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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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REIS, INES NASCIMENTO DE CARVALHO. "INVISIBLE PUBLIC SPACES: LOSSES AND ACHIEVEMENTS IN HEALTH PROMOTION." PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIRO, 2012. http://www.maxwell.vrac.puc-rio.br/Busca_etds.php?strSecao=resultado&nrSeq=20806@1.
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PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIROA presente pesquisa analisou a dinâmica dos espaços públicos de saúde, segundo os referenciais da promoção da saúde e seus desdobramentos, tendo como campo empírico a sala de espera, espaço institucionalizado onde o cidadão aguarda atendimento. O espaço público é expressão das relações sociais e de poder, fundamentado na ética cidadã, na pluralidade, na liberdade, na transparência, no diálogo, na solidariedade, na educação conscientizadora e transformadora. Fez-se uma pesquisa bibliográfica sobre sala de espera e análise documental sobre Promoção da Saúde. A pesquisa de campo foi quali-quantitativa, usou multi-métodos e foi realizada nos 17 Centros de Saúde Escola (CSE) do Brasil, relacionados no Cadastro Nacional de Estabelecimentos de Saúde (Cnes), entre 2009 e 2010. Foram entrevistados 91 cidadãos (24 gestores, 35 profissionais de saúde e 32 usuários), buscando identificar a evolução dos conceitos, das práticas e da institucionalização da Promoção da Saúde, na perspectiva da Atenção Básica de Saúde no âmbito do SUS. Os resultados mostraram uma sintonia na percepção dos entrevistados com essa evolução, identificando variadas dificuldades e vantagens na prática das atividades educativas, notadamente no espaço de sala de espera. Dentre as dificuldades, destacaram as ligadas ao ambiente construído, aos recursos humanos disponíveis, à dispersão dos usuários e à falta de apoio institucional. As vantagens mais citadas foram a de democratização do conhecimento, a interação social, a humanização, a organização do serviço, e a qualificação de discentes e profissionais de saúde. Ficou notória, de um lado, a visibilidade das salas de espera dos CSE como espaços empíricos de ações educativas e informativas; de outro, sua invisibilidade enquanto categoria teórica de espaço promotor de saúde, como espaço público onde se incentive o enfrentamento da questão social brasileira. O estudo conclui 8 que a visibilidade das salas de espera como espaço público pode ser ampliada através da valorização e do enriquecimento do saber popular e do agir em conjunto, para o incentivo à cidadania e ao bem comum, aplicando procedimentos criativos, oportunos e atrativos, sob a ótica de nossas carências atuais de recursos.
This study aimed to analyze the dynamics of public spaces of health, according to the references of health promotion and its ramifications, using as empirical field the Waiting Room (WR). In this study, the WR represents an institutionalized space, a built environment used under the responsibility of a legal institution, where the citizen waits for treatment. The public space expresses the social and power relationships based on ethics, plurality, freedom, transparency, dialogue, solidarity, and transformative education for critical consciousness. There was a literature search on the waiting room and document analysis on the Promotion of Health. The field research is quali-quantitative, used multi-methods and was conducted in 17 School Health Centers (CSE, in portuguese) in Brazil, listed on the National Register of Health Establishments (CNES, in portuguese), between 2009 and 2010. We interviewed 91 people (24 managers, 35 professionals and 32 users) in order to identify the evolution of concepts, practices and institutionalization of health promotion from the perspective of primary health care in the SUS (Health Unique System, in portuguese). The results showed a consistent perception of people interviewed with these developments, identifying different challenges and advantages in the practice of educational activities, especially within the WR. Among the difficulties, were highlighted those related to the built environment, the available human resources, the dispersion of users and the lack of institutional support. The main advantages cited were the democratization of knowledge, the social interaction, the humanization, the service organization, and the qualification of students and health professionals. It became notorious the visibility of the WR of the CSE as an empirical space for educational and informative actions; on the other hand, it became obvious its invisibility as a theoretical category of promoter of health, a public space made to encourage the confronting of social issues in Brazil. The study concludes that the visibility of 10 WR as a public space can be expanded through the enhancement and enrichment of popular knowledge and the acting together to favor common goods and citizenship, applying creative, relevant and attractive procedures, from the perspective of our current lack of resources.
