This thesis examines the role of primary health care delivery in rural India but specifically focuses on aspects from Karnataka state. It broadly reflects on the differences that exist between urban and rural populations' access to healthcare. The concept of primary health care appears to have lost its lustre at present, it was once enthusiastically promoted in the late 1970s and 1980s but as chronic problems appeared to affect the smooth delivery of healthcare and nowadays major global bodies like the WHO and IMF have relegated primary health concept to a lower level. However in countries like India, which adopted this concept although its implementation has been riddled with complex ongoing problems, there are not sufficient grounds to abandon it completely. These problems are mainly due to the slow implementation, which has left a vast rural population with little or no access to healthcare. Primary health care strongly promotes equity of access hence is vital in many developing nations. Recruiting highly skilled personnel to work in rural health centres has been an ongoing problem, which hinders the effective delivery of healthcare. A policy followed by Karnataka state tries to rectify this problem by offering postgraduate positions to junior doctors who are willing to work in rural areas. The efficacy of this policy is closely examined from two perspectives. Those who consume healthcare in rural areas are given an opportunity to voice their concerns and also the doctors who work there represent the views of the providers of healthcare. This study was conducted in Bidar district, which lies in the north of Karnataka. Bidar is identified comparatively as a less developed district that has many problems associated with poverty and poor health status. In the process of conducting research a variety of interesting aspects have been highlighted. My hope is that relevant authorities identify with the problems and take measures that could benefit many people's lives. Interestingly it transpires from the views expressed by the rural population that they have a good grasp of what they think they will need to access a better form of healthcare from the existing system. However it appears that there is almost a universal fatalistic acceptance of them being helpless and voiceless about making any to change by their suggestions nor did most of them have a hope of influencing future prospects. The studies also indicated that where there is a better level of provision there the people tend to access healthcare from authentic sources as opposed to unregistered and unqualified personnel. The doctors suggested that the policy is very useful provide certain intrinsic changes are made. On the one hand they did accept that their cost benefit and academic value of this policy is great. On the other hand they suggested the hurdles put in the course of achieving the postgraduate position are arduous and often vague sets of guidelines are imposed, making it very hard to make a straightforward transition from working in rural areas to getting a postgraduate position of choice. The doctors working on temporary contracts appeared to suffer genuine discrimination especially due to number of years they spent trying to get permanent position, years which were not counted towards their ambition of further education. Where it appears there is very little difference in the roles and responsibility between permanent and temporary contract doctors the question of why it does not occur to the authorities to redress this issue is discussed.

Syftet med studien var att undersöka vilka faktorer som påverkar hur primärvårdens fysioterapeuter ser på sin roll inom cancerrehabiliteringen. Följande faktorer undersöktes: ålder, tidsmässig erfarenhet inom yrket och specifikt inom primärvården, hur ofta fysioterapeuter möter cancerpatienter, upplevd kunskap, upplevd tillgång på resurser, uppskattning från cancerpatienter samt läkares uppfattning om fysioterapeutens roll/kompetens. Studien utfördes med en elektronisk enkät och skickades ut via mail till chefer vid hälsocentraler placerade i Region Västerbotten, Region Norrbotten, Region Jönköpings län samt Region Sörmland. Cheferna ombads vidarebefordra mailet till de fysioterapeuter som arbetade vid hälsocentralerna och sedan återkoppla i ett svarsmail hur många fysioterapeuter som mottagit mailet. Totalt 66 personer besvarade enkäten. Samband analyserades mellan de ovan nämnda faktorerna och utgångsvariabeln “Självklar del”, som handlar om i vilken utsträckning fysioterapeuterna känner sig som en självklar del inom cancerrehabiliteringen. Vid analysen genomfördes en dikotomisering för att få en ökad statistisk power. Signifikansnivån sattes till 0,05 och när analysen genomfördes påträffades två statistiskt signifikanta samband. Det första sambandet innebar att fysioterapeuter som känner sig mer uppskattade av cancerpatienter också känner sig som en mer självklar del inom cancerrehabiliteringen (p<0,001 vid ursprunglig variabel ochp=0,004 dikotomiserad). Det andra sambandet innebar att de som upplever att läkare i större utsträckning är medvetna om fysioterapeutens kompetens också känner sig som en mer självklar del inom cancerrehabiliteringen (p=0,030 vid ursprunglig variabel, p=0,160 respektive 0,007 beroende på hur dikotomiseringen genomfördes).

