Suchergebnisse

A thesis submitted to the University of Bedfordshire, in partial fulfilment of the requirements for the degree of doctor of Philosophy. ; Healthcare self-referral leads to patients receiving care at an inappropriate level and for an unnecessarily higher cost. The patients who most require specialist services are unable to access them in an appropriate manner and the utilisation of Primary Health Care (PHC) services are undermined. In addition, healthcare providers at the referral level regarding care are overwhelmed with minor cases that would have been easily managed at the primary care level. Despite the implications of healthcare self-referral and the large proportion (60-90%) of patients self-referring in the Nigerian healthcare system, there is a dearth of information on the factors that influence healthcare self-referral from the Nigerian context. Therefore, exploratory sequential mixed method approach was employed to address the objectives of this research which were: 1) identify the factors that influence service users' self-referral to secondary healthcare facilities by exploring the perceptions and experiences of the service users and healthcare providers (qualitative approach); and 2) examine the relationships between the identified factors that influence the decision to self-refer among the self-referred service users (quantitative approach). Andersen's initial behavioural model was adopted as the theoretical model for this study. This model posits that individual's use of healthcare services is linked to their predisposing, enabling and need factors for care. Thus, the Andersen's components helped to structure and assist with the understanding of the factors linked with healthcare self-referral. The interviews (qualitative) with the service users (n=24) and healthcare providers (n=18) were analysed using the five stages of framework analysis namely familiarisation with data, identification of thematic framework, indexing, charting, mapping and interpretation of data. This generated several themes associated with service users bypassing their primary healthcare facilities to the secondary level of care. The findings reflected perceptions regarding healthcare providers, equipment, expectations of service users, and advice from friends, relatives and others. Additional factors identified included government regulations on the utilisation of healthcare facilities, medical symptoms and the perception of severity of symptoms service users present with, in addition to an understanding of the healthcare delivery system among the service users. The inferential findings of the quantitative analysis (n=449) ascertained significant differences between levels of education and understanding of healthcare delivery. Significant differences were also established between levels of education and the perceptions of healthcare providers. Further hypotheses that demonstrated significant differences comprised the relationship between employment status and ability to access the secondary level of care. The relationship between age and reported medical symptoms among the self-referred service users was also discovered to be associated with healthcare self-referral. Additionally, the descriptive analysis also disclosed diverse levels of agreement with each of the sub-scale items on the questionnaire. Overall, the quantitative findings were observed to corroborate with large parts of the qualitative findings. The findings of this research suggest the need for a multifacet approach in addressing healthcare self-referral in the Nigerian context. This include ensuring the availability of the services of doctors within the PHC facilities, ensuring equitable distribution of equipped and operational PHC facilities. In addition, there is need to educate the populace on the appropriate utilisation of the different levels of healthcare facilities. In conclusion, an original approach to healthcare self-referral was demonstrated by adopting the exploratory sequential mixed method and Andersen's model to understand healthcare self-referral. The findings also contribute to this field by examining the relationships between the factors identified to predict healthcare self-referrals and consequently, offer recommendations, as it applies to the healthcare system in Nigeria.

In the face of growing anxiety about the environmental sustainability of the world, George Francis, a leading authority in the field of sustainability studies, examines initiatives undertaken in Canada over the past twenty-five years to protect some of our unique environments

Abstract
This article offers a new way of exploring African American protest in Los Angeles in the 1980s and 1990s. It moves beyond reductive explanations of an inevitable economic and cultural conflict between African Americans and Koreans to examine the role of urban space and understanding of "spatial justice" in fostering anger and resentment. Activists in Black Los Angeles had for a long time targeted liquor stores as a form of neighborhood blight in South Central. The article considers three organizational approaches to protesting liquor stores: 1) The South Central Organizing Committee, a coalition of local Black churches, whose morality politics understood liquor stores as representing neighborhood blight and enabling local crime; 2) The Brotherhood Crusade, an organization steeped in Black nationalist thinking, which emphasized economic independence and community ownership in conjunction with xenophobic leanings toward Korean shopkeepers; 3) The Community Coalition for Substance Abuse Prevention and Treatment, which looked to deescalate racial tensions by refocusing the "problem" of liquor stores and their damaging effects on local quality of life as a public-health issue. Rethinking the controversy and tragedy caused by the death of Latasha Harlins as a conflict over contested spaces, rather than interracial hostility, helps us to understand the ways African Americans claimed space and connected social justice to physical spaces in the post-civil rights era despite differing tactics and objectives. Exploring these organizations leads to the conclusion that scholars need to take greater care to consider the role of space and the built environment when examining urban social movements.

Over three million tonnes (t) of tilapia, mostly Nile tilapia (Oreochromis niloticus, L.), are produced annually making it the second most abundantly produced freshwater fish (FAO, 2010). Tilapia are mouthbreeders that often produce stunted populations under pond conditions; one means of prevention is to produce all-male fish with the additional advantage that males usually grow faster than females. All-male populations can be achieved by supplementing feed with androgens such as 17-a-Methyltestosterone (MT) during days 10–25 posthatch (Pandian and Sheela, 1995). However, MT is considered to be carcinogenic (Velazquez and Alter, 2004), and Hulak et al. (2008) also showed that effluents of systems in which carp were fed diets containing MT caused masculinization of female fish. Furthermore, in aquaculture the application of hormones to fish destined for human consumption is prohibited in the European Union under directive 96/22/EC, article 5, which also prohibits import of animal products produced with hormones. Kwon et al. (2000) showed that Fadrozole, a non-steroidal compound, caused masculinization in tilapia by inhibiting aromatase, which is the enzyme responsible for the conversion of endogenous androgens to estrogens. Steinbronn et al. (2004) were able to show that a dose of 2000 ppm Quillaja saponins (Sigma S-2149) inhibited reproduction of tilapia after dietary application for 32 days to first-feeding fry, suggesting saponins as a possible alternative to MT. These secondary plant compounds consist of either a steroid or triterpenoid basic structure (aglycone or sapogenin) plus one or more sugar side chains (Francis et al., 2002a). In a previous experiment a saponin fraction from the soapbark tree (Quillaja saponaria M.) inhibited aromatase in vitro (Golan et al., 2008). The fenugreek plant (Trigonella foenum-graecum L), widely cultivated in the Middle East and Asia, also has a high saponin content. The experiment was therefore conducted to test whether saponin fractions from Q. saponaria and from T. foenum-graecum were able to influence the sex ratio and gonad histology of Nile tilapia.