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Pari, Anees Ahmed Abdul. "Health economic aspects in the management of bipolar disorder." Thesis, University of Oxford, 2016. https://ora.ox.ac.uk/objects/uuid:f8ea6eae-9111-4efe-87d1-52276d97e827.
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Bipolar disorder (BD) is one of the leading causes of disability worldwide and has a detrimental impact on health-related quality of life (HRQoL), and personal and social functioning. Despite this, there is insufficient knowledge of the costs, HRQoL implications relevant to BD, and the cost-effectiveness of current treatments for BD in the UK. This thesis aims to inform decisions about local and national service provision by applying a variety of health economic tools to build an economic case for BD. First, economic evaluations of BD management strategies are systematically reviewed. A cost-of-illness study is then conducted to estimate the societal burden of BD in the UK and explore the factors that drive variations in these costs. The appropriateness of applying the EQ-5D-3L outcome measure in BD is assessed, and the feasibility of mapping disease-specific measures to the EQ-5D-3L is explored. Finally, a cost-utility analysis (CUA) is conducted to bring together evidence on the costs and outcomes associated with alternative psychological interventions in BD management. This thesis makes critical contributions to multiple research domains, informing the allocation of scarce healthcare resources in this context. There is a sheer dearth of evidence on cost-effectiveness strategies for the long-term management of BD in the UK, especially the evidence for psychological therapies is limited. The annual societal costs associated with BD in the UK are estimated to be £5.14 billion, demonstrating the significant economic burden associated with this disease. The EQ-5D-3L instrument is found to be useful in measuring HRQoL in BD patients who predominantly experience depressive symptoms but is not sensitive enough to detect changes in individuals with mania. More psychometric evidence is therefore required before this instrument can be widely applied in economic evaluations of BD-related interventions. Finally, the CUA indicates that a novel structured psychoeducation intervention in individuals on remote mood monitoring in the UK is not cost-effective.
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Catena, Rodolfo. "Essays on health care operations management." Thesis, University of Oxford, 2015. http://ora.ox.ac.uk/objects/uuid:3c2035a6-b5d0-43b7-9b12-4883e5db4526.
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The aim of operations management in health care is to enhance the provision of services to patients and to decrease costs. Overall worldwide health care expenditures represent around 10.5% of the global GDP and are projected to increase at an annual rate of 5.3% from 2015 to 2017 [74]. In order to investigate how to curb health care costs, I study the English NHS, a health care system that provided universal care to around 54 million people in 2014 [243]. The NHS has launched many initiatives to improve the performance of hospital operations such as the "QIPP" program, which has the objective to save £20 billion of costs by 2015 [98]. Given this framework, this research aims to contribute to the theory that is guiding these operational changes, using data on all admissions to hospitals and focussing on the inguinal hernia, one of the most common surgical procedures [86]. In the next chapters, this research describes inguinal hernia care delivery in the English NHS, examines the impact of spillovers and complementarities on costs, and investigates the effects of length of stay reduction on risk of re-admission and risk of death. The findings of this thesis indicate that one of the possible problems in the delivery of inguinal hernia care in the NHS is the decrease in the number of elective operations performed and the increase in readmission rates. They also clarify how decisions on allocation of resources can affect hospital expenditures by showing that loss in focus can increase health care costs and by pointing out that there is little evidence to support the theory of spillovers and complementarities in the surgical context. Finally, the results of this research can be used to suggest the logic of a policy to decrease length of stay that can inform hospital decisions and can decrease hospital costs.
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Starkie, Helen Jane. "Health economic aspects in the management of Chronic Obstructive Pulmonary Disease." Thesis, University of Glasgow, 2010. http://theses.gla.ac.uk/2154/.
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The broad aim of this thesis on ‘Health Economic aspects in the management of Chronic Obstructive Pulmonary Disease’ (COPD) was to study the natural history of the disease in order to inform the conceptualisation and development of a new economic model. Existing economic evaluations for COPD were critiqued and information on the natural history of the disease gathered though literature searches and analyses of two large datasets, a COPD randomised controlled trial called TORCH and a general population observational dataset called the Renfrew/Paisley (MIDSPAN) study. Particular attention was paid to identifying the COPD population using different diagnostic criteria. The elicitation of utility estimates under a number of circumstances was considered. A regression based prediction model was conceptualised and developed. Significant contributions of this thesis include, but are not limited to: a NICE COPD cohort were identified who were found to be at higher risk of all-cause and COPD mortality than a GOLD defined cohort; a mapping equation was successfully developed that predicts the EQ-5D from the SGRQ; and an entirely new concept for modelling COPD was developed that uses a series of regression equations to predict cost and effect based on lung function, symptoms and exacerbations and weighted by survival probability in order to generate a model with one arm representing current treatment and a second arm representing a comparator treatment. The thesis successfully combined information gathered throughout the period of research on the natural history of COPD with treatment effects in a novel way in order to conceptualise and develop a new economic model for COPD.
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Botha, Willings. "A broader economic evaluative space for public health interventions : an integrated approach." Thesis, University of Glasgow, 2017. http://theses.gla.ac.uk/8488/.
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Introduction: There is an increasing need for economic evaluation of public health interventions to ensure efficient allocation of resources. Outcomes of such interventions often consists of health and non-health and do not fit in the conventional economic evaluation of quality-adjusted life year (QALY) framework. A cost-benefit analysis (CBA) could be appropriate but has concerns of assigning monetary values to health outcomes. Questions remain on how to consider the broad outcomes of a public health intervention in an economic evaluation. Objective: This thesis aimed to develop an integrated approach for an economic evaluation of a public health intervention that combines the standard cost-utility analysis (CUA) for health outcomes with the stated preference discrete choice experiment (SPDCE) approach for non-health outcomes on a single monetary metric. Methods: A natural experiment of the Woods In and Around Towns (WIAT) study in Scotland was used for empirical analysis. Costs were assessed using a top-down approach based on resources used. A difference-in-differences (DiD) approach was used to establish the impact. A CUA valued the health outcomes in terms of QALYs while a previously developed conceptual model of the WIAT was used to identify the SPDCE attributes and levels for the non-health outcomes. The WIAT study questionnaire was mapped to the SPDCE which generated relative willingness to pay (WTP) values from a general Scottish population. The WTP estimates were applied to the changes or improvements in the attributes and levels resulting from the intervention. A net monetary benefit (NMB) framework was then used to combine the CUA with the SPDCE on the same monetary scale, effectively deriving a CBA. Results: The WIAT interventions were of low cost despite the base case DiD analysis showing a statistically insignificant effect for interventions. The incremental cost-effective ratios (ICERs) for the interventions revealed that they were cost-effective. The probabilistic sensitivity analysis (PSA) showed that the physical intervention was 73% likely to be cost-effective at WTP of £20,000 and £30,000. The combined physical and social interventions had 74% and 75% likelihood of being cost-effective at WTP of £20,00 and £30,000, respectively. There was a great deal of uncertainty around QALY results. Overall, the integrated approach revealed that the WIAT interventions were cost-beneficial in terms of both health and non-health outcomes. Conclusion: This thesis has proposed and demonstrated the integrated approach that combines the conventional QALY framework with the SPDCE on a single monetary scale, hence a broader economic evaluative space particularly suitable for an economic evaluation of a public health intervention.
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Boyer, Nicole Renée Soldner. "Economic evaluation of population health interventions aimed at children and delivered at school." Thesis, University of Glasgow, 2018. http://theses.gla.ac.uk/9012/.
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Background: Population health interventions by their nature affect an entire population and are typically delivered outwith of health services and within the community, such as in schools. An example of such interventions are those that aim to improve children’s social and emotional wellbeing, which have demonstrated effectiveness in the short-term and potentially the long-term. However, challenges arise when conducting economic evaluations of population health interventions, most notably the difficulties of identifying, measuring, and valuing broader intersectoral costs, health, and non-health outcomes. Economic evaluation in an education context is relatively novel, but could provide decision-makers with information to help them make transparent and consistent decisions about how to allocate limited funds. This thesis examined the role for economic evaluation in school-based interventions and sought to determine appropriate methods for its implementation in addition to examining appropriate child-focused outcome measures. Thus, the overarching research question asked, ‘How should the cost-effectiveness of school-based, population health interventions aimed at children be determined?’ Methods: A mixed methods approach to this thesis was used: (i) a systematic literature review and narrative synthesis to determine which evaluation methods (economic and non-economic) are currently being used in school-based population health interventions; (ii) a case study to illustrate an economic evaluation (including cost-utility and cost-effectiveness analysis) of a school-based intervention to reflect on the advantages and disadvantages for decision making in this context; and (iii) an exploration of outcome measures (through mapping validation) for valuing child health and social and emotional wellbeing in school-based programmes to support future evaluation work in this context. Data for the economic evaluation and mapping validation study were available from a cluster randomised controlled trial of the Roots of Empathy programme in Northern Ireland (Ref: 10/3006/02). Results: The systematic review found that the methods currently being utilised to evaluate school programmes are varied (including economic evaluation, cost only, and effectiveness only studies), with poor quality reporting for the economic evaluations. Of the few cost-utility analyses in school-based settings identified, none had directly measured health-related quality of life using child measures or values. The case study cost-utility analysis using Child Health Utility 9D of a school-based intervention was found to be cost-effective from the National Health Service perspective with an incremental cost-effectiveness ratio of £11,000 per quality-adjusted life year (confidence interval: -£95,500 to £147,000), however the wide confidence interval demonstrates considerable uncertainty. This uncertainty is likely due to a lack of statistically significant effect that remained at the 36-month follow-up. Cost-effectiveness analysis using child behavioural descriptive measure, the Strengths and Difficulties Questionnaire, resulted in an incremental cost-effectiveness ratio of £197 per unit decrease in total difficulties score (confidence interval: £77 to £471). The Strengths and Difficulties Questionnaire is suitable for measuring social and emotional wellbeing, but is less advantageous for cost-effectiveness decision-making as no consensus has been reached as to what a clinically meaningful change in score represents, nor has a cost-effectiveness threshold been defined. It remains uncertain how these cost-effectiveness results will be interpreted in an education decision-making context where cost-effectiveness thresholds have not been set up. The mapping validation study validated a mapping algorithm to convert the Strengths and Difficulties Questionnaire into child health utility. Using this algorithm provides an option for valuing incremental changes in health-related quality of life against a generally accepted cost-effectiveness threshold from a health service perspective. Conclusions: Given the findings from the various aspects of work undertaken for this thesis to address population health issues, this thesis identified cost-benefit analysis as currently the most comprehensive method for determining the value for money of school-based public health interventions. Cost-benefit analysis incorporates monetary valuation of multisector outcomes in a final net benefit/loss result allowing clear, consistent, decision-making criteria to be set. Other methods such as cost-consequence analysis, cost-utility analysis, and multi-criteria decision analysis may also be suitable depending on the decision-making context and problem. This thesis demonstrates a lack of clear decision-making criteria in place for funding allocation decisions in education (e.g. education specific cost-effectiveness thresholds). Furthermore, there is no equitable method currently in place for apportioning the cost of funding public health interventions that generate benefits for multiple sectors. From a health service perspective, directly measuring child health utility using the Child Health Utility 9D is preferred as it is the only preference-based measure developed specifically for children and valued by young people. Mean child health utility can be predicted by mapping from the Strengths and Difficulties Questionnaire. This affords the opportunity to estimate longer-term utility by utilising long-term cohort data that routinely collects the Strengths and Difficulties Questionnaire, as long-term cost-effectiveness of school-based preventive programmes is an area in need of further research. The school setting plays an important role in shaping our young people’s futures. Economic evaluation of school-based population health interventions is justified, as schools need to maximise their existing resources in order to give children the best start in life.