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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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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
Doctoral
Doctor of Philosophy
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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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Galant, Desiree Marchelle. "The economic value of public open spaces : an approach for the City of Cape Town." Thesis, Stellenbosch : University of Stellenbosch, 2011. http://hdl.handle.net/10019.1/8531.
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Thesis (MBA)--University of Stellenbosch, 2011.The fact that parks and urban green spaces have value is no longer disputed. The literature is awash with evidence attesting to this fact. The City Parks Department of the City of Cape Town is responsible for the provision and maintenance of in excess of six thousand green public open spaces across the Metropolitan area but is currently challenged in terms of ensuring that the service it provides is recognized and that it is adequately resourced from City coffers. This research was undertaken to find a mechanism that the Department can utilize to establish the value of the service it provides within a language that people generally understand and appreciate, the language of money and economics. Using the economic theoretical frameworks and paradigms as context, the key considerations and challenges facing the City Parks Department was considered in terms of competition for adequate land, definitions and the various values which can be attached to public open spaces. Considering the data and information contained in the literature, case studies and established economic valuation approaches and methods, a Valuation Framework was devised for the City Parks Department. The Valuation Framework is meant to be used as a mechanism for establishing the economic value of the public open spaces for which the Department is responsible. It consists of four sections namely a Site Selection Matrix, Site Valuation Components, Valuation Approaches and Methods and a Seven-Step Methodology. The Framework is devised for application at site level but with the understanding that the accumulation of outcomes can be integrated to draw conclusions and inferences about the total economic value which is created directly or indirectly by the Parks Department through its service offering.
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Magalhães, Alexandre Pedro Tavares da Fonseca. "How distances to Urban Green Spaces and Open Sport Spaces can influence physical activity in teenagers of Porto Community. The Epiteen (Epidemiological Health Investigation of Teenagers in Porto) Cohort." Dissertação, Faculdade de Medicina da Universidade do Porto, 2009. http://hdl.handle.net/10216/55455.
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Magalhães, Alexandre Pedro Tavares da Fonseca. "How distances to Urban Green Spaces and Open Sport Spaces can influence physical activity in teenagers of Porto Community. The Epiteen (Epidemiological Health Investigation of Teenagers in Porto) Cohort." Master's thesis, Faculdade de Medicina da Universidade do Porto, 2009. http://hdl.handle.net/10216/55455.
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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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Davis, Kierrynn Miriam Davis. "Cartographies of rural community nursing and primary health care : mapping the in-between spaces /." [Richmond, N.S.W.] : University of Western Sydney, Hawkesbury, 1998. http://library.uws.edu.au/adt-NUWS/public/adt-NUWS20030509.135659/index.html.
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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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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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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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Li, Pui-lin Jennifer. "Aspects of bacteriology/virology of shellfish in relation to public health /." Hong Kong : University of Hong Kong, 1997. http://sunzi.lib.hku.hk/hkuto/record.jsp?B18734261.
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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.
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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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Martin, Susan P. "Young people's sexual health literacy : seeking, understanding, and evaluating online sexual health information." Thesis, University of Glasgow, 2017. http://theses.gla.ac.uk/8528/.