by Yu Hong. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1994. / Includes bibliographical references (leaves 91-100). / ABSTRACT --- p.I / ACKNOWLEDGEMENTS --- p.III / TABLE OF CONTENTS --- p.IV / Chapter CHAPTER ONE - --- INTRODUCTION AND STATEMENT OF RESEARCH PROBLEM --- p.1 / Chapter CHAPTER TWO - --- LITERATURE REVIEW --- p.6 / Chapter 2.1 --- Psychiatric morbidity in Western patients with fatigue --- p.7 / Chapter 2.2 --- Chronic fatigue syndrome as a contemporary version of neurasthenia --- p.9 / Chapter 2.3 --- The evolution of Shenjing Shuairuo in Chinese societies --- p.11 / Chapter 2.4 --- The place of fatigue in Shenjing Shuairuo --- p.15 / Chapter 2.5 --- Shenjing Shuairuo and chronic fatigue syndrome --- p.17 / Chapter 2.6 --- Mood disturbances in Shenjing Shuairuo --- p.20 / Chapter 2.7 --- Somatization in Shenjing Shuairuo --- p.23 / Chapter 2.8 --- Current and future research issues --- p.25 / Chapter CHAPTER THREE - --- OBJECTIVES AND HYPOTHESES --- p.28 / Chapter 3.1 --- Objectives --- p.29 / Chapter 3.2 --- Significance --- p.29 / Chapter 3.3 --- Hypotheses --- p.30 / Chapter CHAPTER FOUR - --- METHOD --- p.32 / Chapter 4.1 --- Research design --- p.33 / Chapter 4.2 --- Site of study --- p.35 / Chapter 4.-3 --- Subjects --- p.35 / Chapter 4.4 --- Instruments --- p.37 / Chapter 4.5 --- "Coordination, training and reliability" --- p.41 / Chapter 4.6 --- Summery of procedure --- p.42 / Chapter 4.7 --- Data management and analysis --- p.45 / Chapter CHAPTER FIVE - --- RESULT --- p.46 / Chapter 5.1 --- Sociodemography --- p.47 / Chapter 5.2 --- DSM-III-R diagnoses --- p.49 / Chapter 5.3 --- The diagnosis of neurasthenia --- p.51 / Chapter 5.4 --- The diagnosis of chronic fatigue syndrome --- p.51 / Chapter 5.5 --- Psychopathological profiles --- p.52 / Chapter 5.6 --- Aspects of illness experience --- p.54 / Chapter 5.7 --- Comparison by diagnostic categories --- p.59 / Chapter 5.8 --- Duration and severity of fatigue --- p.64 / Chapter 5.9 --- Comparison by sex --- p.67 / Chapter CHAPTER SIX - --- DISCUSSION --- p.69 / Chapter 6.1 --- Psychiatric morbidity of patients with chronic fatigue --- p.70 / Chapter 6.2 --- "Shenjing Shuairuo, depression and anxiety disorders" --- p.72 / Chapter 6.3 --- The delegitimation of fatigue --- p.75 / Chapter 6.4 --- Shenjing Shuairuo and chronic fatigue syndrome --- p.77 / Chapter 6.5 --- Shenjing Shuairuo and somatization --- p.81 / Chapter 6.6 --- Limitations of study --- p.84 / Chapter CHAPTER SEVEN - --- CONCLUSION AND FUTURE DIRECTION --- p.88 / Chapter 7.1 --- Conclusion --- p.89 / Chapter 7.2 --- Suggestions for future research --- p.90 / REFERENCES --- p.92

(1) Were among the antihypertensive drugs with the lowest likelihood of discontinuation implying a potentially superior tolerability profile (2) Had similar odds of short and long term rates of add-on pharmacotherapy implying a similar efficacy with other drug classes (3) Were associated with statistically similar all cause and CVS mortality (4) Had similar odds of presenting with impaired fasting glucose in the short-term. (5) Had higher odds of presenting with hypercholesterolemia in the short-term but the absolute increase in cholesterol was minimal (in the magnitude of 0.14 mmol/1). > (6) Had similar odds of presenting with hyponatremia and hypokalemia in the short-term. / Due to the large sample size these studies are likely to be representative and are new findings among ethnic Chinese patients presenting with uncomplicated hypertension. These results point towards thiazide diuretics as a favorable first-line antihypertensive agent in the management of uncomplicated hypertension in Hong Kong primary practice, in addition to favorable public health considerations including affordability. These studies are in support of guidelines from international authorities recommending thaizide diuretics as the best choice of first-line antihypertensive agent, and suggest that such international guidelines may be generalizable to patients of Chinese race. (Abstract shortened by UMI.) / In these studies we have characterized the major antihypertensive drug classes in terms of their prescription patterns, efficacy, tolerability and association with adverse clinical as well as biochemical outcomes. The completeness of CDARS and e-CMS of the Hospital Authority allows retrieval and comparison of these clinical outcomes of the commonly used antihypertensive agents. The present studies showed that prescription of CCB and BB were high compared with international trends and that of thiazide particularly low and showed a declining trend. Yet when compared with other drug classes, thiazide diuretics: / Wong Chi Sang. / Adviser: Stewart William Mercer. / Source: Dissertation Abstracts International, Volume: 70-09, Section: B, page: . / Thesis submitted in: September, 2008. / Thesis (M.D.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 223-260). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / School code: 1307.