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Muir, Lauretta, and n/a. "The impact of economic theory on the art of clinical practice : a study of science, meaning, and health." University of Otago. Dunedin School of Medicine, 2006. http://adt.otago.ac.nz./public/adt-NZDU20060911.160405.
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In being philosophically based this thesis is concerned with understanding the human condition with particular reference to matters of meaning and how these find expression in systems of government and social policy.
This study is based on the premise that concepts determine how the world is viewed and people use a variety of conceptual schemes to answer different classes of questions. Scientific endeavour is based in a scheme that enables questions about the material world to be answered. It cannot however answer classes of questions related to many features of human lives as its methods necessitate the development and use of abstractions and generalisations that are ill-equipped by design to determine what is important to people and what motivates and satisfies them. Therefore, the reality of any particular individual or group cannot be adequately understood in scientific terms.
The thesis examines the scientific conceptual framework and minimalist abstractions of the medical model and the quasi-scientific conceptual frameworks of economics and identifies their conceptual limits. It shows that if the medical model is assumed to provide a complete representation of realities in health and is uncritically used as the basis of medical practice it has the potential to overlook the patient as a person and distance medical practice from its social roots which can lead to adverse outcomes for both clinical practice and medicine itself. It also observes that the economic scheme has conceptual limits that create their own distorted representations of reality. A similar dislocation in the meaning of people�s lives occurs when abstractions are made by adopting concepts from other schemes based in science, such as the medical model, without any awareness of their conceptual limits. Further distortions occur when these other accounts are turned into economic ones. Not only is the patient as a person overlooked, so is the patient as an entity.
In light of these observations the thesis examines health reforms that have taken place in New Zealand, whereby the economic scheme has been given dominance in the development of public policy and set the parameters for rationality and what can acceptably be said. It shows that in not recognising features of meaning these parameters have led to health sector reforms that have had unintended and adverse consequences for clinical practice, as shown in the particular case of reforms of maternity services. Furthermore these reforms have severed the health sector from its social roots and moral frameworks and created barriers between it and government so that health sector problems that cannot be understood using economic parameters cannot be addressed in forums where public policy is developed.
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Grangård, Halfdan. "Health and the economy : three essays." Thesis, London School of Economics and Political Science (University of London), 2011. http://etheses.lse.ac.uk/207/.
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The main questions of this thesis are how a period of in utero malnutrition can impact the health of young children and their later development, and how job promotions can affect health. In the first chapter I analyse to what extent the South-East Asian financial crisis affected the height of Indonesian children who had in utero exposure to the crisis. I find that they are significantly shorter than children who were exposed at later ages. There is a large difference in effect for urban and rural children. This finding helps attribute the detrimental health effects to the crisis and not other events which occurred during the period of analysis. The second chapter exploits the exogenous shock of the crisis to analyse how early childhood height causes later cognitive development. I argue that this question should be analysed using instrumental variables. The results show a large and significant effect of early childhood height on cognitive ability and the use of instrumental variables changes the results significantly compared to OLS with or without fixed effects. Lastly, I analyse how on the job promotions of British civil servants affect health. In a cross-section, the direction of causality is almost certainly two-way. I argue that the use of individual fixed effects will alleviate this concern. The results show a large, positive effect of a job promotion on health in the subsequent survey phase.
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Baba, Camilla Rose Evatt. "Valuing the health and wellbeing aspects of community empowerment in an urban regeneration context using economic evaluation techniques." Thesis, University of Glasgow, 2016. http://theses.gla.ac.uk/7940/.
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Background and Rationale: Urban regeneration programmes are well placed to address social inequalities, and improve residents' quality of life and thus, are increasingly regarded a form of population health intervention. Within such programmes, the central role of communities is becoming increasingly recognised as important, with policy makers highlighting the need for activities that foster community empowerment and community involvement in programmes’ delivery. A motivating factor for this emphasis on community empowerment is the envisaged health gains it can produce. Existing literature has demonstrated that community empowerment is linked to positive health (specifically mental health) however, little is known about this link within an urban regeneration context and the value of allocating resources to foster community empowerment as an outcome of urban regeneration programmes. Previous attempts to value community empowerment as an outcome of urban regenerations have failed to fully capture and measure this complex, multi-faceted outcome or its theorised links to health. This thesis crosses disciplines, addressing issues of public health, urban planning and health economics. However, as outlined in Chapter 1, its leading discipline is health economics, drawing on methodology from the field to make a contribution to the evolving focus of public health economic evaluation. Specifically, the thesis demonstrates how health economic methodology can be adapted or expanded upon to aid the challenges researchers face when trying to identify, measure and value complex, non-health outcomes (such as community empowerment) for inclusion in economic evaluations of population health interventions (such as urban regeneration), which, as discussed at length in Chapter 5, present numerous challenges for techniques previously used solely within the health sector, and commonly in controlled settings (randomised controlled trials). Methods: The thesis initially outlines the policy context of the study (community empowerment in urban regeneration), defines what is meant by community empowerment and the study’s overall health economics focus in Chapter 1. Chapter 2 continues this introduction to the study’s context by highlighting how community empowerment relates to other concepts, whether it is viewed as an outcome or a process and how this impacts on efforts of measuring the concept and through a rapid scoping review, summarises what is known in the current evidence base on community empowerment and its links to health. It clearly highlights that community empowerment is a context specific concept and that in order to identify, measure and value it within an urban regeneration context, investigation of its specific, quantifiable ‘elements’ within this context must be identified. This is presented in Chapters 3 and 4. Firstly, a systematic review with narrative synthesis was then conducted (Chapter 3) to identify whether urban regeneration interventions can lead to a sense of empowerment and key community empowerment elements within this context. Then in Chapter 4, analyses of cross-sectional data from Glasgow’s GoWell neighbourhoods regeneration study (n=4254) was used to further test the causal relationship between community empowerment and self-reported health. The final part of the thesis (Chapters 5-8), firmly centres these initial findings into the health economics focus of the thesis to demonstrate how discrete choice experiments could be used to value a non-health outcome such as community empowerment for future inclusion in economic evaluations of population health interventions. It outlines the challenges of conducting economic evaluations of population health interventions and the importance of health economics as a discipline for decision-makers (Chapter 5). Then in Chapters 6-8 it presents the conceptualisation, design and results of a UK representative population discrete choice experiment survey (n=311) and how its results can value community empowerment as a potential outcome (using the payment vehicle ‘time’) for use in economic evaluation of population health interventions within urban regeneration. Results: The thesis identifies that community empowerment can result from urban regeneration interventions and that there are specific community empowerment ‘elements’ within this context which can be used to start conceptualising how to measure and value this concept and its links to health. The thesis also demonstrated that this was not always a positive relationship between urban regeneration and community empowerment and that a sense of disempowerment could be felt by the affected communities. These elements were sense of inclusion, sense of belonging, residents’ time commitment, a sense of trust in stakeholders, availability of stakeholder help and support and, availability of information about the regeneration programme (Chapters 2-3). Regression analysis of the GoWell data (Chapter 4) highlighted significant associations between community empowerment and improved general health and mental wellbeing. The discrete choice experiment’s (shown in Chapters 6-8) mixed logit model analyses demonstrated that there is an overall value for community empowerment activities within urban regeneration. The general populations respondents strongest preferences were shown for the delivery of community empowerment activities which require less time commitment, offer opportunities to participate, fully explain decision making processes, increase social interactions with their neighbours, have help and support from stakeholders and, keep them informed of the regeneration programme. Respondents’ strongest preferences were for delivery of community empowerment attributes that increase sense of belonging and feeling informed about the regeneration programme. Conclusions: The thesis provides valuations for attributes of community empowerment which can be used to inform future resource allocation decisions related to the cost-effectiveness of community empowerment generating activities as part of the delivery of urban regeneration programmes. Progress on the application of economic evaluation methodology to public health has been challenging, thwarted by complexities due to broad ranging costs and outcomes that are not readily suited to established economic evaluation techniques. The thesis contributes to the growing field of public health economic evaluation by highlighting the use of stated preference techniques, specifically discrete choice experiment methodology as a tool for measuring and eliciting values for the non-health outcomes of population health interventions for inclusion in economic evaluations. Failure to capture and include all benefits or costs of these multi-sector interventions which seek to look beyond health gains could lead to under or over estimation of their value and total effectiveness. This could ultimately result in poor investment decisions. To conclude, this study has contributed to current evidence by providing a means for identifying, measuring and valuing community empowerment both as an outcome in its own right and as an interim surrogate outcome linked to health. Thus, it has begun to address and tackle the research gaps identified in previous studies (outlined in Section 1.2.2). It has valued individual elements of CE within urban regeneration programmes which can be used by policy makers for decisions regarding future investment in CE and has further evidenced claims that community empowerment is linked to health within this context. Therefore, the thesis is able to recommend investment for community empowerment promoting activities in the delivery of urban regeneration programmes as a pathway to mental health gains.
