Background: The majority of adults in the UK are overweight or obese, and many embark on weight loss attempts, often without professional support. This dissertation set out to hone in on the cognitive and behavioural strategies used by adults with overweight and obesity attempting to lose weight, particularly in self-guided attempts, and to test the relationship between use of these strategies and weight loss success. Methods: A new taxonomy and questionnaire were developed to provide a framework to identify the cognitive and behavioural strategies used by individuals during weight loss attempts. The taxonomy was used in a systematic review and meta-analysis of self-help interventions for weight loss and in a systematic review of qualitative studies of self-directed weight loss. The questionnaire was used in an observational cohort study in adults with overweight and obesity trying to lose weight. Results: The taxonomy and questionnaire consist of 117 strategies. The qualitative review illuminated a range of attitudes and beliefs towards these strategies and highlighted the centrality of interpretation of self-monitored data. The quantitative review found that self-help interventions led to greater weight loss than unsupported attempts to lose weight at six months. In the cohort study, despite heterogeneity in the strategies employed, coherent patterns of behaviours emerged for individual participants. Strategies related to motivational support, dietary impulse control, and weight loss planning and monitoring were associated with greater weight loss. Conclusion: This dissertation demonstrates that self-help interventions can lead to significant weight loss and provides results to guide the content of such interventions. It maps out a previously uncharted area and provides a set of tools for further research and intervention development.

No / Mainstream health psychology supports neoliberal notions of health promotion in which self-management is central. The emphasis is on models that explain behaviour as individually driven and cognitively motivated, with health beliefs framed as the favoured mechanisms to target in order to bring about change to improve health. Utilising understandings exemplified in critical health psychology, we take a more socially situated approach, focusing on practicing health, the rhetoric of modernisation in UK health care and moves toward democratisation. While recognising that within these new ways of working there are opportunities for empowerment and user-led health care, there are other implications. How these changes link to simplistic cognitive behavioural ideologies of health promotion and rational decision-making is explored. Utilising two different empirical studies, this article highlights how self-management and expected compliance with governmental authority in relation to health practices position not only communities that experience multiple disadvantage but also more seemingly privileged social actors. The article presents a challenge to self-management and informed choice, in which the importance of navigational networks is evident. Because health care can become remote and inaccessible to certain sections of the community, yet pervasive and deterministic for others, we need multiple levels of analysis and different forms of action.

Background: Reviews of primary research in developed countries and policy in the UK demonstrate there is a lack of evidence from well conducted RCTs on lifestyle interventions for childhood obesity (NICE 2006, SIGN 2003, Oude Luttikhuis et al. 2009). Objectives: To develop, implement and evaluate the Y W8? family focused childhood obesity treatment programme using a randomized controlled trial. Methods: The programme was developed using Bartholomew’s Intervention Mapping framework. Using this stepped process a needs analysis was undertaken, a steering group formed, focus groups were completed in local schools and interviews took place with parents of obese children. The determinants identified by these processes were combined with relevant theories and information gathered through a literature review to develop the programme. Y W8? is a 12 week course for families with children aged 8–13 years designed to assist with weight management. The RCT was designed as an individually randomised parallel-group trial with a waiting-list control group. Children in the intervention group (n=59) had their height, weight, self-reported physical activity levels, self-reported fruit and vegetable consumption and a measure of self-esteem recorded at pre- and post-assessment, whilst only height and weight was collected from the children in the control group (n=55). Results: Twelve week (post course) results showed a significant difference in change in BMI z-score between the control and intervention group, mean difference = -0.12 (95% CI: 0.09 to 0.16, F (1, 98) = 54.04, p < 0.0005), with the control group increasing and the intervention group decreasing their BMI z-score. Analysis showed this positive effect on weight status did not adversely affect linear growth. For the intervention group 81% of children completed the programme. Implications: This RCT offers evidence to support the use of family-based treatment programmes in the treatment of childhood obesity and displays positive results in the short-term, at a lower cost than similar interventions. The thesis also demonstrates how a public health programme can be implemented and sustained in routine NHS practice.

