore people¡¦s needs of medical seeking from the health news offered by medical institutes and to probe into the influence of health news on choice of medical seeking. Furthermore, the difference of people¡¦s medical seeking behavior of different demographic characteristics and health condition would also be discussed. This research adopts the quantitative survey method of questionnaire to collect data of outpatients in the over 15 age group on a regional hospital in Kaohsiung City. We received 381 valid questionnaires totally and 352 surveys are usable. The valid sample returns-ratio is 92.3%. The results for statistical analysis show that the rank order of demands on issues of news for people¡¦s seeking medical care are listed as follows according to the assisting extent of healthcare provider: ¡§The new trend of health and diseases¡¨, ¡§novel treatments or technique,¡¨ ¡§information of healthcare and hygienic education,¡¨ ¡§introduction of new equipment and facility,¡¨ ¡§medical discovery,¡¨ and ¡§doctor introduction or profession¡¨. The average mean of the required level marks above 4¡§satisfaction¡¨. (The score 5 is the highest.) By excluding other factors, it achieves levels of significance in aspects of health news path and health news issues on explanation of each dimension of people¡¦s medical seeking behavior. Health news shows significant effect on people¡¦s medical seeking behavior. The standardized coefficient is analyzed for further check that health news path and health news issues are positive predictable variables in each dimensions of people¡¦s medical seeking behavior. It implies that for people¡¦s medical seeking behavior, the higher the health news path uses and the higher the demand of health news requires, the stronger the influence on people¡¦s medical seeking behavior. In the discussion of the difference of people¡¦s medical seeking behavior of different demographic characteristics and health condition, it shows that gender, age, level of education, occupation, medical seeking under discomfort, commercial medical insurance, health condition and frequency of medical seeking in recent month would intervene how health news influence people¡¦s medical seeking behavior. By logistic regression analysis, it is found that level of education, coverage on newspapers, hospital handouts, introduction of new equipment and facility and medical discovery are possible predictors of the purpose of medical seeking. On the other hand, easy to choose of healthcare seeking , critical illness, frequency of medical seeking in recent month, coverage on newspapers and medical discovery are possible predictors of the site of medical seeking. In addition, age, level of education, medical seeking under discomfort, health condition, hospital website, community healthcare service and public relationship activity are possible predictors of the frequency of medical seeking. The conclusion of this research could be adopted by the hospital manager and the public relations practitioner for reference as they intend to release health news.

Background: It is well accepted that gestational weight gain (GWG) outside of the Institute of Medicine recommendations is a modifiable risk factor for pregnancy complications, regardless of a woman’s pre-pregnancy body mass index. Objectives: Given that not all prenatal healthcare providers (HCPs) are aware of these guidelines nor discuss them with their patients, this thesis sought to examine counselling practices and evaluate a pilot knowledge translation tool for the improvement of such counselling. Methods: 1) A literature review was conducted to assess current prenatal GWG counselling practices between patients and HCPs; 2) an electronic survey was conducted to determine patients’ perceptions of GWG counselling and whether certain patient characteristics increase chances of counselling; 3) a quasi-experimental study was implemented to evaluate the Canadian Obesity Network’s 5As of Healthy Pregnancy Weight Gain tool. Results: GWG counselling was often infrequent and inaccurate. Women of higher socioeconomic status, older age, nulliparous, history of dieting, low physical activity and those categorized with overweight/obesity were more likely to receive GWG advice. The 5As of Healthy Pregnancy Weight Gain Tool is effective at initiating Ask and Advise components of HCP-mediated GWG counselling, but work is still needed to improve all other components of the 5As (Assess, Agree, Assist). Conclusions: Weight gain counselling is an essential component of prenatal healthcare, but discussions between HCPs and patients is inconsistent. Future steps include the development of GWG knowledge translation tools and improving GWG education for HCPs.