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Willis, Eileen. "Accelerating control : an ethnographic account of the impact of micro-economic reform on the work of health professionals /." Title page, table of contents and abstract only, 2004. http://web4.library.adelaide.edu.au/theses/09PH/09phw7341.pdf.
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Jarumai, Cyril Joshua. "Some aspects of modern Irish law." Thesis, National Aviation University, 2021. https://er.nau.edu.ua/handle/NAU/48765.
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By the early 21st Century further amendment to the Constitution has been necessitated by Ireland’s membership of the European Union, which has involved the cession of a degree of sovereignty and the subordination of national law to European law. A significant amendment was effected pursuant to the Good Friday Agreement, when Ireland removed its territorial claim to Northern Ireland and replaced it with the principle of unity by consent.Today’s Irish law due to the pandemic conditions of its development is on
the way to its own improvement to regulate social relations effectively and protect the interests of their participants.
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Wilmot, Carolyn Margaret. "Influence of socio-economic status on people’s perception of the health condition of the Elsieskraal River, Cape Town, South Africa." Thesis, Cape Peninsula University of Technology, 2015. http://hdl.handle.net/20.500.11838/814.
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Thesis submitted in partial fulfilment of the requirements for the degree
Master of Technology in Environmental Management
In the Faculty of Applied Sciences
Department of Environmental and Occupational Studies
At the
Cape Peninsula University of TechnologyRivers, lakes and streams are the only way people encounter water sources in urban areas. Human endeavours have consequently deteriorated the environmental quality provided by river systems thus rivers are supporting a fraction of their original biodiversity and abundance. Urban streams are highly valuable and sensitive systems which, can be assessed by means of impacts of urban catchment and pathway influences. Many of the problems associated with environmental quality and management of urban watercourses are as a result of poor public perception. Advances in river assessment and management has come about through the recognition that water resource problems involve biological, physical and chemical components and more recently the addition of social and economic aspects. Social public participation is therefore achieved by studying and acting on people’s values, behaviours and perceptions of environmental quality. The main aim of this research was to identify whether a difference in socio-economic status is an influential factor in people’s perception of environmental quality. The objectives of the research were to determine whether the Elsieskraal River has a perceived low environmental relevance and quality (health and aesthetics), to determine what sensitizes people about issues relating to the natural environment and to identify people’s uses and perceptions of the Elsieskraal River corridor and its importance to the enjoyment as a recreational space. The study used a qualitative approach to obtain the data using the focus group technique. The purposive sample of participants from Pinelands and Thornton were the population that this study sought to investigate. Two focus group discussions; one in each study area was conducted. The results of this study found both similarities and differences in people’s perceptions of the Elsieskraal River between the two different socioeconomic urban communities. The perceived observation that the Elsieskraal River was a canal and not a river set the foundation for the envisaged low environmental quality the river so acquired. The majority overall environmental quality scores for the attributes of aquatic life, vegetation and water quality were found to be lower than they were scientifically found to be. Two clear avenues concerning environmental information sourcing and sensitization to the public was found. Politicians and government officials were unreliable to relay environmental information of a trustworthy nature. Community newspapers were a useful tool to present theevidence of information concerning the status of the natural environment especially at a local level. Three themes namely safety, maintenance and facilities and community attachment emerged on the importance of the Elsieskraal River as a recreational space. It is recommended that further studies should examine the perceptions of other similar rivers in the urban environment, both natural and canalised within Cape Town and the greater South Africa. The findings can assist environmental managers, planners and educators identify the gaps between the scientific environmental conditions and what people’s perceived awareness and knowledge about environmental quality are (factual versus perceived). It is also recommended that emphasis and support from local authorities must be given to non-governmental organisations (NGO’s) and adjacent property owners to aid in mobilising people into “ownership of rivers” within their communities to enhance their value and utilisation.
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Gislason, Maya K. "Health and the environment : a critical enquiry of the construction and contestation of ecological health." Thesis, University of Sussex, 2012. http://sro.sussex.ac.uk/id/eprint/39727/.
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A crucial contemporary public health issue is the construction and contestation of the relevance of the natural world to human health. Taking a critical approach, this thesis examines how the natural environment as a health determinant is positioned in relation to the 'social' within social epidemiological studies of health, illness and disease. Using conceptual and empirical forms of enquiry, this study shows how current constructions of natural environmental health drivers contour public health practice in the UK and that by challenging the limits of existing structures, innovative responses emerge, which can generate new frameworks for health policy and practice. Having identified a lacuna in research on the 'natural' environment in medical sociology, this inductive qualitative research project brings into conversation the findings from extensive desk and field research. Specially, a study of the elaboration of environmental health discourses within the UK public health policy arena and disciplinary wide discourse analyses of key academic journals are read together to describe the discursive practices shaping environmental public health work in the UK. Linking theory to practice, data from in-depth interviews with sixty health professionals working on health and the environment in the UK and internationally are used to investigate how public health practitioners produce the environment within their work remits. The research breaks ground for further social scientific studies of health and the environment and in particular substantiates the call for an extended notion of the 'environment' using ecological principles. Methodologically, the interdisciplinary reach of this research draws attention to the tensions that arise when working across the medical, natural and social sciences. Practical and philosophical questions about the challenge of expanding the sociological imagination in the contemporary moment are also considered. Empirically, to medical sociology the 'EcoBioPsychoSocial' framework is offered as a tool for studying health at the nexus between the 'social' and the 'natural environment.' Finally, the ways informal public health institutions are serving as 'invisible' forces impeding the uptake of prevention oriented environmental health policies are findings offered to the health policy arena.
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Liang, Lilin. "Hospital responses to changes in reimbursement methods : an economic analysis of Taiwan’s national health insurance programme." Thesis, London School of Economics and Political Science (University of London), 2011. http://etheses.lse.ac.uk/308/.
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In 1995, the Taiwanese government introduced the Case Payment Scheme (CPS) to initiate a prospective payment method for diagnosis-related groups under the National Health Insurance (NHI) programme. The aim of the CPS was to rectify the supplier induced demand caused by the fee-for-service plan and to improve the efficiency of health services. However, this scheme created a dual reimbursement system for the NHI, under which, some services were reimbursed on the basis of claims for fees, while others were bundled together and paid a fixed rate per discharge. This study examines changes in hospital behaviour in this context based on the assumption that hospitals have incentives to maximise the profits from both payment plans. The aim is to quantify the effects of reimbursement changes on different dimensions of the delivery of health care. This research also evaluates the global budget programme which has changed the budget allocation mechanism within the hospital sector since 2002. Empirical investigations were carried out for all the hospitals contracted into the NHI over the period 1998-2004. To model hospital behaviour, this study employs different econometric methods, including instrumental variables, panel data model, semiparametric estimation, seemingly unrelated regressions and limited dependent variable models. The results suggest that hospitals react to the shift toward the dual payment system by selecting patients, altering treatment patterns, changing the case mix and adjusting treatment intensity. Policymakers do not appear to have anticipated these phenomena. These findings indicate that there could be fundamental problems in the parallel use of retrospective and prospective payments, due to the improper reimbursement incentives embodied within the system. As mixed payment systems have been adopted around the world, this research has implications for existing and future reimbursement reforms.
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McAteer, Helen. "The use of health economics in the early evaluation of regenerative medicine therapies." Thesis, University of Birmingham, 2011. http://etheses.bham.ac.uk//id/eprint/1357/.
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The aim of this thesis is to help the RM industry avoid misguidedly investing in technologies that are unlikely to be cost-effective and reimbursed by healthcare providers. Health economics provides the tools to demonstrate value for money. These tools are typically used by healthcare providers to drive demand side decisions. However, they can be used by manufacturers to inform the supply side. I propose a simple approach, termed the headroom method. This ‘back of the envelope’ calculation is based on estimates of effectiveness of the proposed treatment towards the upper end of the plausible range. The method can be used either to inform an intuitive decision to continue or abandon development, or as a screening test to decide if more elaborate models are justified. One problem I encountered was the development of technologies without clearly defining the clinical problem. In particular, the marginal gain in benefit over alternative treatments is frequently overlooked. A large part of this thesis is therefore concerned with the clinical epidemiology of the conditions at which treatment is targeted. In this way, it was found, for example, the headroom for health gain from new treatment for inguinal hernia was much smaller than that for incisional hernias.
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Kashm, Mohammed Abdullah. "Health-care priority setting decisions in Saudi Arabia : an exploration of the context, and potential, for using economic evaluation." Thesis, University of Birmingham, 2016. http://etheses.bham.ac.uk//id/eprint/6894/.