<p> Understanding the relationships between human health, water, sanitation, and environmental health is a requirement to understanding the challenges that face researchers when it comes to addressing global health relating to water and sanitation. Access to improved water and sanitation is not only a precondition to health, but to all aspects of daily living. Target 7.C of the Millennium Development Goals (MDGs) addresses worldwide disparities in access to improved water and sanitation by calling for the reduction in <i> "half of the proportion of people without sustainable access to safe drinking water and sanitation by 2015".</i> Over 90% of the population of Costa Rica has access to improved water and sanitation, thus exceeding the water and sanitation targets for the Millennium Development Goals (MDGs). Despite having access to water and sanitation, little is known whether communities are only interested in access or if quality and quantity of water and sanitation systems are as equally as important. Target 7.c of the MDGs does not include water quality in the definition of safe water. Furthermore, the use of the words "safe" and "improved" in the target are often interchanged and can be misleading, especially when considering the impact of water quality on population health. In Costa Rica, households in the Nandamojo watershed have access to improved water and sanitation; it is unclear whether the drinking water is potable with respect to Costa Rican and the World Health Organization (WHO) water quality standards. The impact of leaking septic systems on human and environmental health is also unknown. </p><p> Illnesses associated with recreational water are an increasing public health problem, causing a great burden of disease in bathers every year. The global health impact of infectious diseases associated with recreational water exposure has been estimated at around three million disability-adjusted life years (DALYs) per year, resulting in an estimated economic loss of around twelve billion dollars per year. Fecal and chemical contamination of recreational water is a concern, especially in areas of non-point source pollution. Health-based water monitoring is often conducted in recreational waters as a tool for assessing risk. In Costa Rica, recreational water sampling is conducted at coastal beach areas only, neglecting other surface waters used by residents and tourists. Community perspectives regarding recreational water use and the associated risks are limited. Understanding these perspectives will enable public health professionals to better target community needs, such as education and to address the concerns of participating communities. </p><p> This dissertation was divided into three chapters. The first chapter explored community perceptions on improved water and sanitation, the second chapter assessed community water systems and the risk of acute diarrheal disease, and the third chapter captured community perceptions on recreational water use and the risk of waterborne illness. Methodologies for water sampling and analyses were used to assess water quality, while household interviews and focus groups were conducted to capture qualitative data. </p><p> Results from the first chapter showed participants had positive perceptions towards their improved water and sanitation systems. Household interviews revealed almost half of the respondents had concerns with water quality, while less than 25% did not think their septic tanks leaked or overflowed during rain events. Focus group discussions revealed common themes. Participants identified water quality, health, pipes, water scarcity, odors, insects, and overflow/infiltration of water and sanitation to be important issues. Participants revealed convenience, improved health and safety and the lack of odors to be themes directly related to customer satisfaction of improved water and sanitation. </p><p> Results from the second study revealed 57% of household samples had total coliform bacteria above the Costa Rican standard for safe drinking water exceeding the single standard limit of zero, while 61% failed the World Health Organization standard for fecal coliforms exceeding the single standard limit of zero. AGII was identified in 41 of the 378 household residents (11%). The odds ratio for AGII among household residents with a water sample positive for total coliforms was 1.88 (0.81-3.17). Fecal coliforms were statistically significant for those with AGII (OR = 3.19, 1.43-7.12). Regression modeling analyses revealed individuals with AGII and household drinking water positive for fecal coliforms to be statistically significant (OR = 3.01, 1.33 - 6.84), while other covariates (total coliforms, gender, treated water, and families) also had odds ratios greater than one, but were not significant. </p><p> Results from the third chapter indicated most respondents felt recreational water sources, such as streams and rivers were contaminated with human, animal, and chemical wastes. Focus group participants also stated they did not use inland waters for recreational purposes for these reasons. However, many did admit using marine water for recreational bathing and felt these areas were not contaminated. These beliefs did coincide with the water quality results from freshwater sources, but not marine sources. Fecal coliform contamination was widespread throughout the watershed in freshwater sources. Marine water samples failed the World Health Organization (WHO) and Costa Rican recreational water standards for fecal coliform and enterococci in 36% and 6% of the samples, respectively. </p><p> The overall results of this dissertation suggest that the definitions of improved water and sanitation have to include, at a minimum, water quality, water quantity, proper construction and containment of storage tanks, and oversight and maintenance of these systems. Given the challenges facing communities in the Nandamojo watershed regarding water and sanitation, it is essential for scientists, researchers, policy makers, water committees, health providers, and community members to design and implement strategies in water resource management and proper waste management. Communities and water committees would also be best served if they worked with government agencies to conduct concurrent testing of both recreational water and drinking water, especially since both them target many of the same parameters.</p>

Crisis management is a dynamic science. This is particularly true for developing world countries like Kenya. The aim of this work is to contribute to the prevention or minimization of risks and possibly to manage their consequences within the project of the Czech medical facility Itibo in the southwestern part of Kenya. This facility, thanks to a group of enthusiasts and support of many people, helped tens of thousands of patients since 2005 who would otherwise not have access to health care. In the framework of the thesis, a risk analysis was elaborated based on a local survey, which was subsequently evaluated, and its results used to create a "Plan of preparedness for emergencies." The plan is a practically applicable tool for managing non-standard situations that occur relatively frequently in the project site. An essential part was the active involvement of the author in the actual functioning of the Itibo healthcare facility in the form of an internship. The main benefit of the work is a plan intended for health-educated persons, who mostly do not have knowledge in the field of crisis management. The benefit is also an insight into the issue of crisis management in the area of health care in another country, which is very different in most of its parameters.

No description available.