Millard County, Utah, rural and sparsely populated, continues to experience challenges in recruiting and retaining primary health care providers. My study addressed the lack of a rigorous and systemic analysis of this problem by collecting and analyzing data from a series of semi-structured interviews conducted between January and March 2019. These interviews were with nineteen of the twenty-four known health care providers who began practice in the county from the mid1980s to 2018, as well as with four administrators. The study, taking advantage of this comprehensive analysis, provided a more extensive understanding of the root causes underlying the recruitment and retention shortcomings. Findings showed that decisions to stop practice in the county were not typically made for a single over-riding reason but occurred when the cumulative effect of negative experiences reached a tipping point, prompting the provider to seek another practice venue. Providers who left reached this tipping point in spite of most having a rural background. The study recommended implementing a comprehensive and on-going support program aimed at addressing providers concerns. The stressors associated with rural health care practices need to be regularly assessed and resolved in a timely fashion.

Rheumatic diseases are often chronic and involve a lifetime of suffering. The focus of rheumatology care is to support patients to manage their lives and master their disease. Healthcare providers and patients have different views on the consequences of living with rheumatic diseases and patients are reporting unmet healthcare needs. There is a need to integrate providers' perspective to develop the quality of rheumatology care. The aim was to explore healthcare providers' experiences of their interaction with patients in their management of RA. Interviews with 18 providers from different clinical settings were analysed in accordance with the grounded theory method. A core category; Delivering knowledge and advice was found to be the most important task and involved providing the patient with information about the disease and appropriate forms of treatment. Healthcare providers' attitudes and patients' responses influenced the outcome of the delivery of knowledge and advice and three dimensions emerged; completed delivery, adjusted delivery and failed delivery. There were differences in the providers' experiences in their interaction with patients as well as in reflections on their role as the delivering part. There could be difficulties in the interaction when patients' expectations and preferences were not taken into account when giving advice. These findings highlight the importance of developing rheumatology care, as no provider or patient benefits if the delivery of knowledge and advice becomes a failed delivery. The healthcare organization must acknowledge the difficulties involved in the interaction with patients in their management of RA and find methods to develop a more person-centred approach to care.

For the healthcare provider, disclosing a pediatric patient's difficult diagnosis in the form of an acute or chronic condition to the parents is a challenging task. Healthcare providers often feel unprepared when relaying the news of such diagnosis, and the parents feel equally unprepared upon receiving it (Pririe, 2012). This systematic literature review examined the various communication techniques used in the past, and the techniques' effectiveness in increasing parental satisfaction when first learning of the child's diagnosis. A scarce number of studies related to the most effective techniques were found in the literature, and even fewer were found that evaluated the techniques presented. Overall, three of the most commonly occurring communication themes identified from the studies were: 1) Parents desired privacy during the disclosure and wanted a support system present (mostly a spouse); 2) The diagnosis must be given as soon as the healthcare provider suspected it, and; 3) The healthcare provider must emphasize the positive characteristics of the pediatric patient, as well as the patient's future with the diagnosis. Both parents and providers agreed that further research is needed to identify effective communication techniques used during disclosure. The aim of the research should be to identify the most effective means of communication to increase parental satisfaction. Furthermore, all healthcare providers need collaborative and interdisciplinary training in delivering a difficult diagnosis to increase parental satisfaction.