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Recent health care reforms within Saudi Arabia have advocated use of economic evaluation in health care decision making. Little research has, however, considered the use of economic evaluation to set priorities in rentier state settings. This thesis explores the nature of the rentier state and the basis of health care priority setting, and conducts a systematic review of the use of economic evaluation in priority setting. The thesis uses in-depth qualitative research to explore health care priority setting and use of economic evaluation in Saudi Arabia. Qualitative data comprised 22 in-depth interviews with decision makers at the national and district levels, 3 focus groups, and one meeting observation. Data collection and analysis were conducted iteratively using constant comparison. Findings show that contextual factors have a great influence on the decision making process and that the use of economic evaluation is still very limited. There appeared to be two types of barriers to the use of economic evaluation: decision context-related barriers and barriers relating to the production of economic evaluation data. Incorporating economic evaluation into the health care decision making process in Saudi Arabia is proving to be complex and contextual factors have more influence on priority decisions than economic evaluation.
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陸艷媚 and Yim-mei Kiano Luk. "Sport tourism and public health: the implications of the 4th East Asian Games for Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B39559075.
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Mullen, J. M. "The relationship between empathy and Self-Management Support in general practice consultations in areas of high and low socio-economic deprivation." Thesis, University of Glasgow, 2013. http://theses.gla.ac.uk/4533/.
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Aim: Empathy is widely regarded as an important attribute of healthcare professionals, and has been linked to higher patient satisfaction, enablement, and some health outcomes. The ‘mechanism of action’ of clinical empathy is not well understood. An ‘effect model’ of empathic communication in the clinical encounter has been proposed by Neumann et al (2009). In this model, clinician empathy is seen as having a positive effect in encouraging patients to tell more about their symptoms and concerns (for example, by picking up on emotional cues and responding in an encouraging way). This can result in ‘affective-oriented effects’ (such as the patient feeling listened to and understood) or ‘cognitive/action-oriented effects’ which include the clinician collecting more detailed information (medical and psychosocial), gaining a more accurate perception of the problem (and possible diagnosis) and enhanced understanding and responses to the patients’ individual needs. Such responses may include Self-Management Support of various kinds, which help enable the patients to better manage their condition(s), leading to improved outcomes. Recent Government policy in Scotland has focused on Self-Management Support and Anticipatory Care as key priorities in primary care, in response to the rise in chronic disease and health inequalities. However, the amount and type of Self-Management Support and Anticipatory Care that occurs in routine consultations in primary care is not known, nor their relationship with empathy and patient enablement. Thus the ‘effect model’ of empathy as proposed by Neumann, which postulates a relationship between empathy, Self-Management Support, and outcomes in the consultation remains largely theoretical. The aim of this thesis was to examine the relationships between patients’ perceptions of doctors’ empathy, patient enablement, health outcomes and the amount and the type of Self-Management Support (including Anticipatory Care) in general practice consultations. Due to the wide health inequalities that exist in Scotland, and the continuing operation of the ‘inverse care law’, a comparison was made between consultations in areas of high or low socio-economic deprivation to establish whether the relationships varied by deprivation. The thesis had the following research objectives; • To assess the nature, type and frequency of Self-Management Support (including Anticipatory Care) in general practice consultations in high and low deprivation groups • To determine whether patients’ perceptions of GP empathy is related to Self-Management Support (including Anticipatory Care) in consultations in high and low deprivation groups • To explore the effects of Self-Management Support (including Anticipatory Care) on patient enablement and health outcomes in high and low deprivation groups • To assess patients’ perception of empathy in terms of the nature, type, and frequency of emotional Cues and responses by GPs rated as high or low in empathy by their patients in consultations in high and low deprivation groups Methods: The research objectives were investigated by a secondary analysis of data collected between 2006-2008 by Mercer and colleagues in the Section of General Practice and Primary Care at the University of Glasgow. These data were collected as part of a research project in general practice in areas of high and low deprivation funded by the Chief Scientist Office of the Scottish Government. The research produced database, includes 659 videoed baseline consultations, with patient rated experience measures, including the Consultation and Relational Empathy (CARE) Measure, the Patient Enablement Instrument (PEI) and outcomes (self-reported symptom change and well-being) at 1 month post-consultation available on 499 patients. An observer-rated method of assessing Self-Management Support and Anticipatory Care was sought from the literature to answer objectives 1-3. However, there were a lack of validated observer-rated tools available that were specifically designed to measure these constructs. As such, the Davis Observation Code was identified as a validated system of coding primary care consultations across a broad range of consultation components which included items deemed to relate to Self-Management Support and Anticipatory Care. The process of selecting the Davis coding system, and the rejection of alternative coding systems is discussed in detail in Chapter 5. The Davis coding system was also considered feasible given the large size of the database. Self-Management Support and Anticipatory Care were then measured by using combinations of seven codes deemed relevant to Self-Management Support within the consultation setting. Four additional codes were added to the Davis system, in order to include tasks relevant to UK general practice consultations. These additional codes were not part of Self-Management Support or Anticipatory Care but were added to achieve a complete coding system of activities within the consultations. The Verona coding system measured emotional cues, concerns and health provider responses that were observed within the consultations. As such, this system was used to answer objective 4. The choice of this system reflected a desire to use an observer-rated measure to help ‘validate’ the patient-rated empathy measure (the CARE Measure) in terms of the first part of the Neumann et al (2009) model, i.e. eliciting concerns and symptoms, separate from the cognitive/action oriented effects relating to Self-Management Support. Results: Reliability of the objective coding systems Preliminary work was carried out on both coding systems in order to establish reliability in the application of the codes. This was a lengthy process, involving several cycles of coding by two coders (the author and one of her supervisors) but resulted in acceptably high levels of inter-rater reliability (kappa > 0.7 for the Davis coding system, and > 0.9 for the Verona coding system). Objective 1: The nature, type and frequency of Self-Management Support (including Anticipatory Care) in general practice consultations in high and low deprivation groups In both the high and low deprivation groups, time was predominantly allocated to gaining information about the patient’s complaint, conducting physical examinations and planning treatment. There was no difference observed in the amount of Self-Management Support overall in the consultations between high and low deprivation areas. However, there were significant differences in the nature, type and frequency of certain aspects of Self-Management Support, with significantly more Anticipatory Care in the consultations in the high deprivation areas. The results also showed that patients in the high deprivation group tended to experience a more direct biomedical focused consultation that featured practical tasks such as physical examinations and discussion of substance misuse. In the low deprivation group, a biopsychosocial approach was more common, which involved more time spent within the consultation discussing treatment effects, compliance or discussing how previous interventions had impacted on the patient’s health. For both groups, little time was allocated to gathering family information or counselling, answering patient questions or discussing health knowledge. Objective 2: Patients’ perception of GP empathy and relationship with Self-Management Support (including Anticipatory Care) in consultations in high and low deprivation areas. The relationship between empathy and Self-Management Support was explored using the Consultation and Relational Empathy Measure (CARE) and the Davis observation code respectively. Potential confounding variables were taken into account. Patients' perceptions of their GP's empathy were significantly associated with Self-Management Support in the low deprivation group, but not the high deprivation group.
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Zigante, Valentina. "Consumer choice, competition and privatisation in European health and long-term care systems : subjective well-being effects and equity implications." Thesis, London School of Economics and Political Science (University of London), 2013. http://etheses.lse.ac.uk/850/.
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Consumer choice has become a key reform trend in the provision of public services in Western European welfare states. Research on the welfare effects of choice reforms – including greater provider choice for the individual and competition between providers – has largely focused on economic evaluations of the extrinsic (outcome) effects of choice, thereby leaving its intrinsic, or procedural, value unexplored. The overarching objective of this thesis is to investigate the welfare effects of choice in the provision of health and long-term care (LTC) and their implications for equity. The thesis utilises the subjective well-being approach – incorporating both procedural and outcome utility from choice – to measure welfare effects based on quantitative analysis of survey data. Welfare effects and equity implications are examined in relation to: competition in health care in the English National Health System (NHS); choice of care package in the German long-term care system; and individual preferences and views of choice as a priority in the provision of health care in three NHS countries. The thesis argues that both service characteristics – extent of competition, information availability, technical complexity – and individual capabilities – ability to process information, capacity to manage transaction costs, availability of private support – influence the benefits that individuals derive from choice. Results suggest that choice policies have an overall positive welfare effect in both health and long-term care. However, while direct evidence of outcome improvements is found, the empirical analysis only finds indirect evidence of procedural utility. Middle class characteristics, primarily income and education, are found to have a positive influence on the benefits of choice, amounting to evidence of inequitable facets of choice policies. The middle class further exhibits preferences for choice over and above other characteristics of health care systems. Overall, this thesis advocates a holistic approach to the analysis of choice, incorporating its procedural value and paying particular attention to the equity implications of the choice situation, information processing and differences in available options as well as preferences for choice.
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Rodrigues, Antonio Alves. "Cooperação intermunicipal no âmbito do SUS." Universidade de São Paulo, 2003. http://www.teses.usp.br/teses/disponiveis/12/12140/tde-08122003-145138/.