Health inequity refers to differences in health status between populations ( health inequalities ) that are unnecessary and avoidable and, additionally, are considered unfair or unjust. The history of the concept is reviewed and the mechanisms by which inequity affects health surveyed, with a focus on multi - level models of health production. The origins and development of the Primary Health Care approach is then considered with an emphasis on the Australian setting and on HIV / AIDS policy. The construct of homosexuality is then explored and concepts of sexual attraction, ' orientation ', identity and behaviour differentiated. What is known about the health characteristics of homosexually active men in the First World is then surveyed by means of a systematic literature review. It is concluded that there is evidence that they are affected by substantial health inequality in a range of areas including mortality, suicidality, depressive disorders, anxiety disorders, report of childhood sexual abuse and problematic substance use. Few of these inequalities have been confirmed in the Australian context, however, and almost none have been confirmed specifically in South Australia. The background to the development of a Primary Health Care programme focused on homosexually active men, is then described. The baseline health characteristics of the programme ' s cohort of 542 homosexually active South Australian men ( including their sexual behaviour in the context of HIV transmission ) are described and compared with other samples of men to identify inequalities. It is concluded that men in the cohort were subject to health inequality in a wide range of health parameters including mortality, suicidality, sexually transmitted infections, depressive and anxiety disorders, levels of substance use and self - rated health on the short - form 36 ( sf36 ) instrument. The relationships between these characteristics and factors indicative of disadvantage and victimisation are then explored. It is concluded that many of the health inequalities identified were related to sociohistorical factors such as emotional withdrawal by one ' s father, low income, unemployment, reduced educational attainment, and recent experience of violence and abuse from strangers. It is argued that some of these factors can be considered to be examples of unfairness and injustice and that, as a consequence, at least some of the health inequality experienced by this population is also health inequity. The elements of the Primary Health Care programme devised to meet the needs of homosexually active men is described and the trajectory of health characteristics of its participants over three time points is examined. 210 homosexually active men had reached Second Review, an average of thirty - six months after enrolment, by the time of analysis. Among this group, significant sustained improvement in a range of health outcomes, including prevalence of depressive disorders, sf36 scores and rate of recent suicidal ideation, is reported in association with involvement in the programme. Participant ' s subjective satisfaction with the programme is then described and their beliefs about the causes of their improved health explored using a qualitative methodology. It is concluded that the programme had largely met the needs of participants and they believed that it had been responsible for their improved health. Limitations of the study are considered and discussed. Limitations of the investigation to identify health inequality include questions of external validity arising from the absence of a perfect comparator group and concerns with construct validity related to the possibility of geographical and cultural variation in definitions of ' homosexually active men '. In the investigation to determine the extent to which health inequalities were also examples of inequity, issues of conclusion validity