Family-centered care (FCC) focuses on considering the family in planning/implementing care and is associated with increased patient satisfaction. Little is known about factors that influence FCC. Using linear mixed modeling and Generalized Estimating Equations to analyze data from a cross-sectional survey of primary care practices in Ontario, this study sought to determine whether models of primary care service delivery differ in their provision of FCC and to identify characteristics of primary care practices associated with FCC. Patient-reported scores of FCC were high, but did not differ significantly among primary care models. After accounting for patient characteristics, practice characteristics were not significantly associated with patient-reported FCC. Provider-reported scores of FCC were significantly higher in Community Health Centres than in Family Health Networks. Higher numbers of nurse practitioners and clinical services on site were associated with higher FCC scores but scores decreased as the number of family physicians at a site increased.

Healthcare data can contain sensitive, personal, and confidential information that should remain secure. Despite the efforts to protect patient data, security breaches occur and may result in fraud, identity theft, and other damages. Grounded in the theoretical backdrop of integrated system theory, the purpose of this study was to determine the association between data privacy breaches, data storage locations, business associates, covered entities, and number of individuals affected. Study data consisted of secondary breach information retrieved from the Department of Health and Human Services Office of Civil Rights. Loglinear analytical procedures were used to examine U.S. healthcare breach incidents and to derive a 4-way loglinear model. Loglinear analysis procedures included in the model yielded a significance value of 0.000, p > .05 for the both the likelihood ratio and Pearson chi-square statistics indicating that an association among the variables existed. Results showed that over 70% of breaches involve healthcare providers and revealed that security incidents often consist of electronic or other digital information. Findings revealed that threats are evolving and showed that likely factors other than data loss and theft contribute to security events, unwanted exposure, and breach incidents. Research results may impact social change by providing security professionals with a broader understanding of data breaches required to design and implement more secure and effective information security prevention programs. Healthcare leaders might affect social change by utilizing findings to further the security dialogue needed to minimize security risk factors, protect sensitive healthcare data, and reduce breach mitigation and incident response costs.

Background Rising surgery rates have raised questions about the indications for spinal surgery. The study investigated patient-level and regional factors associated with spinal surgery for patients with spinal diseases. Methods We undertook a cohort study based on routine healthcare data from Germany of 18.4 million patients within 60.9 million episodes of two patient-years before a possible spinal surgery in the time period 2008 to 2016. Using a Poisson model, the effects of a broad range of patient-related (sociodemographic, morbidity, social status), disease- and healthcare-related (physicians’ specialty, conservative treatments) and regional variables were analyzed. Results There was substantial regional heterogeneity in the occurrence of spinal surgery which decreased by only one quarter when controlling for the various determinants assessed. Previous musculoskeletal and mental health disorders as well as physical therapy were associated with a lower probability of surgery in the fully-adjusted model. Prescriptions for pain medication and consultations of specialists were associated with a higher probability of surgery. However, the specific severity of the vertebral diseases could not be taken into account in the analysis. Furthermore, a substantial proportion of patients with surgery did not receive a consultation with an outpatient specialist (29.5%), preoperative diagnostics (37.0%) or physical therapy (48.3%) before hospital admission. Conclusion This large study on spinal diseases in Germany highlights important patterns in medical care of spinal diseases and their association with the probability of spinal surgery. However, only a relatively small proportion of the regional heterogeneity in spinal surgery could be explained by the extensive consideration of confounders, which suggests the relevance of other unmeasured factors like physicians’ preferences.