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Realizou-se um estudo das interações entre vários agentes que poderiam estar envolvidos com a estruturação de uma cooperação intermunicipal voltada à política pública de saúde. Pudemos observar que as estruturas formatadas ocorrem como uma combinação linear de plenamente espontânea, quando, então, há a interação dos personagens a nível municipal, a totalmente induzida, quando, então, a capacidade de coerção exercida pela União é suficiente para induzir os Municípios a adotarem uma postura de compartilhamento dos recursos a nível regional. De qualquer forma, o estudo verificou que interferem na formatação de uma estrutura de cooperação algumas variáveis tais como as externalidades, a motivação e incentivos, as instituições e suas alterações, a capacidade de coordenação e de solubilidade da assimetria informacional, entre outras. Assim sendo, desenhamos um arcabouço teórico apoiado nas teorias tradicional de finanças públicas, de escolha coletiva, de contratos e na institucional, a fim de esmiuçarmos dois exemplos diametralmente polarizados: a estruturação da cooperação na forma de uma coalizão por meio de um consórcio intermunicipal e a estruturação da cooperação na forma de convênios por meio da institucionalização de normas operacionais editadas pelo SUS.A study on the interactions between several agents that could be involved with the arrangement of an intermunicipal cooperation facing the public policy of health has taken place. We could observe that the formatted structures happen as a linear combination of plenarily spontaneous, when, thus, there is the interaction of the personages at a municipal level, totally induced, when, hence, the coercion capacity set forth by the Union is enough to induce municipal districts to adopt a resourcesharing deportment at a regional level. Nevertheless, the study has verified that some variables interfere in the formulation of a structure of cooperation, such as the externalities, motivation and incentives, institutions and its modifications, the capacity of coordination and solubility of informational asymmetry, among many others. Therefore, we have designed a theoretical structure sustained on the theories of traditional public finances, of public choice, of contracts and on the institutional, aiming to crumble two diametrically polarized examples: the formulation of the cooperation as a coalition through an inter-municipal consortium and the arrangement of cooperation as pacts, which are made by the institutionalization of operational norms edited by SUS.
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Mulonya, Rodrick K. A. R. "The political economy of development aid: an investigation of three donor-funded HIV/AIDS programmes broadcast by Malawi television from 2004 to 2007." Thesis, Rhodes University, 2010. http://hdl.handle.net/10962/d1002926.
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Development aid in most of the developing countries can sometimes compromise the principles of public service broadcasting (PSB). This may be true when reflected against the tension between donor financed programmes in Malawi and the mandate of Television Malawi (TVM). Although the donor intentions are noble, the strings attached to the funding are sometimes retrogressive to the role of PSBs. A case in point is how donors dictate terms on the HIV/Aids communication strategies at TVM. Producers receive money from donors with strings attached on how the money should be used and accounted for. If producers deviate they are sanctioned through withholding funding, shifting schedules and reducing the funding frequency. The donors also dictate who to interview on what subject, how to conduct capacity building. Some scholars have researched much on the impact of commercialisation of the media. This study is a departure from these traditional interferences; it interrogates the interest of philanthropy tendencies by international donors in the three chosen HIV/Aids programmes broadcast by TVM. The study investigates the extent of pressure exerted by donors on the producers of HIV/Aids programmes in Malawi. Thus, the study seeks to illicit specifics in the power relationship between the donor and the producer hence the study employs the political economy of development aid as applied to the public service broadcasting and communication for development. The study employed qualitative research methods and techniques (in-depth interviews, case study and document analysis). The study reveals how donor ideologies dominate the Aids messages-content output of the texts constructed. The study argues that cultural alienation of the Malawian audiences retards efforts of donors in combating HIV infection rate.
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Karlsbakk, A. "Patents versus patients : global governance and the role of civil society in South Africa's quest for affordable drugs." Thesis, Stellenbosch : Stellenbosch University, 2005. http://hdl.handle.net/10019.1/50414.
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Thesis (MA)--Stellenbosch University, 2005.ENGLISH ABSTRACT: This thesis is an explanatory study into civil society's increased influence in global governance. More specifically this situation is examined by looking at the generic medicine debate that came in the wake of the passing of the Medicines and Related Substances Act by the South African government in 1997. This debate gained worldwide attention and touched some of the prevailing inequalities between the developed world and the developing world in our globalised society. The research question that is addressed here is to what extent did civil society influence the signing of the Doha Declaration of the TRIPS Agreement and Public Health by the members of the World Trade Organisation (WTO) in 2001? In doing so, this thesis looks at the role of the US government, the South African government, the pharmaceutical industry, the WTO's TRIPS Agreement and civil society in the form of nongovernmental organisations like Treatment Action Campaign (TAC), Oxfam and Medecines Sans Frontieres (MSF). The study applies a constructivist approach in order to analyse how civil society used global advocacy networks to inform and communicate the normative concerns regarding South Africa and developing countries' lack of access to HIVand AIDS drugs. Moreover, it examines how civil society's use of moral authority challenged the regulative power of the WTO. The study concludes that civil society played a vital role in influencing the WTO member states' decision to sign the Doha Declaration on the TRIPS Agreement and Public Health. However, it was not only civil society's ability to set the agenda concerning the HIV/AIDS pandemic, but also the content of the normative concerns themselves that help explain its success. Consequently, the study further concludes that civil society's success in this specific case must be seen in light of its growing influence in challenging global governance.
AFRIKAANSE OPSOMMING: Hierdie tesis is 'n verduidelikende studie van die burgerlike samelewing se groeiende invloed in globale regering. Hierdie situasie word meer spesifiek ondersoek deur te kyk na die generiese medisyne debat wat gevoer is na die Suid-Afrikaanse Regering die Medisyne en Verwante Stowwe Wet van 1997 goedgekeur het. Hierdie debat het wêreldwye aandag geniet en het geraak aan sommige van die bestaande ongelykhede wat daar heers tussen die ontwikkelde en ontwikkelende wêreld in die geglobaliseerde samelewing. Die navorsingsvraag wat hier aangespreek word is tot watter mate die burgerlike samelewing die ondertekening van die Doha Verklaring van die TRIPS Ooreenkoms en Publieke Gesondheid deur lede van die Wêreld Handelsorganisasie (WHO) in 2001 beïnvloed het. Deur dit te doen, sal hierdie tesis kyk na die rol van die Amerikaanse regering, die Suid- Afrikaanse regering, die farmaseutiese bedryf, die WHO se TRIPS Ooreenkoms en die burgerlike samelewing in die vorm van nie-regerings organisasies soos die Treatment Action Campaign (TAC), Oxfam en Medecines Sans Frontieres (MSF). Die studie maak gebruik van 'n konstruktiwistiese benadering om 'n analise te doen van hoe die burgerlike samelewing globale ondersteunings netwerke gebruik het om die normatiewe besorgdhede wat heers oor die tekorte in Suid-Afrika en die ontwikkelende lande ten opsigte van toegang tot MIV en VIGS medisyne, toe te lig en te verkondig. Verder ondersoek die studie hoe die gebruik deur die burgerlike samelewing van morele gesag die regulerende mag van die WHO uitgedaag het. Die studie kom tot die gevolgtrekking dat die bugerlike samelewing 'n uiters belangrike rol gespeel het in die WHO lidlande se besluit om die Doha Verklaring van die TRIPS Ooreenkoms en Publieke Gesondheid te onderteken. Dit was egter nie net die burgerlike samelewing se vermoë om die agenda daar te stel ten opsigte van die MIV/VIGS pandemie nie, maar ook die inhoud van die normatiewe besorgdhede self wat bygedra het om hierdie sukses te verduidelik. Gevolglik kom die studie tot die verdere gevolgtrekking dat die burgerlike samelewing se sukses in hierdie spesifieke geval gesien kan word in die lig van sy groeiende invloed in die uitdaging van globale mag en gesag.
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Adams, Ubanesia Lolita. "Reinterpreting the implementation gap : a case based analysis of District Health System implementation in the Western Cape Province in South Africa." Thesis, University of Sussex, 2011. http://sro.sussex.ac.uk/id/eprint/6921/.
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This dissertation examined an implementation gap through a case study on implementing a District Health System (DHS) in the Western Cape Province of South Africa between October 2001 and April 2006. The research project explored why this implementation gap existed and what could be learnt about public policy implementation from studying this implementation gap. The main data collection methods included interviews, public and other documents and observations on the public health system in the Western Cape Province. I argue that implementation gaps could be interpreted as a signal of policy change instead of implementation failure. The key finding is that the Provincial Government of the Western Cape shifted its intentions regarding DHS implementation. The initial intention was to decentralise primary health care services to a metropolitan municipality. The decision, which was actively implemented, however centralised these services within the provincial government and started the process of the provincialisation of personal primary health care services in the Western Cape Province. This dissertation contributes to public policy implementation and public policy process literatures. It demonstrates why policy change is an alternative interpretation of implementation gaps to implementation failure and how policy change occurs during implementation. Policy change and public policy implementation are commonly two separate research themes within Public Policy Studies. The persuasion framework developed through this research project is an analytical tool that may be applied in research on implementation processes to examine whether an implementation gap is signalling policy change. The central theoretical elements in this framework that link policy change and implementation processes are the interactive effects of ideas and interests and the role of argument as a persuading factor that leads to policy change. The dissertation emphasises the role of language in public policy processes and argument and persuasion were deemed important elements in public policy processes.
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Heintz, Emelie. "Health economic aspects of diabetic retinopathy." Doctoral thesis, Linköpings universitet, Utvärdering och hälsoekonomi, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-76283.