Bakgrund: Kroniska sår innefattas av bensår, fotsår, trycksår, diabetessår, sårskada, tumörer, reumatiska sår och vårdskador vid komplikationer efter kirurgiska ingrepp, som inte har läkt inom 6 veckor. Forskning visar att trots att förebyggande strategier används, utvecklas det sår som kräver behandling. I mötet med vården är en god omvårdnad och en god vårdrelation viktig. Bristen på dessa leder ofta till ett lidande som individen måste kämpa emot med copingstrategier. Syfte: Syftet med denna litteraturstudie var att belysa personers erfarenhet av att leva med kroniska sår. Metod: En litteraturöversikt gjordes i denna studie med 15 vetenskapliga artiklar, som bestod av både kvantitativ och kvalitativ metod. Resultat: 3 huvudkategorier identifierades: begränsningar, lidande samt coping. Deltagarna ansåg att en brist på information samt begränsningar i vardagen påverkade individens sociala umgänge och fysiska aktivitet. Smärta, skam och rädsla ledde till depression. För att hantera detta använde individerna sig av familjen och stöd av vårdpersonalen Slutsats: Det framkom att individernas dagliga liv påverkades av det kroniska såret. Den konstanta smärtan orsakade sömnsvårigheter hos individen, vilket ytterligare försvårade hanteringen av smärtan och vardagen. Kontinuitet hos vårdpersonal och i behandlingen gav personerna en trygghet och en ökad förståelse för sitt tillstånd. Det belystes att det var viktigt att vårdpersonalen ser individen bakom såret, och inte bara lägger sitt fokus på sårläkningen och behandlingen. / Bakground: Chronic wound comprises of leg ulcer, foot ulcer, decubitus, diabetic ulcer, damaged ulcer, tumors, rheumatic wounds and care damage with complications after surgical intervention, which hasn't healed within six weeks. Research gives the results of showing that, even though prevention of strategies are used, the ulcer is still developing and needs treatment. In the meeting with the healthcare, it is important to have a good nursing and a good relationship care. Lack of this often leads to suffering that the individual must endure with the aid of coping strategies. Aim: The aim of this study was to explore the persons experience of living with a chronic ulcer. Method: In this study a literature review was done, with 15 scientific articles, which consisted of both quantitative and qualitative methods. Results: 3 main categories where identified: restriction, pain and coping. The participants felt that it was lack of information and limitations in everyday life which affected the individual's social life and physical activity. Pain, shame and fear led to depression. To get the capability to handle the situation, the individuals turned to their families and care provider for support. Conclusion: As it is stated, the individuals where affected in their everyday life due to the chronic ulcer. The constant pain which is caused the sleeping disturbances in the individual´s made coping the pain and everyday life harder. Continuity with the healthcare provider and treatment gave an understanding and safety for the individuals for their condition. It was important that the health professionals not only put their focus on the healing of the wound and the treatment, they must also put attention to the individual with the wound.

Objective: Depression is a common psychiatric condition, and despite the availability of effective treatments, this condition is largely under-recognized and undertreated, particularly among African Americans. One reason for this discrepancy may be that depressive symptoms often co-occur with physical health conditions, which can influence both the reporting of depressive symptomology, willingness to seek care, and the type of healthcare provider sought. The purpose of this study was to explore the relationship between treatment-seeking characteristics and diagnostic attributions of depression among community-dwelling African American adults. Methods: Data come from the National Survey of American Life, a nationally representative sample of African Americans, Caribbean blacks and non-Hispanic whites. Analysis is limited to African Americans (N = 3,432), of whom 64% were women. Lifetime history of Major Depressive Disorder (MDD) was assessed using the Composite International Diagnostic Inventory (CIDI). Participants were categorized into four diagnostic groups: Never MDD, MDD never attributed to physical health problems (e.g., typical depression), MDD sometimes attributed to physical health problems (e.g., complicated depression), and MDD always attributed to physical health problems (e.g., physical depression). Whether or not care was sought for depression, and the type of healthcare provider seen, was assessed by self-report. Multinomial logistic regression was used to assess the cross-sectional relationship between treatment-seeking characteristics and diagnostic type of depression. Models were adjusted for age, sex, insurance status, health behaviors, and comorbid health conditions. Results: 441 (12.8%) of the sample met CIDI criteria for MDD, and of these 66.7% were classified as typical depression, 18.1% were complicated depression, and 15.2% were physical depression. In fully-adjusted models, seeking treatment from a mental health professional was significantly associated with diagnosis of complicated depression (Odds ratio (OR): 5.53; 95% Confidence Interval (CI): 2.27 – 13.43) as opposed to typical depression. In adjusted analysis treatment-seeking from a family doctor was significantly associated with diagnosis of physical depression (OR: 2.94; 95% CI: 1.20 – 7.19) as opposed to typical depression. Seeking care from three or more different types of healthcare providers was significantly associated with diagnosis of complicated depression (OR: 2.10; 95% CI: 1.13 – 3.92) relative to typical depression. There was no significant relationship between seeing multiple providers and physical depression. Conclusions: Type of healthcare provider sought for care for depressive symptoms is significantly related to how those depressive symptoms are diagnosed. These findings are consistent with the hypothesis that healthcare providers influence whether depressive symptomology is attributed to physical health problems. However, this study cannot definitively differentiate the role of personal choice in seeking particular types of care providers from differences in assessment and attribution of depressive symptomology by types of providers. Future research is necessary to determine the factors related to both choosing a care provider when experiencing psychiatric symptoms and how different types of providers assess depressive symptoms and confer diagnosis.