Als Bundesland mit dem höchsten Altersdurchschnitt in Deutschland und besonderen Strukturmerkmalen ländlich geprägter Gebiete sind die Folgen des demographischen Wandels bereits heute in Sachsen spürbar. Um die medizinische Versorgung von Parkinson-Patienten zu verbessern, bedarf es einer Status-quo-Analyse der aktuellen Versorgungspraxis. Ziel der Arbeit (Fragestellung) Inwieweit unterscheidet sich die Inanspruchnahme der medizinischen Leistungserbringung von Parkinson-Patienten im Vergleich von städtisch und ländlich geprägten Gebieten sowie im Vergleich von Parkinson-Patienten mit und ohne Neurologenkontakt im Beobachtungszeitraum von 2011 bis 2019? Material und Methoden Die Kohortenstudie basiert auf umfangreichen Routinedaten der Krankenkasse AOK PLUS der Jahre 2010 bis 2019 für Sachsen. Untersucht wurde eine Kohorte von insgesamt 15.744 Parkinson-Patienten (n = 67.448 Patientenjahre) und eine gematchte Vergleichskohorte (n = 674.480 Patientenjahre; Kriterien: Geburtsjahr, Geschlecht, Versicherungsjahr, Wohnsitz Stadt/Land) ohne ICD-10-Kodierung einer Bewegungsstörung. Ergebnisse Insgesamt war eine kontinuierliche Zunahme der Anzahl der Erkrankten in der dynamischen Kohorte von 2011 (n = 6829) bis 2019 (n = 8254) zu beobachten. Stadt-Land-Unterschiede zeigten sich insbesondere in der geringeren (Mit‑)Behandlung durch niedergelassene Neurologen in ländlich geprägten Gebieten. Parkinson-Patienten hatten ein 3,5- bzw. 4‑fach erhöhtes Risiko zu versterben im Vergleich zu Versicherten der Vergleichskohorte. Veränderungen der medikamentösen Parkinson-Therapie (Zunahme COMT- und MAO-Inhibitoren) sowie der Heilmittelerbringung (Zunahme Ergotherapie und Logopädie) über die Beobachtungszeit zeigten sich primär bei Parkinson-Patienten mit Neurologenkontakt. Diskussion In der Studie konnten eine erhöhte Morbidität und Mortalität bei Parkinson-Patienten identifiziert werden, die sich als Ziel für innovative Versorgungskonzepte eignen. Die zunehmende Zahl an Patienten und die beschriebenen Unterschiede dokumentieren hierfür den Bedarf. Gleichzeitig zeigen die Veränderungen in der Verordnungspraxis, dass innovative Therapien von niedergelassenen Neurologen eingesetzt werden. / Background The consequences of demographic change are already noticeable in Saxony, the federal state with the highest average age in Germany and predominantly rural areas. In order to improve medical care for patients with Parkinson’s disease (PwP), a status quo analysis of current care practice is required. Objective To what extent does the utilization of medical services by PwP differ a) between urban and rural areas in Saxony and b) between PwP with and without neurologist contact in the observation period from 2011 to 2019? Material and methods The cohort study was based on extensive routine data for Saxony from the health insurance company AOK PLUS from 2010 to 2019. A cohort of 15,744 PwP (n = 67,448 patient-years) was compared to a matched cohort (n = 674,480 patient-years; criteria: year of birth, gender, year of insurance, place of residence: urban/rural) without an ICD-10 coding of a movement disorder. Results Overall, there was a steady increase in the number of PwP in the dynamic cohort from 2011 (n = 6829) to 2019 (n = 8254). Urban-rural differences included a smaller proportion of patients being seen by a neurologist in rural areas. The PwP had a 3.5 to 4‑fold higher risk of dying compared to those in the comparison cohort. Changes in drug therapy for Parkinson’s disease (i.e., increases in COMT and MAO inhibitors) and in remedy delivery (i.e., increases in occupational therapy and speech therapy) over the observation period were primarily seen in PwP who were seen by a neurologist. Discussion The study identified increased morbidity and mortality in PwP who are suitable targets for innovative care concepts. The increasing number of patients and the described differences document the need for this. At the same time, changes in prescription practice show that innovative forms of treatment are being used by neurologists in outpatient care.

Given the importance of the ability to read, learners must have access to books in schools. The lack of functional school libraries in South Africa, especially in primary schools, is to the detriment of learners’ reading achievement. In the 2011 Progress in International Reading Literacy Study (PIRLS) study, Grades 4 and 5 children achieved the lowest scores in the reading comprehension tests of the 40 participating countries. The researcher proposes that one intervention that would help solve the low levels of reading literacy among learners would be for schools to have an official school library policy, and to have functional well-stocked school libraries. This study seeks to identify the self-reported reading attitudes of learners who took part in the PIRLS 2011 study using a secondary data analysis, and to investigate by means of a systematic literature review, materials published between 1994 and 2017 on the non-implementation of school library policies. This study recommends speeding up progress in meeting minimum norms for school infrastructure in order to create a space for functional school libraries in all schools. Secondly, it suggests that access to books for primary school learners should be improved, and lastly, that the national guidelines for school libraries on planning and reforming school libraries should be finalised and implemented. Key / Information Science / M. Inf. (Information Science)