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To ensure that the resources of the health care sector are used effectively, new technologies need to be evaluated before implementation to examine if they generate health outcomes at an acceptable cost. This information can be collected by performing health economic evaluations in which the costs and health outcomes of different technologies are compared. To estimate the effect on health care budgets, there is also a need for information about the prevalence of the specific disease. Health outcomes in health economic evaluations are often measured in quality-adjusted life years (QALYs), which are calculated by multiplying the remaining life years after an intervention by a weight representing the health-related quality of life (HRQoL) during those years. This thesis aims to provide deeper knowledge of the health economic aspects of diabetic retinopathy (DR), an eye complication that affects patients with diabetes and may in the worst case lead to blindness. The focus is on three empirical and two methodological health economic research questions. The empirical research areas cover prevalence, costs, and HRQoL related to patients with DR. The methodological research questions explore the performance of different methods for estimation of QALY weights. This is of interest since it has been argued that the most common methods for estimating QALY weights may not capture all relevant vision-related aspects of quality of life. The analyses comprehend the validity of different methods for estimating QALY weights among patients with DR and if the results of one of the specific methods for estimating QALY weights, the time trade-off (TTO) exercise, are affected by patients’ subjective life expectancy (SLE). The empirical results demonstrate that DR is seen in approximately 40% and 30% of patients with type I and type II diabetes respectively, indicating that the prevalence of DR has decreased in both of these patient groups. Healthcare costs vary considerably between different severity levels of the disease, being estimated at €26, €257, €216, and €433 per patient per year for background retinopathy, proliferative diabetic retinopathy (PDR), diabetic macular oedema (DMO), and PDR combined with DMO respectively. Blindness due to DR is associated with an increased use of transportation services, caregiving services, and assistive technologies as well as productivity losses. This suggests that preventing the progression of DR may lower healthcare costs. Patients with vision impairment due to DR have lowered HRQoL in various dimensions, but the diagnosis of DR in itself has only a limited effect on HRQoL. The results on the methodological research questions show that different methods for estimating QALY weights seem to give different results. In comparison to EQ-5D, the Health Utilities Index Mark 3 (HUI-3) is the most sensitive method for detecting differences in QALY weights due to DR, and if decisions are to be made based on values from the general public, it can be recommended for use in cost-utility analyses of interventions directed at DR. Neither of the direct methods, TTO and the visual analogue scale, seems to be sensitive to differences in visual function, and more research is needed concerning the role of vision in people’s responses to the TTO exercises. In TTO exercises with time frames based on actuarial life expectancy, the patients’ SLE has an effect on their willingness to trade off years for full health. Thus, applying time frames deviating from patients’ SLE may result in biased QALY weights. Such bias may appear stronger within patient populations than within the general public. In conclusion, this thesis offers estimates for prevalence, costs, and QALY weights that can be used in economic evaluations of interventions directed at DR and as benchmarks for future DR research in order to follow up consequences of changes in diabetes care. In addition, it demonstrates that the choice of method for estimating QALY weights may have an impact on whether an intervention is considered cost-effective.
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Mani, Kevin. "Abdominal aortic aneurysm epidemiological and health economic aspects /." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-110810.
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周坷 and Ke Zhou. "Charging private vehicles to develop public transportation system." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2000. http://hub.hku.hk/bib/B31260469.
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Bhadhuri, Arjun. "Including health spillovers in economic evaluations." Thesis, University of Birmingham, 2018. http://etheses.bham.ac.uk//id/eprint/8080/.
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Patient chronic illness and disability impacts the health of family members and household members who experience psychological distress and care burden. These impacts, known as ‘health spillovers’, are typically ignored in economic evaluations, despite being relevant to ensuring maximum health benefits from scarce resources. This thesis explores methods for including health spillovers in economic evaluation. Three empirical studies were carried out. The first study generated evidence supporting the validity of the EQ-5D-5L and SF-6D for measuring health spillovers. The second study examined the health spillover from a behavioural intervention on related household members’ outcomes. Further trials are warranted which measure household member outcomes for patient health interventions. The third study demonstrated and applied a methodology which could be used to include health spillovers in a cost-utility analysis. The general conclusion is that family member costs/outcomes should be systematically accounted for in extra-welfarist economic evaluations, and though there remains uncertainty about the best way to achieve this, the findings from this thesis show that this is possible and advance the methods forward.
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Kato, Ryuta. "Three essays in health economics : uncertainty and public health policy." Thesis, University of Essex, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.310085.
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Boodhna, T. "Trends and health economic aspects of service delivery of glaucoma." Thesis, City, University of London, 2017. http://openaccess.city.ac.uk/17931/.
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Glaucoma describes a group of optic neuropathies characterised by progressive irreversible loss of visual function. Within this thesis, a health economic model was constructed to map service provision from diagnosis considering two competing strategies: the current practice of annual visual field (VF) monitoring against the proposed guidelines of performing 6 VFs in the first two years. The constructed model found the proposed practice to be cost effective at a willingness to pay ceiling ratio of £30,000 per quality adjusted life year (QALY), identifying an incremental cost effectiveness ratio (ICER) of £21,679. The findings of the model however were potentially sensitive to the modelled infrastructure improvement costs required to undertake the proposed guidelines and a costing study to more accurately ascertain these costs was recommended. Following this study, statistical analysis of 473,252 VFs was undertaken to investigate trends in initial identification and progression rates whilst also narrowing their parameters within the health economic model. Consequently, the average level of glaucomatous vision loss at diagnosis was found to be improving by 0.11 dB per year on average whilst proportions of patients with ‘advanced’ loss at diagnosis fell significantly from 30% to 21%. Average progression rates were found to have fallen from -0.11 dB per year to -0.06 dB per year whilst average rates of loss in older eyes ( > 70 years) were found to progress faster than in younger eyes ( < 60 years). Furthermore, testing frequency was found not to vary by visual impairment risk factors. The constructed health economic model was subsequently updated to incorporate the more narrowly defined parameter distributions whilst also being re-specified to incorporate societal costs of visual impairment to count the true costs of the disease. This resulted in an improved ICER of £11,382. In conclusion, it is likely that implementing the proposed guidelines of 6 VFs in the first two years is more cost-effective than annual monitoring. This argument is further reinforced once societal costs are accounted for however a scoping study to examine the required costs of improving the glaucoma monitoring infrastructure is required.
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Gerard, Karen M. "Economic aspects of consumer involvement in health care benefit assessment." Thesis, University of Southampton, 2005. https://eprints.soton.ac.uk/57928/.
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Gyllensvärd, Harald. "Health Economic Aspects of Injury Prevention at the Municipal Level." Licentiate thesis, Linköpings universitet, Avdelningen för samhällsmedicin, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-106227.
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Unintentional injuries are a global health problem, which in 1996 was estimated to cause up to 3 million deaths per year. In Sweden, about 4,600 people die annually due to external causes of morbidity and mortality (injuries and poisoning). Among children 1 to 17 years old, injuries are the leading cause of death in Sweden for both boys and girls. Injuries are also the leading cause of life years lost before age 65 in men and the second most common in women. Injury prevention interventions and programs can be implemented to mitigate the magnitude of this public health problem, the number of injuries in society, and the substantial costs associated with injuries. Society's resources are however limited and therefore it is pivotal that interventions are cost-effective and not only effective: that is, that they provide good value for money. Hence, the aim of this thesis was to develop new knowledge and improve decision making by elaborating on some of the important health economic aspects of injury prevention. Consequently, a critical appraisal of the existing cost-effectiveness studies on injury prevention interventions and estimations of the societal costs for different types of injuries that needed medical attention were conducted. The critical appraisal of studies was limited to those studies that investigated interventions that could be implemented by municipalities. The results shows that injuries are associated with substantial societal costs but differ considerably between different types of injuries. The average cost per injury was estimated at € 2,726 and varied between € 892 and € 15,537. Furthermore, the results indicate that there are injury prevention interventions that offer good use of societal resources. However, there is a general lack of economic evidence surrounding injury prevention interventions. This thesis has expanded the knowledge in some important health economic aspects of injury prevention. The generated knowledge may advantageously be used in future research, including cost-effectiveness analyses of injury prevention interventions, and assist in the targeting of new research. Future research should focus on estimating the cost-effectiveness of different interventions and the reductions in quality of life due to different injuries. Costeffectiveness data help decision-makers make judiciously resource allocation decisions that maximise health gain given limited budgets.
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Otter, Robert. "Aspects of environmental public health in Portsmouth, 1764-1864." Thesis, University of Portsmouth, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.387284.
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Fitzwater, Kendra K. "Assessment of environmental and public health hazards of electronic waste." Virtual Press, 2007. http://liblink.bsu.edu/uhtbin/catkey/1380100.
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Electronic waste or `e-waste' is a rapidly growing form of solid waste worldwide. The heavy metals present in various electronic components demand attention because such metals may leach and pose significant health and environmental hazards (U.S. EPA, 2007). Knowledge of the potential of heavy metal leaching from e-waste represents an important contribution for developing U.S. standards for classifying e-waste as hazardous waste. Hazardous elements which leach from a variety of electronics wastes were assessed in laboratory batch studies. Electronic components evaluated included PC cathode ray tubes, PC motherboards, PC mice, television remote controls, and cellular phones. Each component was disassembled and digested using the Toxicity Characteristic Leaching Procedure (TCLP), EPA Method 1312, Method EA NEN 7371 (Dutch Environmental Agency), and Method DEV-S4 (Germany). The extracts were analyzed for lead, cadmium, chromium, silver, and cobalt. The TCLP consistently leached the greatest amounts of all metals; TCLP-soluble lead was extracted well beyond federal limits for several electronic devices.Department of Natural Resources and Environmental Management
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Lewis, David. "Public Conservation Land and Economic Growth in the Northern Forest Region." Fogler Library, University of Maine, 2001. http://www.library.umaine.edu/theses/pdf/LewisDJ2001.pdf.
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Woo, Chunho Anthony, and 鄔俊豪. "Molecular ecology and public health risks of urban bio-aerosols." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B49617680.