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Background: Improving the sexual health of young people is a key policy focus in Scotland. As the influence of the internet has grown within a rapidly changing health information landscape, so have opportunities for both sexual health promotion, and concerns about the challenges faced by young people in navigating this online environment. This study explores young people’s sexual health literacy (SHL), primarily within this online context. Methods: Paired interviews with friendship groups and observational online activities were used to explore young people’s experiences of finding, understanding and evaluating online sexual health information. A purposive sample of 49 participants (aged 16-19), diverse in terms of gender, sexuality and religion, were recruited from across Scotland from areas that varied in terms of deprivation and urban/rural classification. Findings: Participants varied in their confidence and ability to find and identify reliable information, and typically regarded identifying and filtering reliable sources as challenging. Barriers to accessing information on websites included: inaccessible language; inappropriate or non-relatable information; and websites that were difficult to navigate or did not function correctly. Concerns about stigma and ‘being seen’ seeking sexual health information was a key barrier. Stark differences, often mediated by gender, sexuality and educational circumstances, emerged in perspectives towards accessing sexual health information and support online. Findings suggest that different social media platforms present different opportunities and challenges; for example, social content sharing services such as YouTube may be useful venues for developing critical SHL, while social networking sites such as Facebook, may be less suitable to user’s active engagement in identity construction. Dissatisfaction with school-based sexual health education appears to be a catalyst for online information-seeking, but school-based sexual health education did little to equip young people to use the online environment effectively. Conclusions: Gender, sexual identity, stigma, structural factors and social support converge and intersect around young people’s SHL. A broad range of targeted interventions are needed to improve SHL, focusing on overcoming stigma, presenting positive messages and developing interactive and critical skills. Schools could do more to develop SHL skills, including teaching the digital and critical skills to seek and appraise online information. Expanding online sexual health services may effectively complement traditional services and encourage uptake, but it is essential that research establishes a robust, comprehensive conceptualisation of SHL, and develops measurement tools specific to SHL such that interventions can be evaluated and refined.
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Huang, Kai Katie, and 黄恺. "The effects of walkability on air pollution and public health." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46937213.
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Munro, Catherine A. M. "Developing a dialogue on health : user involvement in health and health services." Thesis, University of Glasgow, 2008. http://theses.gla.ac.uk/291/.
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In common with other areas of public services, recent years have seen a shift in the National Health Service (NHS), with increased power and authority transferring from professionals towards the users of services. As a result, user involvement has come to form a central element of government policy on public services, and health in particular, with a series of specific policy commitments to give users a stronger voice and to involve them in the health service having been published by both the Westminster and Scottish parliaments. These seek to increase users’ involvement in making decisions about their own care and treatment, in examining and improving the quality of services and in policy and planning activity. In doing so, this policy aspires to respond to the changing culture of personal and societal expectations of health and the health service; to build democratic participation in the difficult targeting and rationing decisions faced by health agencies and, thus, to help renew public trust and strengthen confidence in the NHS. These are ambitious aims with far-reaching implications as they represent a transformation in the interaction between users, health professionals and health policy makers. This thesis examined how this policy has been understood and implemented in the NHS by exploring the scope, relevance and quality of the user involvement processes available in three health service settings. In order to develop a better understanding of the issues in user involvement it explored the nature of user participation; the character of user representation and the barriers and facilitators to user involvement in maternity, gynaecological oncology and mental health services. The study examined the response to this policy within these three settings; the functioning of existing user involvement mechanisms and their capacity to involve users in determining their individual health care and in shaping health services and policy to their definition of need. From this examination it defined the key features of a model process for user involvement within the professional service culture and organisational ethos of the NHS. The study then drew conclusions on the capacity of these current user involvement processes to deliver on the policy directive to develop both individual treatment and health services in ways that are responsive and accountable to users. Finally, the thesis identified those areas that require further research before proposing the lessons for the further development of this significant and potentially influential policy directive.
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Palmer, Diana. "Women, health and politics, 1919-1939 : professional and lay involvement in the women's health campaign." Thesis, University of Warwick, 1986. http://wrap.warwick.ac.uk/34625/.
