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No description available.

No description available.

This study began as an investigation into models of service delivery for people with communication disorders in less developed countries. To compensate for the limited data on this client group, exploration of national and international literature, together with perspectives on disability in general, were supplemented by a situation analysis of the services offered to this group of people in Oyo State, Nigeria. These revealed impairment-led activities with low coverage levels and terminology so diverse and inconsistent, that meaningful comparison among limited data available were difficult to achieve. Three groups of theoretical questions relating to people with communication disorders were developed from the review and analysis. The questions concerned disability, needs and attitudes. The explorations of these form the basis of this research. Complementary use of qualitative and quantitative methodologies enabled collection of data relevant to the questions posed, through surveys, interviews and focus group discussions, with professionals, parents and community members. Each phase of the data collection was modified to take account of the findings of the previous phase and a process of triangulation was used to validate the data. The data establishes `people with communication disorders' as part of the population of disabled people and develops a `communication disability model' as a means of understanding and developing appropriate service delivery structures. This includes adoption of the term 'people with communication disabilities' as one that expresses and encompasses the author's perception of the target population.

The inclusion of user representatives in committees and groups alongside health professionals is one of several ways of involving users in the planning and monitoring of health services. However, there have been reports of barriers to the involvement of users in such groups and very little is understood about the processes that take place and the factors which promote effectiveness. This study addresses this shortfall in relation to a specific type of user involvement forum in maternity services - the Maternity Services Liaison Committee (MSLC). MSLCs are attached to hospital trusts or health authorities and bring together health professionals and local users to plan and monitor local maternity services. The study is a qualitative assessment of a sample of eight MSLCs using a combination of observation and interview methods. It investigates the structure and work of MSLCs, the way members participate, and the meaning and value of MSLCs to members, in order to establish the effectiveness of MSLCs and potential for improvement. The committees were found to have a limited direct impact on maternity services. Arguably their greatest influence was in promoting collaboration between constituent groups and the accountability of health professionals. The impact of MSLCs and the extent to which users were involved were limited by factors to do with the structure and processes of the committees. MSLCs could be improved to some extent through changes to these, but improvement beyond a certain point would be difficult to achieve because the problems reflect fundamental issues to do with the structure of the health service and the way MSLCs were set up, the high degree of professional control over MSLC activity and health care in general, and characteristics of users. These findings have implications for the effectiveness of other forums for user involvement presently being implemented in the health service.

Women from poor communities in Northeast Thailand can be considered as a disadvantaged group who have struggled against several problems in their daily living and who have worked hard to sustain their lives through unskilled labour. In such a strong Buddhist culture these women have vital roles within the household and in earning money. The combination of which it is suggested, has had an impact on their physical and psychological health. In Thailand, there is limited data available about such women's health, life experience and work. A better understanding of their situation is required in order to inform and redesign effective health intervention programmes to promote the health and well-being of women from these communities. An holistic nursing perspective was used to inform the design of this research. Only by understanding the context, the living experiences and the understandings of the women themselves is it possible to construct effective health intervention programmes. Thus the purpose of the study was to understand women's health and work in the sociocultural context of poverty in Northeast Thailand. A combination of quantitative and qualitative techniques were used in the overall data collection process. The study was conducted in two distinct phases. Phase 1 provided an overall of baseline account of the socio-cultural context of six communities and the health of a sample of women who live therein. It involved focus group interviews (N=102) with residents and a survey (N=209) of households. Phase 2 was a more focused case study (N=49) of women's life experiences, their health and work in one selected community. Phase 1 of the study found that the majority of women had a substantial role in household economics. Coping strategies that women frequently used were `Tam Chai' (accept and not think too much about it). The majority of women in the communities were primary breadwinners and were self-employed as vendors. Regarding women's health, the findings showed a high level of musculoskeletal and psychological complaints. The study showed that nearly all of the women were optimists and felt happy. In the second phase of the study. Buddhism and the Thai way of living emerged as the major factors which influenced women's views on health and well being. The data illustrated that women struggled to survive in the community and that they had to work hard to make ends meet. Women used networks in the community as resources for coping. They saw `health in terms of being strong enough to work and earn a living'. Health per se is the lowest priority in their life. To work and earn money to support their families is the highest. Indeed, the Buddhist teaching of `self-reliance' has a great impact on them. The conclusions reached suggest that nursing interventions and health campaigns could be used to promote and maintain the optimum health of women and their families. Finally recommendations are made with regard to further research; development of services; development of nurse-education and health promotion for women in low-income communities.

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No description available.

This research study utilised the grounded theory method as developed by Glaser and Strauss (1967) in order to construct a theoretical framework for understanding the functioning of staffed group homes for children and youth. Ten residential settings in five governmental regions of British Columbia were studied over a period of fourteen months using the techniques of on-site participant observation, transcribed interviews and document analysis. The core theme that emerged from the constant comparative analysis was "congruence". The notions of the "struggle for congruence" and "the flow of congruence" in service of the children's best interests were seen to play a pivotal role in the functioning of group home life and work, and three properties of congruence were identified: consistency, reciprocity and coherence. Three major psychosocial processes also emerged as sub-categories, including: "creating an extrafamilial living environment", the overall task of a home; "responding to pain and pain-based behaviour", the major challenge for staff; and "developing a sense of normality", the primary goal for residents. Completing the framework matrix were eleven key interactional dynamics that were evident across all five levels of operation of the group homes, namely: extra-agency, management, supervision, carework/teamwork, and youth and families. Ten selected residential child and youth care studies published in Canada, the United Kingdom, and the United States are analysed through the lens of the framework. While seen to be complementary to the related texts, this study brings forward several previously neglected aspects of group home life and work together with more commonly explored notions into an integrated and accessible framework. Implications for residential child and youth care policy development, education, practice and research are proposed.

This study traces the development of General Practice in the Scottish islands from the earliest times up until the present day. The earliest evidence of medical practice is trephination carried out in the Bronze Age. In the Dark Ages, and succeeding centuries, medical practice was in the hands of the Columban missionaries, for whom medical cures demonstrated the superior power of monotheism over pagan gods. There was also a rich body of folk-beliefs, based on witchcraft, evil-eye etc., with healing by means of incantations, charm-stones and well-rituals In the twelfth century, the island chiefs employed well-educated hereditary clan physicians, but their influence declined in the early eighteenth century. For those less highly placed in the clan hierarchy, recourse was still made to folk-medicine. Increasingly, from the seventeenth century, readily recognisable medical practitioners were to be found in the islands. Medical practice was most unsatisfactory in the Scottish islands until the middle of the nineteenth century, when the Poor Law Amendment Act was passed. Although this Act improved medical practice considerably, the structure of landownership in the islands delayed its full benefits. A significant development was the Highlands & Islands Medical Service of 1912, which was practically unchanged by the advent of the National Health Service. It is second in importance only to the coming of air-service to the islands, which largely removed the geographical truism of remoteness and isolation.