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The Earth’s atmosphere supports microorganisms and they include potential pathogens and microbial allergens. Whilst indoor environments have been well studied, relatively little is known of bio-aerosols in outdoor locations and their potential influence on human health, particularly with regard to urban development. Hong Kong provides an ideal model system for testing hypotheses related to the impact of urbanization on bio-aerosols, with a well-defined gradient of urbanization and large population. This thesis describes work to establish the biodiversity and spatio-temporal dynamics of outdoor bio-aerosols in Hong Kong. A comprehensive study of multi-domain microbial diversity and allergen levels in urban aerosols over a contiguous annual timescale and along a gradient of urbanization was carried out. A comprehensive suite of climatic and pollutant variables were also recorded during the sampling interval. Terminal restriction fragment length polymorphism (T-RFLP) was employed to investigate variations in bacterial and eukaryal assemblages, followed by phylogenetic assessment using high-throughput sequencing. The results revealed a strong seasonality in both bacterial and eukaryal assemblages, with Archaea forming a negligible part of the urban bio-aerosols. The most abundant bacteria were proteobacteria but community shifts were seen due to increases in algae in summer, and betaproteobacteria and cyanobacteria in winter. This was most parsimoniously explained by considering the backward trajectory analysis of air mass. A greater abundance of marine-associated phylotypes such as Bacillariophyta and Chlorophyta were identified when the dominant air mass arriving in Hong Kong in the summer originated from oceanic sources. In contrast, betaproteobacteria, which indicated soil sources were prevalent when the origin of air mass was from terrestrial sources. A trend in fungal phylotypes was also apparent, with summer samples dominated by basidiomycetous Agaricales, and winter samples by the ascomycete genus Cladosporium. This was likely due to favourable climatic conditions during wetter summer months enhancing release of fungal basidiospores. A range of airborne human pathogens was also detectable at low levels including pathogenic bacteria such as Acinetobacter baumannii, Clostridium perfringens, Escherichia coli O157:H7, and Ricinus communis, and the pathogenic fungus Aspergillus terreus. Microbial allergens including bacterial endotoxins and fungal glucans were also quantified with immunological assays. These generally followed variations in biomass, and during some months were recorded at levels that may impact human health upon chronic exposure. Carbon dioxide levels were the only climatic or pollutant variable that correlated with allergen levels. Conversely changes in microbial assemblages were strongly correlated to several climatic variables including temperature, rainfall, air pressure and relative humidity, but not with the degree of urbanization or airborne pollutants. This study highlights the importance of including microbial assessments in future bio-surveillance of urban aerosols.published_or_final_version
Biological Sciences
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Doctor of Philosophy
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O'Grady, Kathryn. "Effect of neighbourhood economic characteristics on the health of individuals." Thesis, University of Ottawa (Canada), 2005. http://hdl.handle.net/10393/26999.
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This multilevel study examined the influence of neighbourhood socioeconomic context on individual health as measured by self-rated health status and the Health Utilities Index (HUI) in urban neighbourhoods of the City of Ottawa and the combined cities of Ottawa and Gatineau. The samples were drawn from the respondents to the Canadian Community Health Survey 2000--2001 which included individuals 12 years of age and older. There were 1441 respondents within the 37 Ottawa neighbourhoods and 711 respondents within the 14 Gatineau neighbourhoods. The neighbourhood characteristics were derived from the 2001 Census.
In Ottawa there was significant variation in health at the neighbourhood level. In age-adjusted models the neighbourhood low income rate and the neighbourhood low education rate were significantly associated with self-rated health (OR=1.35, 95% CI 1.01--1.81; OR=1.03, 95% CI 1.00--1.06, respectively) and a HUI score <0.973 (OR=1.31, 95% CI 1.10--1.56; OR=1.27, 95% CI 1.07--1.52, respectively). However, adjustment for individual level factors reduced the influence of the neighbourhood level variables such that they were no longer statistically significant. Similar results were found for the analysis of the combined cities.
This study suggests that the differences in health between neighbourhoods of Ottawa and Ottawa-Gatineau can be attributed primarily to the compositional impact of the characteristics of individuals within the neighbourhoods.
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Tong, Hoi-yee Henry, and 唐海誼. "Evidence-based public health analysis in casino gambling." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B4694221X.
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Eyre, Robert W. "Complex statistical modelling of socio-economic variables in public health." Thesis, University of Warwick, 2018. http://wrap.warwick.ac.uk/106563/.
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The statistical inference of socio-economic variables in public health is key to the design of interventions to address the many health inequalities that exist across the world. However, such inferences are achieved commonly using a small standardised library of statistical methods. Meanwhile other fields such as computer science and systems biology have seen the development of many new methods allowing for more varied and useful analyses. Here we present analyses in three important contextual areas of socio-economic variables in public health, bringing in modern and sophisticated methods in order to develop highly useful and flexible results and further expand the library of statistical methods in public health. In the first, we further develop and apply a non-linear temporal model to analyse the spread of health aspects such as mood and weight over US adolescent friendship networks by a process known as social contagion. The use of this model improves our ability to more realistically reflect patterns we expect to see result in the data from contagion. This was achieved using analysis of the Add Health dataset. In the second, we use the flexibility and complex features of Gaussian processes to analyse two different aspects of pregnancy in rural South Africa using the Agincourt HDSS dataset. First, the modelling of fertility-patterns over combinations of variables where some have established models and others do not, allowing us to incorporate such variables into our model without risking the enforcement of unjustified assumptions. Second, analysing social contagion of pregnancy risk behaviour where no social network data exists, demonstrating how the use of sophisticated methods can enable us to attempt complicated research questions. Finally, in the third we build three possible Bayesian belief network models of household food security in the Agincourt study area. The structural features of these models make them potentially highly useful causal tools that enable us to model a wide range of interventions on our system. Through these analyses we demonstrate the importance of expanding the library of statistical methods in public health to include the many modern and sophisticated methods being developed in other fields, whilst also producing findings and tools of great robustness, flexibility, and utility.
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Velasco, Lauren Hoehn. "Essays on the Economic Causes and Consequences of Public Health." Thesis, Boston College, 2018. http://hdl.handle.net/2345/bc-ir:107988.
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Thesis advisor: Claudia OlivettiThis dissertation tracks a particular public health program and examines the economic causes and consequences of the institution of public health. I follow the United States rollout of county-level health departments (CHDs) over 1908 to 1933 and track the short-run benefits, the long-run benefits, and the factors that led to adoption. At the turn of the twentieth century, rural areas lagged behind urban centers in access to public health services, despite the fact that there had been convergence in urban-rural mortality. With 60 percent of the US population living in rural areas, this lack of public health was a population-wide problem. By 1908 the rural health problem drew national attention from the United States Public Health Service (USPHS) and health-interested private organizations. These organizations targeted rural health conditions by opening local public health departments that were operated by the existing county government. This revolutionary approach initiated the first nationwide rural public health program in United States history. The rollout of health infrastructure improved sanitation and provided access to child health services in under-served areas throughout the US. The sanitation improvements included inspections, hygiene training, and installation of toilets, wells, and drainage. Health services appeared in the form of exams, nutritional consults, immunizations, and midwife hygiene training. Local tax dollars provided the majority of funding for this program, although supplemental support arrived from outside organizations including the USPHS, state governments, the Rockefeller Sanitary Commission (RSC), and the Sheppard-Towner Act. In the first chapter, Taxation, Inequality, and the Provision of Local Public Health, I consider the factors that shaped the appropriation of rural public health. Using digitized county-level records on property values and taxation, I argue that adopting regions had local governments centered around the county as compared to the town or township. Within state, specific counties that adopted this program had more active local governments, as measured by county taxation, county debt, and measured property values. Next, because CHDs provided a bridge between the rural and urban areas of the county, I consider whether the CHDs were redistributive in nature. I find that CHDs operated in areas with higher levels of land and income inequality, which is distinct from what related literature has established with education spending. These results suggest that public programs based on local revenue may help to mitigate disparities within the region of jurisdiction but may exacerbate inequalities between adopting and non-adopting areas. External funding from higher levels of government as well as private donors helped to randomize the effort and spread the health services more evenly between counties. In the second chapter, Explaining Declines in US Rural Mortality, 1910-1933: The Role of County Health Departments, I assess the short-run impact of CHDs in terms of aggregate county-level mortality. Using two novel datasets--CHD administrative records and US county-level rural mortality--I track the rollout of CHDs throughout the United States and use variation in when and where CHDs operated to identify the mortality benefits. With an event study design, I establish that CHD entry led to a decline in infant mortality, but provided little advantage to overall population health. For infants, CHDs prevented two deaths per 1,000 births, which accounts for 8-10% of the period-specific mortality decline. The effect is most substantial in rural-only counties, as well as in the Midwestern region of the United States. In these areas, infant mortality declined by three to four deaths per 1,000 births. In the final chapter, The Long-term Impact of Public Health Measures Targeting Children, I examine whether the public health initiative was effective at improving adult human capital. While previous studies have established the lasting detrimental effect of poor child health, fewer studies have evaluated whether public health programs can mitigate these adverse effects. To address this question, I estimate whether childhood exposure to a public health intervention affects adult income, education, and health. The historical vantage point of the CHD program allows me to follow exposed children through adulthood and observe the life-cycle benefits, including the total lifespan. To estimate the long-term benefits, I use linked census data, World War II enlistment records, and Social Security death records and exploit variation in the timing, location, and age of CHD exposure. Based on this methodology, I find that children treated under the age of five show later-life earnings improvements of three to four percent. I investigate the mechanisms underlying the effect and demonstrate that higher earnings emerge from better adult health, measured by cognition, body mass index, and the probability of living past age 80
Thesis (PhD) — Boston College, 2018
Submitted to: Boston College. Graduate School of Arts and Sciences
Discipline: Economics
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Saramunee, Kritsanee. "General public views on community pharmacy services in public health." Thesis, Liverpool John Moores University, 2013. http://researchonline.ljmu.ac.uk/6170/.