are discussed particularly in relation to multiple comparisons and the balance between Type I and Type II errors. In the evaluation of the impact of the Primary Health Care programme, there are concerns about internal validity resulting from the absence of randomisation and an uncontrolled design. The components of this issue are discussed and some support for internal validity is found in the reported subjective beliefs of participants about the cause of their health improvement and the outcomes of critical reflection by the programme team. The implications of the findings for policy, practice and further research are explored. It is argued that the health inequity experienced by people of sexual diversity will require profound social change for complete resolution. In the meantime, however, focused Primary Health Care with a community of sexual diversity has the potential to mitigate the health inequity its members experience and to help them to survive and function while they wait for a fairer and kinder society. / Thesis (Ph.D.)--School of Population Health and Clinical Practice, 2005.

The aim of the study was to determine the practice of nurses employed in integrated care projects in New Zealand from late 1999 to early 2001. Integrated care was a major health reform strategy that emphasised primary health care as a means to improve service provision between the health sectors. An investigation of nurses’ practice sought to determine the extent to which primary health care principles had been adopted in practice, as a comprehensive primary health care approach has been advocated globally in the management of chronic conditions; the leading cause of disability throughout the world and the most expensive problems faced by health care systems. The philosophical basis of the research was postpositivism. The study employed a quantitative non-experimental survey design because it allowed numeric descriptions of the characteristics of integrated care projects to be gained for the purpose of identifying nurses’ practice. The unit of inquiry was the integrated care project, and 80 comprised the study population. Data were obtained on projects from expert informants (n=27) by telephone survey using a structured interview questionnaire developed by the researcher. Data obtained from interviews were statistically analysed in two stages. First, data were produced to comprehensively describe the characteristics of integrated care projects and nurses practice. The ‘Public health interventions model’ was used as a framework to analyses the interventions (activities) and levels of population-based practice of nurses. Following this, the social values embedded in nurses’ practice were determined using ‘Beattie’s model of health promotion’ as a framework for analysis. A strong association was found between nurses’ practice in projects and strategies used in integrated care, such as information sharing, guideline development and promotion, and case management, and projects with an ethnic focus, low income focus, chronic condition focus, and well-health focus. Whilst nurses undertook interventions most frequently at the individual practice level they were also strongly ii associated with the small proportion of interventions that were undertaken at the community level. The majority of interventions by nurses reflected the health promotion value of health persuasion, indicating a paternalist and individual-oriented philosophy. Nurses were engaged in two interventions that indicated a collectiveoriented philosophy - coalition building and community development, the latter reflecting health promotion values of negotiation, partnership and empowerment. The study demonstrated that nurses’ practice in projects was predominantly centred on individual-focused population-based practice suggesting the need for a framework to assist nurses to transition their practice to include more activity at the community and systems levels. Without a reorientation of practice, nurses will remain limited in their ability to achieve health gains for populations. In response to this conclusion, and drawing on research results and reviewed literature, a new model, The ‘Primary Health Care interventions model’ was constructed. Recommendations include advocacy for the acceptance of the model by the health funder, professional nursing bodies, health organisations, educational institutions, nurses, communities, and individuals.