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This thesis analyses the aspirations and achievements of the lay women who were active in the campaign to improve women's health, and of those women who sought entry into paid occupations in the health services. After an introduction, Section One is intended to place the substantive data in context. Middle-class women's enthusiasm for voluntary work and the terms on which women entered national politics are discussed. These issues are used to illustrate the effects the maintenance of rigid social-class divisions had on the unity of the women's movement and the implications for the future of the movement of the decision to seek entry to the public domain on the grounds that women could make a unique contribution. Section Two is devoted to the lay women. First, the effect of the maintenance of rigid social-class divisions on the women's health campaign and on women seeking a career in the health services is discussed. Secondly, the consensus between both middle-class and working-class women, the medical profession and the Ministry of Health on the need to extend medical services is analysed, revealing an eagerness to follow technical advice which affected the strategy of the lay campaign and meant support for women workers in the health services was often circumspect. Thirdly, the reasons for the collapse of this consensus in the l93Os are discussed. This section is concluded with an assessment of the lay women's health campaign and a discussion of the impact the campaign had on women health workers. In Section Three, women's position as paid employees in the health services is analysed, and three occupations, midwifery, medicine and health visiting, have been selected. Difficulties these women encountered establishing themselves in paid employment, and their status and their relations with male colleagues and with the Ministry of Health are assessed. The differences between these three occupations, which prevented a sense of solidarity and an identification with the goals of the women's movement, are discussed. Their achievements during the period are assessed, and the effects of the medicalisation of childbirth and the increasing involvement of the state in maternity and child welfare are investigated. A fourth, concluding section draws these strands together. The lay women's health campaign and the goals and tactics of the women health workers are related to the maintenance of the existing social-class divisions, the ideological splits within the women's movennt and the persistence of barriers preventing women from competing on equal terms with men in the public domain. Although the number of women working in the health services increased dramatically and women's place in these services was assured, women generally remained in subordinate positions, excluded from the prestigious and lucrative posts, while they achieved only a statutory presence on decision-making bodies.
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Mramba, Furaha W. "Ecological and public health aspects of stable flies (Diptera :muscidae): microbial interactions." Diss., Manhattan, Kan. : Kansas State University, 2006. http://hdl.handle.net/2097/237.
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Warrick, Rona Lee, and rona warrick@deakin edu au. "Motherhood and health: Perception and practice." Deakin University, 1995. http://tux.lib.deakin.edu.au./adt-VDU/public/adt-VDU20070614.112804.
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Watson, Megan. "Exploring the role of greenspace and neighbourhood level inequalities in determining physical activity, health and wellbeing outcomes in young people in Aberdeen City." Thesis, University of Aberdeen, 2019. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=240699.
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This thesis examines the contribution of urban greenspace to public health and inequalities in young people. Taking a comprehensive, environmental justice approach variations in provision, access, use and experience of greenspace related to neighbourhood level inequalities are explored in relation to physical activity, mood and wellbeing in 16-25 year olds. The project used a three phased, mixed methods design via spatial mapping, real-time monitoring and community-based participatory research. The first phase used Geographical Information Systems (GIS) to conduct an analysis of the provision, accessibility and quality of public greenspace in Aberdeen City. Scottish Index of Multiple Deprivation data were used explore and contrast these characteristics between areas categorised as affluent or deprived. The second phase used real-time measures to gather within-person data on greenspace use, physical activity, and mood in 16-25year olds over a seven day period, further exploring how socio-economic variations in good quality greenspace influenced the use and effect of greenspace. The third study phase used qualitative, community-based participatory research to empower young people to explore their experience and importance of greenspace for health. The results suggest a potential positive role of greenspace in public health in relation to increasing physical activity, decreasing sedentary behaviour and providing opportunities for restoration in young people. However, they also demonstrate that social inequalities are present in the provision of good quality greenspace and highlight that quality of greenspace and wider issues related to area level deprivation play a crucial role in the use and experience of greenspace, as well as the effect on physical activity and mood in young people. This has important implications for public health as the promotion of greenspace at a population level could deepen rather than improve health inequalities, by exposing those in affluent areas to health enhancing good quality greenspace and those in deprived areas to the potentially detrimental effects of poor quality greenspace.
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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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Bishop, Simon. "HRM in public private partnerships : working in a health production system." Thesis, University of Nottingham, 2011. http://eprints.nottingham.ac.uk/12159/.