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Community pharmacists are increasingly providing public health services in response to government policies. Published literature regarding the views of the general public related to pharmacy public health services, although important in ensuring uptake of these services, was limited. This study series aim to explore the general public's perspective on how to maximise the appropriate utilisation of community pharmacy services for improving public health. A large study comprising four sequential phases was designed and conducted in Sefton borough. Initially, to gather background information, focus group discussions (FGDs) and semi-structured interviews were undertaken with the general public and key stakeholders. The second phase involved the development and testing of a questionnaire extracted from the qualitative findings and a literature review. The questionnaire focused upon seven pharmacy public health services related to cardiovascular risks as well as views on factors influencing pharmacy use and advertising/promotion techniques. Geodemographic concepts, widely recognised in public health, were also included to identify potential benefits to pharmacy practice research. Next, a large scale survey was administered among the general public using eight survey modes, to additionally evaluate the range of methods available/for gathering public views. Finally, survey findings were evaluated by representatives of survey respondents using a FGD. Results indicated that, although stakeholders considered that community pharmacy can make an extensive contribution in supporting public health, pharmacy public health services are used at a relatively low level by the general public and awareness of services is also low. Survey respondents indicated a willingness to use services in the future. Important factors influencing pharmacy use include loyalty, location and convenient accessibility. Appropriate promotional campaigns are a key facilitator to help raise the public's awareness. The findings will help the profession to increase uptake of pharmacy public health services. The variety of survey modes used proved beneficial in obtaining diverse population demographics, with street survey being the optimal technique, however, the potential for social desirability bias must be considered with this and other interviewer-assisted approaches. MOSAIC™ as a geodemographic tool is potentially useful in helping to target services for specific groups and is recommended for use in further research.
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Ngomba, Peter Njoh. "The developmental impact of public investment in education, science and technology in Cameroon, 1960-1980 /." Thesis, McGill University, 1987. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=75784.
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Linking education, science and technology with national development is a subject of increasing concern in many developing countries. In this dissertation, we have studied empirically the contribution, or lack of it, which public investment in education, science and technology has made to the attainment of development objectives in Cameroon since 1960. Using a small computable macroeconometric model of Cameroon incorporating some major relevant quantitative aspects of the knowledge sector, we have investigated the effects on that sector and on the overall economic system of increased education- and research-service resources. We have also analyzed some of the major qualitative factors that are important in this sector.Our results suggest that, given existing patterns of education, science and technology in Cameroon, the contribution of public investment in this sector may be small compared to the potential contribution suggested in the literature. The implications of these results are examined for policy-making and planning at the national level.
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Pulikottil-Jacob, Ruth. "Challenges encountered in the economic evaluation of medical devices." Thesis, University of Warwick, 2016. http://wrap.warwick.ac.uk/93535/.
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This thesis concerns the linking together of the challenges encountered in the economic evaluation of medical devices and credible ways of performing economic evaluation in such a scenario. Although the standard methods of estimating cost-effectiveness have gained widespread acceptance, there are concerns around the methods for conducting economic evaluation in the health technology assessment of devices. Currently, the lack of appropriate comparators and evidence generation (i.e. quantity and quality of the clinical and economic evidence) have been identified as the main challenges.
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Oppong, Raymond Awuah. "Economic analysis alongside multinational studies." Thesis, University of Birmingham, 2017. http://etheses.bham.ac.uk//id/eprint/7288/.
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Conducting economic evaluations alongside multinational studies presents a range of diverse challenges which have contributed to a lack of consensus on how they should be approached particularly because of the difficulties of resolving between country differences. This thesis examines the implications of conducting economic evaluation alongside multinational studies and (i) explores different approaches to obtaining unit costs; (ii) investigates the impact of using different tariffs to value EQ-5D health state descriptions; and (iii) provides a systematic comparison of the pooled and split approaches to economic evaluation alongside multinational trials. This study documents challenges that have been reported in published studies and makes recommendations to help researchers undertake economic evaluations alongside multinational studies. Results indicate that the main challenge related to dealing with the differences between countries. Collecting unit cost data in all participating countries proved a difficult task, but was most effectively done by collaborating/direct contact with project partners and researchers/health economists from participating countries. Applying different EQ-5D value sets within the context of multinational trials did not make a difference to the conclusions in most cases. However, it is recommended that results from various tariffs are compared within sensitivity analysis. This study also showed that the choice of whether to pool or split the data can lead to different conclusions and recommendations about the cost-effectiveness of interventions. The culmination of this work is a 10 point checklist to guide good practice in the design, conduct and analysis of multinational economic evaluation studies and also highlights many areas where further research is needed. The work provides researchers, policy makers and stakeholders with additional insight into the economic analysis of multinational studies.
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Wood, Susan. "Mental health literacy and mental health in at-risk populations." Thesis, University of Warwick, 2016. http://wrap.warwick.ac.uk/88088/.
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This thesis explores mental health literacy (MHL) and mental health difficulties in at-risk populations. Young people, particularly males, are vulnerable to the onset of mental health difficulties, failing to access support and increased risk of suicide. Supporting people with mental health difficulties and improving prognosis is an important area of public health concern. Chapter one is a systematic review of gender differences in MHL of young people (ages 12-25 years). 14 studies were identified and critically assessed. The nature of gender differences in MHL of young people is complex but most consistently reported in depression. Females tended to have higher levels of MHL than males. The implications for public health interventions and future research are discussed. Methodological components of MHL research, such as the use of case vignettes are also considered. Chapter two is a qualitative research study of male professional footballers’ lived experiences of mental health difficulties and help-seeking using interpretative phenomenological analysis. One superordinate theme emerged from the data; Survival. This is discussed through six subordinate themes and alongside existing literature pertaining to identity, transition, personality and emotional development. The clinical implications of the findings are discussed, as well as suggestions for future research. Chapter three is a reflective paper considering the use of Cognitive Analytic Therapy as a tool for reflexivity in qualitative research. The opportunities and limitations of this approach are considered, alongside reflections on the research process.
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Boardman, Jason David. "The social determinants of health race, resources, and neighborhoods in the Detroit tri-county area /." Access restricted to users with UT Austin EID Full text (PDF) from UMI/Dissertation Abstracts International, 2002. http://wwwlib.umi.com/cr/utexas/fullcit?p3077407.
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Danis, Ajau. "Health communication and health literacy : participants perspectives on the PROSTAR Health Promotion Programme." Thesis, Liverpool John Moores University, 2006. http://researchonline.ljmu.ac.uk/5800/.
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Bjornstrom, Eileen E. S. "Local Inequality and Health: The Neighborhood Context of Economic and Health Disparities." The Ohio State University, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=osu1246394529.
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陳卓然 and Cheuk-yin Shaun Chan. "A public health perspective on air pollution: planning for zero emissions public transport in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B4167943X.
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Collins, B. J. "Applying economic evaluation to public health : case studies in cost effectiveness." Thesis, University of Liverpool, 2016. http://livrepository.liverpool.ac.uk/3000651/.
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For local public health teams, commissioning services that work and are cost effective is important. Having ways of evaluating and assessing their cost effectiveness is invaluable. Health economics and public health have a natural kinship as they both take a population approach to maximising health. The aim of this investigation is to give examples of how a mixed methods approach can be used. This thesis gives three case studies where public health commissioned services for alcohol, tobacco and drug addiction in the North West of England have been evaluated for their cost effectiveness using a mix of economic evaluation techniques combined with elements of realist evaluation and equity impact analysis. These mixed methods evaluation techniques involve engaging with stakeholders to develop a common understanding of outcomes and assumptions in reaching a common understanding of the causal mechanisms that make an intervention work. This thesis outlines how the results of these evaluations were useful in informing strategy and the commissioning process and how they may be used more in the future. There were some novel analyses including matching up crime data and putting a cost on these crimes for people in contact with a drugs test on arrest programme, which found that costs were lower after the drug intervention. The researcher found that there was not a significant change in admissions post-detoxification which indicates that perhaps inpatient residential detoxification has only a limited effect on long term health prospects. This thesis has shown that economic evaluation and realist evaluation methods pose some challenges but can be carried out at a local level as a way of looking at public health interventions through a more complex lens.
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Li, Pui-lin Jennifer, and 李佩蓮. "Aspects of bacteriology/virology of shellfish in relation to public health." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1997. http://hub.hku.hk/bib/B31253799.
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Reece, Thomas Ray. "Public health and swine production medicine aspects of vH1N1 influenza virus." Kansas State University, 2012. http://hdl.handle.net/2097/13807.
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Master of Public HealthDepartment of Diagnostic Medicine and Pathobiology
Robert L. Larson
Variant H1N1 influenza (vH1N1) virus is an issue both in swine production medicine and in the arena of public health. Influenza viruses can infect but not always produce disease in avian, humans and swine. Swine are unique among the three previously mentioned species in that their respiratory epithelium possesses three receptor sites for the virus types common to each of the three mentioned species. Swine influenza virus (SI) is common and widespread in nearly all Midwestern swine herds and can be transmitted by both direct contact and aerosolization. All of the three previously mentioned species have the potential to re-assort (produce virons containing genetic material of different virons to produce a unique influenza virus (IV). Because of their three specific receptor sites, swine have the greatest re-assortment capability. This re-assortment has the potential is a low mortality/high morbidity disease that is a substantial cost to the swine industry due to its negative effect on production parameters such as average daily gain (ADG) and feed efficiency (FE). It is a public health concern due to its potential to produce different virus types which may have increased mortality/morbidity in humans. Avian are the IV reservoir and have the ability to introduce virus types that are foreign to specific populations in all venues on the planet. It is in the mutual best interest of public health and swine production to mitigate the introduction of different virus types in swine and to control existing infections in swine populations with a goal of establishing SI-free herds. Mitigation for swine populations can occur through vaccination, diagnosis/isolation, and Biosecurity procedures designed to reduce/eliminate IV introduction into swine production facilities. In addition, preventing the interaction of infected humans with swine is another component of swine population Biosecurity.