The aim of the study was to determine the practice of nurses employed in integrated care projects in New Zealand from late 1999 to early 2001. Integrated care was a major health reform strategy that emphasised primary health care as a means to improve service provision between the health sectors. An investigation of nurses’ practice sought to determine the extent to which primary health care principles had been adopted in practice, as a comprehensive primary health care approach has been advocated globally in the management of chronic conditions; the leading cause of disability throughout the world and the most expensive problems faced by health care systems. The philosophical basis of the research was postpositivism. The study employed a quantitative non-experimental survey design because it allowed numeric descriptions of the characteristics of integrated care projects to be gained for the purpose of identifying nurses’ practice. The unit of inquiry was the integrated care project, and 80 comprised the study population. Data were obtained on projects from expert informants (n=27) by telephone survey using a structured interview questionnaire developed by the researcher. Data obtained from interviews were statistically analysed in two stages. First, data were produced to comprehensively describe the characteristics of integrated care projects and nurses practice. The ‘Public health interventions model’ was used as a framework to analyses the interventions (activities) and levels of population-based practice of nurses. Following this, the social values embedded in nurses’ practice were determined using ‘Beattie’s model of health promotion’ as a framework for analysis. A strong association was found between nurses’ practice in projects and strategies used in integrated care, such as information sharing, guideline development and promotion, and case management, and projects with an ethnic focus, low income focus, chronic condition focus, and well-health focus. Whilst nurses undertook interventions most frequently at the individual practice level they were also strongly ii associated with the small proportion of interventions that were undertaken at the community level. The majority of interventions by nurses reflected the health promotion value of health persuasion, indicating a paternalist and individual-oriented philosophy. Nurses were engaged in two interventions that indicated a collectiveoriented philosophy - coalition building and community development, the latter reflecting health promotion values of negotiation, partnership and empowerment. The study demonstrated that nurses’ practice in projects was predominantly centred on individual-focused population-based practice suggesting the need for a framework to assist nurses to transition their practice to include more activity at the community and systems levels. Without a reorientation of practice, nurses will remain limited in their ability to achieve health gains for populations. In response to this conclusion, and drawing on research results and reviewed literature, a new model, The ‘Primary Health Care interventions model’ was constructed. Recommendations include advocacy for the acceptance of the model by the health funder, professional nursing bodies, health organisations, educational institutions, nurses, communities, and individuals.

The aim of the study was to determine the practice of nurses employed in integrated care projects in New Zealand from late 1999 to early 2001. Integrated care was a major health reform strategy that emphasised primary health care as a means to improve service provision between the health sectors. An investigation of nurses’ practice sought to determine the extent to which primary health care principles had been adopted in practice, as a comprehensive primary health care approach has been advocated globally in the management of chronic conditions; the leading cause of disability throughout the world and the most expensive problems faced by health care systems. The philosophical basis of the research was postpositivism. The study employed a quantitative non-experimental survey design because it allowed numeric descriptions of the characteristics of integrated care projects to be gained for the purpose of identifying nurses’ practice. The unit of inquiry was the integrated care project, and 80 comprised the study population. Data were obtained on projects from expert informants (n=27) by telephone survey using a structured interview questionnaire developed by the researcher. Data obtained from interviews were statistically analysed in two stages. First, data were produced to comprehensively describe the characteristics of integrated care projects and nurses practice. The ‘Public health interventions model’ was used as a framework to analyses the interventions (activities) and levels of population-based practice of nurses. Following this, the social values embedded in nurses’ practice were determined using ‘Beattie’s model of health promotion’ as a framework for analysis. A strong association was found between nurses’ practice in projects and strategies used in integrated care, such as information sharing, guideline development and promotion, and case management, and projects with an ethnic focus, low income focus, chronic condition focus, and well-health focus. Whilst nurses undertook interventions most frequently at the individual practice level they were also strongly ii associated with the small proportion of interventions that were undertaken at the community level. The majority of interventions by nurses reflected the health promotion value of health persuasion, indicating a paternalist and individual-oriented philosophy. Nurses were engaged in two interventions that indicated a collectiveoriented philosophy - coalition building and community development, the latter reflecting health promotion values of negotiation, partnership and empowerment. The study demonstrated that nurses’ practice in projects was predominantly centred on individual-focused population-based practice suggesting the need for a framework to assist nurses to transition their practice to include more activity at the community and systems levels. Without a reorientation of practice, nurses will remain limited in their ability to achieve health gains for populations. In response to this conclusion, and drawing on research results and reviewed literature, a new model, The ‘Primary Health Care interventions model’ was constructed. Recommendations include advocacy for the acceptance of the model by the health funder, professional nursing bodies, health organisations, educational institutions, nurses, communities, and individuals.