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This study explores the changing nature of employment and employment management within multi-organisational public services ‘partnerships’. In line with international trends, a major feature of the 1997-2010 New Labour government’s public policy was encouraging partnerships between organisations of all sectors to run public services. Within healthcare, central government has increasingly been seen as taking on a role of market regulator, with organisations from all sectors allowed to plan as well as provide public services (Illife and Munro, 2000). As part of this picture, bringing private companies into partnership arrangements with the National Health Service has been seen as a catalyst for workforce re-configuration and employment change through furthering the reach of private sector type Human Resource Management. However, research has illustrated how inter-organisational contracts can also restrict an organisations choice of employment practice, disrupt the direct relationship between managers and employees, and undermine any aspirations for fair or consistent employment (Marchington et al, 2005). In more recent healthcare partnerships, employment is further complicated as partnerships involve powerful professional groups with their own protected employment systems and established norms of practice. This study seeks to investigate the prospects for HRM within such a professionalised partnership context through comparative case study of two Independent Sector Treatment Centres (ISTCs) operating under differing employment regulations and contractual agreements. In both cases, private sector management sought to impose a more ‘rationalised’ and standardised approach to work with a greater focus on outputs and productivity, placing ISTCs at the forefront of the Fordist ‘scientific-bureaucratic’ (Harrison, 2002) approach to medicine. However, the study identifies a number of limits to the degree to which the management of the private health care companies could shape HRM practices in line with these aims. The thesis also examines how being separate from, or integrated with, existing National Health Service organisations can lead to different types of contingencies affecting work and employment, and multiple varieties of inconsistency across the workforce. The findings of the study are explored in terms of the implications for public policy, health service management and HRM theory.
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Tolosana, Sandra. "Aspects of medical waste disposal in the Cape Peninsula." Master's thesis, University of Cape Town, 1996. http://hdl.handle.net/11427/26572.
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Hazardous waste management practices at ten medical institutions in Cape Town were studied and tests undertaken to determine concentrations of specific chemicals and radioactivity in liquid effluent outflows, as well as emissions from incinerators. To investigate the sewage outflow for Chemical Oxygen Demand (COD), N, pH and heavy metals, a continuous sampler was installed at two hospitals and a Medical School. Samples were analysed by atomic absorption spectrometry for As, Hg, Cd, Co, Cr, Cu, Mn, Ni, Pb, Zn and Fe. Mercury levels ranged from l-70μg l⁻¹, exceeding the Environmental Target Quality of 0.04μg l⁻¹, and the South African General Effluent Standard of 20μg l⁻¹ . All other heavy metals were below General Effluent Standard Limits. In addition, a sludge sample from the Athlone Wastewater Plant was tested for Hg, realising 6mg kg⁻¹ on a dry weight basis, which was within Department of Health (DOH) Guidelines of 10 mg kg⁻¹. Samples of incinerator bottom ash analysed for heavy metal content gave Hg concentrations of 1.1-4.0mg kg⁻¹, and Zn concentrations of 5.1-11.0g kg⁻¹. Incinerator ash was also analysed for radio-activity and substantial levels of ¹²⁵I (332-650 bq kg⁻¹ ), and Ga⁶⁷ (9186bq kg⁻¹) recorded, which exceeded the South African limits of 200bq kg⁻¹. In Cape Town, hospital incinerators are old, burn large amounts of plastics and produce toxic emissions. They are all situated in residential or inner-city areas, and even though there is legislation dealing with emissions and chemical waste, these laws are not being enforced. Based on the above results, an investigation was carried out to assess attitudes to and knowledge of hazardous waste in the ten institutions. One thousand questionnaires were administered to staff, and the data from the 80% response rate statistically analysed. Results suggest that there is an urgent need for an holistic approach to toxic waste management, encompassing enforceable legislation coupled with on-going educational programmes and strong support from top management and all levels of staff.
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Santiago, Vanessa L. "ASSESSMENT OF TIME SPENT IN GREEN SPACES AND PERCEIVED STRESSORS AMONG HIGH SCHOOL YOUTH." Miami University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=miami1563883356033913.
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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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Harrison, Helen E. "In the picture of health, portraits of health, disease and citizenship in Canada's public health advice literature, 1920-1960." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/NQ63424.pdf.
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Dale, Kelly S., and n/a. "Determining optimal approaches for successful maintenance of weight loss." University of Otago. Department of Human Nutrition, 2007. http://adt.otago.ac.nz./public/adt-NZDU20080129.122806.
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Objective: Since short-term weight loss is often achievable in overweight individuals but long-term weight maintenance is generally poor, this thesis examines the effect of the nature of support programmes and macronutrient composition on weight maintenance following weight loss.