Introduktion: Våld i nära relationer är ett globalt fenomen och utgör ettåterkommande inslag i arbetet inom hälso- och sjukvården, polismyndigheten ochsocialtjänsten. Våld i nära relationer förekommer i alla samhällsklasser, åldrar,oavsett sexuell läggning och är inte relaterad till vare sig etnicitet, kulturell ellerreligiös bakgrund. Det finns flertal myndigheter som ger skydd och stöd tillvåldsutsatta. För att säkerställa ett professionellt omhändertagande av denvåldsutsatta måste de olika myndigheterna samverka. Forskning visar dock attsamverkan ofta brister vilket kan resultera i ett försämrat omhändertagande av dendrabbade individen.Syfte: Att undersöka vilka faktorer som är av betydelse för myndigheterssamverkan vid vuxnas utsatthet för våld i nära relationer, utifrån hälso- ochsjukvårdens, polismyndighetens, och socialtjänstens perspektiv.Metod: Studien är en integrativ litteraturstudie. Litteratursökningarna eftervetenskapliga artiklar genomfördes i databaserna Cinahl, Pubmed, Criminal justiceabstracts, Social services abstracts, Psycinfo och Social science premium collection.De för studien relevanta artiklarna har kvalitetsgranskats, kodats, kategoriserats ochanalyserats enligt gällande metod.Resultat: Resultatet baseras på tio vetenskapliga artiklar och visar att det finns ettflertal faktorer som har betydelse för myndigheters samverkan vid våld i närarelationer. Faktorer som kunskap, organisation, kommunikation och kultur har idenna studie visat sig vara särskilt utmärkande. Dessa faktorer kan verka bådehämmande och främjande beroende på rådande omständigheter inom respektivemyndighetSlutsats: Samverkan mellan myndigheter är en absolut förutsättning för ett adekvatomhändertagande av den individ som utsatts för våld i en nära relation. Fenomenetmedför en komplex problematik. Det finns ett uppenbart utbildningsbehov för flerayrkeskategorier, främst gällande identifikation och bemötande av den våldsutsattasamt klargörande kring de olika myndigheternas olika ansvarsområden ochbefogenheter. Arbetet bör i framtiden organiseras utifrån den drabbades behov avolika hjälpinsatser istället för att som idag utgå från de olika myndigheternasrespektive kompetensområde.

The rising complexity in healthcare, exacerbated by an ageing population, results in ineffective decision-making leading to detrimental effects on care quality and escalates care costs. Consequently, there is a need for smart decision support systems that can empower clinician's to make better informed care decisions. Decisions, which are not only based on general clinical knowledge and personal experience, but also rest on personalised and precise insights about future patient outcomes. A promising approach is to leverage the ongoing digitization of healthcare that generates unprecedented amounts of clinical data stored in Electronic Health Records (EHRs) and couple it with modern Machine Learning (ML) toolset for clinical decision support, and simultaneously, expand the evidence base of medicine. As promising as it sounds, assimilating complete clinical data that provides a rich perspective of the patient's health state comes with a multitude of data-science challenges that impede efficient learning of ML models. This thesis primarily focuses on learning comprehensive patient representations from EHRs. The key challenges of heterogeneity and temporality in EHR data are addressed using human-derived features appended to contextual embeddings of clinical concepts and Long-Short-Term-Memory networks, respectively. The developed models are empirically evaluated in the context of predicting adverse clinical outcomes such as mortality or hospital readmissions. We also present evidence that, surprisingly, different ML models primarily designed for non-EHR analysis (like language processing and time-series prediction) can be combined and adapted into a single framework to efficiently represent EHR data and predict patient outcomes.

<p> As the Baby Boomers age, the question of how to care for the burgeoning frail-elderly population grows more pressing. Sandwich-generation adult children are often called upon to make long-term care choices for their frail-elderly parents. This study used a Likert-type survey to determine if any of the six options for long-term care &ndash; no care, skilled nursing facilities, group homes, assisted living residences, home health care, and living at home with the sandwich-generation adult child &ndash; led to the highest degree of satisfaction for the sandwich-generation adult child who made the long-term care decision. The results indicated that having the frail-elderly parent live with the sandwichgeneration adult child brought the highest level of satisfaction.</p>

<p> The purpose of this project was to translate evidence-based literature into policy and practice guidelines in order to improve leadership standards and skills among nurse managers and improve patient outcomes and the quality of care. Guided by the American Nurses Credentialing Center Magnet Model and Lewin's change theory, which sets the framework for creating exceptional nursing leaders, a literature search was conducted from studies ranging from 2010 to 2012 from several databases. Inclusion criteria were based on the presence of one or more leadership styles discussed in the articles and the impact of leadership style on nursing satisfaction. A total of 25 articles were found during the electronic search, but only 7 articles met the inclusion criteria for analysis. The results of this review revealed that transformational leadership enhanced nursing satisfaction rates, while transactional leadership and situational leadership contributed to low levels of nursing satisfaction rates. This project contributes to positive social change for nurse managers because there is limited research available that focuses on leadership styles and its implication for practice. This project will inform the work of nurse managers by illuminating the importance of leadership styles on nursing satisfaction and work environment conditions.</p>