70 Abstract: Criminal Liability of Legal Entities focusing on Healthcare Providers As of 1 January 2012 a new act no. 418/2011 Coll., Act on Criminal Liability of Legal Persons and Procedure against them, has been effective in the Czech Republic, which incorporated a possibility to prosecute legal persons for selected crimes besides individuals. In June 2016, a new act no. 183/2016 Coll. Act that makes changes to the act. no. 418/2011 Coll., Act on Criminal Liability of Legal Persons and Procedure against them was adopted. The main change it brings to the Czech legal system is that legal persons will be able to commit all the crimes stated in act no. 40/2009 Coll., Criminal Code, except for few crimes enumerated. Under this act, legal persons will be able to commit crimes against the life and health and due to that there is a big chance of prosecution of healthcare providers. The aim of this master thesis is to define in which situations one should consider the criminal liability of healthcare providers. Additionally, this document also aims to outline the general rules of the subject matter, and to determine the limits of its application. To interpret the legal regulation, descriptive and analytical methods are being used. The author compares Czech legislation with the legislation of other European...

Pressure ulcers and related skin integrity threats are a significant problem in current transfer/transport systems used for spinal cord injury patients. To understand this problem twenty-three different slings with varying type, material, and features were analyzed in hopes to identify at-risk areas for skin integrity threats such as pressure ulcers. Population samples included non-disabled (otherwise referred to as "healthy") volunteers as well as SCI patients from the James A. Haley Veterans Hospital. High resolution pressure interface mapping was utilized to directly measure the interface pressures between the patient and sling interface. Overall results provide relevant feedback on the systems used and to suggest a particular type of sling that might reduce and possibly minimize skin integrity threats as well as extend safe patient handling guidelines with sling use. It was found that the highest interface pressures convened along the seams of the sling, regardless of manufacturer or type.

abstract: Indigenous Pueblo conceptualization of living well today has shifted mainly due to Federal policies that forced Pueblo people to conform to western way of living moving away from a lifestyle that embraced holistic practices. Native people cannot escape how Western society has shaped the concept of health however, the voices of the Pueblo people and others working in health, acknowledged that Indigenous philosophies, beliefs and practices need to be part of Native health conversations today. My discussion problematizes Native health characterized today as typically represented through the biomedical perspective with the primary focus being the body. Such a limiting perspective dismisses the importance of Indigenous philosophies that embraces broader concepts of well-being to include holistic elements of physical, mental, emotional and spiritual well-being. This study examines the shift in perceptions seeking input from patient and medical providers regarding their interactions, particularly communications in a healthcare setting. Pueblo patients defined what was important in their communications with their health provider. Likewise, health providers referred to their experiences providing healthcare to Native patients to describe what is important to know when treating a Pueblo patient. Patients identified family (without specific medical family histories disclosed), knowledge/beliefs that were or were not associated to the patient’s culture, as well as community and family dynamics (that did not delve into traditional medicine or sacred ceremonial activities) as important for their provider to know. The results from the research study highlights the need to examine Native American cultural diversity education in healthcare including advancing improvements in the training of medical providers. / Dissertation/Thesis / Doctoral Dissertation Social Justice and Human Rights 2020