Research design and methods: A 2x2 multifactorial design was used to compare two support programmes and two diets differing in macronutrient composition on maintenance of weight loss over a 2-year period. Two hundred women who had recently lost at least 5% of initial body weight were randomised into one of two support programmes. One provided intensive expert, health professional support with regular circuit training classes. The other provided brief and frequent �weigh-ins� and support facilitated by a nurse. Participants were also randomised with regard to recommended diet composition. One eating plan was high in carbohydrate and dietary fibre, emphasising low glycemic index foods. The second eating plan was relatively high in monounsaturated fat and protein and had a low overall glycaemic load. At baseline, 1 and 2-years, weight, waist circumference and blood pressure were measured and body composition was estimated using bioelectrical impedance. Three-day weighed diet records were collected to estimate dietary intake. A fasting blood sample was used to measure glucose, insulin and lipids.
Results: At 2-years weight was measured for 87% of participants. On average those randomised to the Expert Support Programme reduced weight by 2.5kg while those on the Nurse Support Programme reduced weight by 3.6kg (difference between support programmes, P=0.976). On the High Carbohydrate Diet average weight loss was 2.4kg compared with a loss of 3.8kg on the High Monounsaturated fat Diet (difference between diets, P=0.419).
At follow-up, there were no signficant differences between the support programmes with regards to body composition, systolic and diastolic blood pressures, blood lipid levels, glucose, insulin, and predicted insulin sensitivity. From a health system perspective and relative to the Nurse Support Programme, the Expert Support Programme cost $NZ 928, 970 per QALY gained (or $9, 290 per person).
At follow-up, there were no signficant differences between the dietary prescriptions with regard to body composition, systolic and diastolic blood pressures, triglycerides, HDL-cholesterol, glucose, insulin and predicted insulin sensitivity. However, total and LDL cholesterol were significantly lower on the High Carbohydrate Diet compared with the High Monounsaturated fat Diet (total cholesterol 0.2mmol/l, P=0.044, LDL cholesterol 0.2mmol/l, P=0.042). At follow-up those on the High Monounsaturated fat Diet reported significantly higher intakes of saturated fat (1.5%TE), total fat (5%TE), monounsaturated fat (2.4%), and a significantly lower intake of carbohydrate (-5%TE) than those on the High Carbohydrate Diet.
Conclusion: A relatively inexpensive nurse led programme appears to be as effective as a more costly expert health professional led programme in achieving weight maintenance over a 2-year period. This inexpensive and successful weight maintenance programme offers a feasible option for implementation in primary health care in New Zealand. Similarly, both dietary approaches produced comparable beneficial effects in terms of weight loss maintenance. However the High Carbohydrate Diet was associated with lower levels of total and LDL cholesterol, possibly due to a lower intake of saturated fat.
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Borruso, Laura. "Organizational Aspects of a Public Health Initiative: Inter-Organizational Interactions in the Healthy Ontario Initiative." Scholarship @ Claremont, 2018. http://scholarship.claremont.edu/scripps_theses/1154.
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This qualitative study focuses on the intersection of Organizational Studies and Public Health. Through the use of cross-sector work, the Public Health field coordinates work across multiple organizations to diagnose and prevent health issues. Interviewing several administrators from organizations who partake in the Healthy Ontario Initiative allowed me to examine how organizations of different types and sectors interact and connect around this project. This study will predominantly focus on the challenges they face, how they overcome them, and how they are evaluated. Highlighting the intersection of Public Health and Organizational Studies and the way a current Public Health initiative organizes and delivers services may impact the way in which the field evolves in the future.
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Netuveli, Gopalakrishnan. "Public health aspects of oral calculus : an analysis of trends and future senarios." Thesis, University College London (University of London), 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.399021.
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Simmons, Rebecca Kate. "Reducing the burden of type 2 diabetes : public health aspects of primary prevention." Thesis, University of Cambridge, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.611898.
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Patel, Rupal. "Mental health and the Gujarati communities : a case study of Leicester." Thesis, University of Nottingham, 2018. http://eprints.nottingham.ac.uk/51721/.