Magister Psychologiae - MPsych / This study utilised secondary data from a larger study that looked at individuals that are already infected by HIV which is entitled Implicative personal dilemmas and cognitive conflicts in health decision making in HIV positive adults and adults with AIDS. The primary aim of the larger study was to examine the cognitive construction of the individual and how they utilised their individual resources to construct who they are and how they perceived the difficulties and challenges that they face and the decisions they make regarding their health. HIV and AIDS is a debilitating disease and it affects millions worldwide. South Africa, presently, has the largest burden of this disease with those between the ages of 15 – 49 years of age being most affected. As previously mentioned the decisions that individuals make can impact on their health. Decisions to take necessary precautions such as protected sex during sexual intercourse can decrease the progression of the disease. Decisions made regarding abstinence of risky behaviour as well as being committed to taking medication could also positively impact health. People living with HIV and AIDS find it difficult to adjust to the challenges that this disease presents. Depression is often experienced due to the changes in self image and perception. Studies show that females are twice more likely to experience depression than men. There has however been no conclusive evidence showing the reason for this, however, the perception of stress based on gender could shed some light on this matter and how these perceptions can increase the likelihood of women being more vulnerable to depression. Due to the limitation of this study, it will only look at depression as it relates to HIV and AIDS. Psychological problems such as depression can hamper the adjustment process and the effect of depression is evident in that it can lower the CD 4 + cells. Not only are those living with HIV and AIDS affected by depression, but they also have a lifetime prevalence to depression. It is important to have an effective screening tool for depression so that the detection of this disease can be made and effective treatment can be implemented to enhance health. The sample consisted of 113 adult participants that have already been diagnosed with HIV and AIDS. The primary aim of this study was to compare the Beck’s Depression Inventory II (BDI II) and the Hospital Anxiety and Depression Scale –(the Depression component) (HADS-D) as a screening tool for depression. Exploratory Factor Analysis revealed a 5 factor structure which accounted for 60.14 % of the total variance. The HADS yielded one factor accounting for 14.33% of total variance. The BDI II has proven to be more a reliable measure of depression with 0.89 according to the Cronbach’s Alpha co efficient opposed to 0.375 as per the HADS-D. The secondary aim was to establish the sociodemographic and disease profiles of the participants under study. / South Africa

Working capital optimization, as an act of balancing liquidity and profitability, presents significant challenges when small businesses lack managerial expertise and access to affordable capital and credit facilities. To remain successful through efficient utilization of working capital, small business leaders need to understand the association between working capital management (WCM), working capital policy (WCP), and business profitability (PFT). Anchored in the cash conversion cycle theory, the purpose of this correlational study was to examine the relationship between WCM, WCP, and PFT. The study employed a retrospective secondary analysis of financial data from 2004 to 2013 from a random sample of 176 publicly traded small U.S. manufacturing companies. The regression results incorporating 3 models were significant in predicting profitability in terms of gross operating profit (GOP), return on asset (ROA), and Tobin's q (TBQ). The regression results showed that WCM and WCP were significant predictors of GOP, F (5, 170) = 8.580, p < .000, R2 = .201; ROA, F (5, 170) = 4.079, p < .002, R2 = .107; and TBQ, F (5, 170) = 6.231, p < .000, R2 = .155. The overall result confirmed that WCM and WCP predicted PFT significantly (p < .05). Small business leaders may incorporate working capital optimization practices into overall corporate strategy, thereby aligning working capital needs with the changing business requirements. The implications for positive social change included the potential to provide small business leaders with knowledge of WCM and WCP as drivers of PFT. Profitable businesses may provide employees and communities with better jobs; stock ownership; and development infrastructures such as road, healthcare, and educational facilities.

<p>In the majority of the schools in South Africa (SA), learners commence education in English. This English milieu poses a considerable challenge for English second-language speakers. In an attempt to bridge the gap between English as the main medium of instruction and the nine indigenous languages of the country and assist with the implementation of mother-tongue based bilingual education, this study focuses on the cross-validation of a monolingual English test used in the assessment of multilingual or bilingual learners in the South African context. This test, namely the Woodcock Mu&ntilde / oz Language Survey (WMLS), is extensively used in the United States in Additive Bilingual Education in the country. The present study is a substudy of a broader study, in which the original WMLS (American-English version) was adapted into SA English and Xhosa. For this specific sub-study, the researcher was interested in investigating the scalar equivalence of the adapted English version of the Verbal Analogies (VA) subscale of the WMLS across English first-language speakers and Xhosa first-language speakers. This was achieved by utilising differential item functioning (DIF) and construct bias statistical techniques. The Mantel-Haenszel DIF detection method was employed to detect DIF, while construct equivalence was examined by means of exploratory factor analysis (EFA) utilising an a priori two-factor structure. The Tucker&rsquo / s phi coefficient was used to assess the congruence of the construct across the two language groups</p>