The aim of the study was to determine the practice of nurses employed in integrated care projects in New Zealand from late 1999 to early 2001. Integrated care was a major health reform strategy that emphasised primary health care as a means to improve service provision between the health sectors. An investigation of nurses’ practice sought to determine the extent to which primary health care principles had been adopted in practice, as a comprehensive primary health care approach has been advocated globally in the management of chronic conditions; the leading cause of disability throughout the world and the most expensive problems faced by health care systems. The philosophical basis of the research was postpositivism. The study employed a quantitative non-experimental survey design because it allowed numeric descriptions of the characteristics of integrated care projects to be gained for the purpose of identifying nurses’ practice. The unit of inquiry was the integrated care project, and 80 comprised the study population. Data were obtained on projects from expert informants (n=27) by telephone survey using a structured interview questionnaire developed by the researcher. Data obtained from interviews were statistically analysed in two stages. First, data were produced to comprehensively describe the characteristics of integrated care projects and nurses practice. The ‘Public health interventions model’ was used as a framework to analyses the interventions (activities) and levels of population-based practice of nurses. Following this, the social values embedded in nurses’ practice were determined using ‘Beattie’s model of health promotion’ as a framework for analysis. A strong association was found between nurses’ practice in projects and strategies used in integrated care, such as information sharing, guideline development and promotion, and case management, and projects with an ethnic focus, low income focus, chronic condition focus, and well-health focus. Whilst nurses undertook interventions most frequently at the individual practice level they were also strongly ii associated with the small proportion of interventions that were undertaken at the community level. The majority of interventions by nurses reflected the health promotion value of health persuasion, indicating a paternalist and individual-oriented philosophy. Nurses were engaged in two interventions that indicated a collectiveoriented philosophy - coalition building and community development, the latter reflecting health promotion values of negotiation, partnership and empowerment. The study demonstrated that nurses’ practice in projects was predominantly centred on individual-focused population-based practice suggesting the need for a framework to assist nurses to transition their practice to include more activity at the community and systems levels. Without a reorientation of practice, nurses will remain limited in their ability to achieve health gains for populations. In response to this conclusion, and drawing on research results and reviewed literature, a new model, The ‘Primary Health Care interventions model’ was constructed. Recommendations include advocacy for the acceptance of the model by the health funder, professional nursing bodies, health organisations, educational institutions, nurses, communities, and individuals.

The study aimed to explore and describe factors which impacted on the satisfaction of patients using the curative component of primary health care in the Ekurhuleni Metropolitan area. A qualitative, explorative and contextual design was followed in this study. Focus group interviews were used to collect data from clients, nurse clinicians and community health committee members. Findings indicated that there was lack of facilities, resources and supplies, lack of safety and security measures, negative attitudes of nurse clinicians, lack of community involvement and lack of clinic management involvement. Suggestions were made by the groups on how to improve the curative primary health care service and intervention strategies were identified from the suggestions made. The implementation of these strategies will help with the improvement of the service delivery at the clinic for primary health care. / Health Studies / (M.A. (Health Studies)