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This thesis explores the ways in which the Gujarati communities come to understand, experience and conceptualise ‘mental health’. These were explored under the following categories: social, cultural, economic and institutional. Ethnic inequalities and ‘mental health’ have been widely researched but explanations can provide a distorted picture for particular communities (Raleigh, 1995). Published information on measuring rates of inequalities focus use of services and wide categories such as ‘South Asians’ can be misleading in health research (Nazroo et al., 2002). Not only are current epidemiological studies problematic with the categories they utilise to group people together, but also using the medical model to define ‘mental health’ as an universally applied term indeed has its’ pitfalls. The major one that is inherent to this thesis is the complex relationship culture and social factors has in contributing to understandings of ‘mental health’ and how they are managed. Therefore, the crux of this thesis explores practices and beliefs the Gujarati communities have that help ‘mental health’ management but also their limitations that constrain and restrict help-seeking from western health services. This research is informed by two key phenomena and the complex relationship between the two – ‘mental health’ and culture. There is an exploration of social processes such as culture and the range of identity and historical factors such as migration, family, social capital and religion to name a few. A Bourdieusian analytical framework is used, in particular his forms of capital; social, cultural and economic to illustrate how culture influences conceptualisations, experiences and management of ‘mental health’ and how culture contributes to the complexity that cuts across the universality/specificity binary of addressing ‘mental health’. Qualitative interviews with the Gujarati communities in Leicester were used to explore these issues. 35 interviews were conducted with first-generation Gujarati migrants and 15 were conducted with second generation Gujarati migrants. These were all recorded, analysed using various thematic analytical techniques, analytic induction and cognitive mapping. It is argued that, strong forms of social and cultural capital contribute to and strengthen cultural opinions of mental illness as ‘mad’, ‘crazy’ and ‘slow’. Thus, these attitudes and understandings are lived realities for the Gujarati communities. However, it is also strong forms of social capital that contribute to potential ‘mental health’ problems due to the pressure of ‘social obligations’. This entails, behaving in a certain manner that abides to and maintains acceptable norms in the Gujarati communities. Consequently, social and cultural capital are underlying factors that explain the stigmatized nature of ‘mental health’ and their help-seeking trajectories. Additionally, the empirical data from my interviews has begun to demonstrate that attitudes towards ‘mental health’ are not as simple as being educated about it but rooted deeply in social and cultural practices, beliefs and traditions. Rightly so, Dogra et al. (2005) argues conceptualisations and expressions of ‘mental health’ can vary across cultures and thus these need to be considered when looking at ethnic groups. Additionally, due to the changing nature of cultures, continuous research is required to uphold suitable treatment and support for ‘mental health’. Therefore, I argue that research that informs policy in this area, such as cultural components of ‘mental health’ needs to be inductive rather than deductive in nature.
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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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McAnally, Helena M., and n/a. "The association between rated intensity of 6-n-propylthiouracil and three health risk factors in a general population sample." University of Otago. Dunedin School of Medicine, 2009. http://adt.otago.ac.nz./public/adt-NZDU20091009.161623.
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This thesis explored whether individual differences in taste perception (as measured by the rated intensity of 6-n-propylthiouracil (PROP)) were associated with tobacco use, alcohol use and misuse and obesity in the Dunedin Multidisciplinary Health and Development Study birth cohort at age 32. This cohort of 1037 participants was assessed at ages 3, 5, 7, 9, 11, 13, 15, 18, 21, 26 and, most recently, at 32 years, when 96% of the living study members were interviewed.
At age 32, participants rated the intensity of a 0.0032mol/L solution of PROP using the general labelled magnitude scale (gLMS). PROP is almost tasteless to some but tastes bitter to others. As bitter tastes are aversive, due to their association with toxicity, it has been suggested that responses to PROP may reflect individual differences in taste perception that, in turn, have a protective effect on health.
Study One sought to establish correlates of rated PROP intensity in this sample. A model controlling for sex, childhood socio-economic status (SES), childhood IQ and gLMS use predicted approximately 12% of the variability in PROP ratings. This finding highlighted the importance of using appropriate covariates in research attempting to link PROP perception with health risk behaviours, as these factors have also been associated with tobacco use, alcohol use and adiposity.