<p>This study utilised secondary data from a larger study that looked at individuals that are already infected by HIV which is entitled Implicative personal dilemmas and cognitive conflicts in health decision making in HIV positive adults and adults with AIDS. The primary aim of the larger study was to examine the cognitive construction of the individual and how they utilised their individual resources to construct who they are and how they perceived the difficulties and challenges that they face and the decisions they make regarding their health. HIV and AIDS is a debilitating disease and it affects millions worldwide. South Africa, presently, has the largest burden of this disease with those between the ages of 15 &ndash / 49 years of age being most affected. As previously&nbsp / mentioned the decisions that individuals make can impact on their health. Decisions to take necessary precautions such as protected sex during sexual intercourse can decrease the&nbsp / progression of the disease. Decisions made regarding abstinence of risky behaviour as well as being committed to taking medication could also positively impact health. People living with HIV and AIDS find it&nbsp / difficult to adjust to the challenges that this disease presents. Depression is often experienced due to the changes in self image and perception. Studies show that&nbsp / females are twice more likely to experience depression than men. There has however been no conclusive evidence showing the reason for this, however, the perception of stress based on&nbsp / gender could shed some light on this matter and how these perceptions can increase the likelihood of women being more vulnerable to depression. Due to the limitation of this study, it will&nbsp / only look at depression as it relates to HIV and AIDS. Psychological problems such as depression can hamper the adjustment process and the effect of depression is evident in that it can lower the CD 4 + cells. Not only are those&nbsp / living with HIV and AIDS affected by depression, but they also have a lifetime prevalence to depression. It is important to have an effective screening tool for depression so that the detection of this&nbsp / disease can be made and effective treatment can be implemented to enhance health. The sample consisted of 113 adult participants that have already been diagnosed with HIV and AIDS. The&nbsp / primary aim of this study was to compare the Beck&rsquo / s Depression Inventory II (BDI II) and the Hospital Anxiety and Depression Scale &ndash / (the Depression component) (HADS-D) as a screening tool&nbsp / &nbsp / for depression. Exploratory Factor Analysis revealed a 5 factor structure which accounted for 60.14 % of the total variance. The HADS yielded one factor accounting for 14.33% of total variance. The BDI II has proven to be more a reliable measure of depression with 0.89 according to the Cronbach&rsquo / s Alpha co efficient opposed to 0.375 as per the HADS-D. The secondary aim was to establish&nbsp / the sociodemographic and disease profiles of the participants under study. </p>

The Labour Supply of Unpaid Caregivers in Canada, Doctor of Philosophy (PhD), Meredith Lenore Lilly, Department of Health Policy, Management and Evaluation, University of Toronto, 2008. As medical care increasingly shifts from the hospital to the home, responsibility for care has also shifted from the state and paid care, to the family and unpaid care. Unpaid caregivers are family members and friends who provide homecare services to recipients in their place of residence without financial compensation, as a result of their close personal relationships. This research tests the multiple hypotheses that unpaid caregiving has an impact on (1) the probability of labour force participation (LFP); (2) hours of labour force work; and (3) earnings by caregivers in Canada. We analyzed the 1996 and 2002 General Social Surveys, applying multivariate probit, logistic, and OLS regression analyses to four equations: 1) the probability of labour force participation; 2) the hourly wage; 3) weekly hours of labour market work; and 4) the probability of being an unpaid caregiver. Results indicate that unpaid caregiving was negatively associated with labour force participation; however, the impact on hours of labour market work and wages was uncertain. Women and men caregivers were impacted differently: only caregiving men in 1996 had significantly lower wages than non-caregivers, and only women in 1996 worked significantly fewer hours in the labour market. When caregiving was defined broadly, only men in 1996 were significantly less likely to be employed than non-caregivers. Yet when we controlled for caregiving intensity in 2002, both male and female primary caregivers were much less likely to be in the labour force than non-caregivers, while secondary caregivers were no less likely to be employed than non-caregivers. We conclude that when caregiving responsibilities are relatively small, individuals seem able to balance both caregiving with employment. Yet when caregiving commitments become heavy, it becomes increasingly difficult to balance employment with caregiving. We make a number of policy recommendations ranging from improving caregiver access to financial supports, formal care and respite services, particularly for primary caregivers. We also encourage the development of workplace legislation and caregiver friendly workplaces for the majority of caregivers who remain in the labour market.