Study Two did not find that greater perceived intensity from PROP was protective against smoking, as pack years smoked was not associated with PROP rating and ratings between groups of smokers were not significantly different. Differences in PROP perception were not protective against the lifetime smoking in this sample.
Similarly, Study Three found no evidence to suggest that greater intensity from PROP was associated with reduced alcohol misuse. Furthermore, the previously observed association between PROP and yearly alcohol consumption may be better explained by the fact that SES accounts for some of the variance in both measures.
In Study Four, rated PROP intensity was associated with Body Mass Index (BMI), waist circumference and body fat percentage, in women, but not in men. These associations were weakened after the inclusion of covariates in the models, but remained significant for both BMI and body fat percentage. Findings from Study Four indicate that taste perception may be associated with measures of adiposity in women.
Taken together, these results highlight the importance of using appropriate control variables in research and indicate that a single measure of PROP perception may not adequately reflect the full effect of individual differences in taste perception on tobacco use or alcohol use and misuse. Since PROP perception was associated with differences in adiposity in women, however, individual differences in taste perception may be of public health importance. Future research should use continuous measures of a wider range of taste stimuli, to establish how taste perception (rather than just bitterness perception) affects health. Research should also ensure that covariates associated with tobacco use, alcohol use and misuse and adiposity (such as sex, SES and IQ) are included in analyses.
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You, Su-Fen. "Health, policy and medicalisation : a case study of Taiwan's health care reforms." Thesis, University of Warwick, 2003. http://wrap.warwick.ac.uk/55733/.
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This thesis charts the rising importance of the state in extending the influence of modern medicine, contexualised within the history and political-economic dynamics of the health care reforms in Taiwan, a leading Newly Industrialised Country (NIC) which has a distinguished record of health improvement. It highlights the processes by which health care reforms represented a shift towards medicalisation, particularly as consolidated by the creation of a universal National Health Insurance (NHI) system in 1995. The thesis seeks to analyse these processes by bridging the gap between medical sociology and health policy evaluation. It deploys a range of methods: historical analysis of secondary sources and multiple methods of data collection. These include qualitative in-depth interviews with key actors, a questionnaire survey and relevant policy documents. This thesis employs an overarching framework for analysis, which embraces both the 'political economy' and the 'cultural critique' approaches to health, in ways which seek to integrate discussion of policy issues and developments at the macro, meso, and micro-levels. It starts by locating the NHI reform against longer-term historical processes of modernisation, often as a result of outside influences, and the associated transformation of medical paradigms that occurred in different periods. It charts how particular structural factors have impinged on medicine to enable it to become dominant collegiate profession, with special reference to the role of the state promoting the legitimation of particular modes of medical intervention. The thesis highlights the fact that the NHI has extended the influence of doctors, paradoxically also provides the basis by which medical autonomy has been undermined. On the other hand, it charts the social impacts of modern medical care, and argues that the NHI has played an important role in stimulating the process medicalisation and consequently fostered a culture of dependency and passivity contained in medical technology and in the healing relationship. This thesis is a reminder that the contemporary Taiwanese health care state is arriving at a moment of crisis, and that deep reflection on the strengths and weaknesses of the NHI reform is necessary in order to deal with problems associated with growing medicalisation, public demands for greater social equity, and new threats to health, the latest being SARS.
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Bernardi, Roberta. "Health information systems reform in Kenya : an institutionalist perspective." Thesis, University of Warwick, 2012. http://wrap.warwick.ac.uk/51354/.
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The development outcome of ICT and information systems in developing countries is often influenced by international development policies and the action of international actors such as donor agencies. In particular, ICT adoptions and implementations in developing countries may be influenced by the contradictions arising mainly from the tension between international managerialist development policies and the main rationalities of actors in the local implementation context. Based on the case study of health information systems in Kenya, the objective of this thesis is to increase the understanding of how these contradictions may affect the development and change potential of health information systems and ICTs in developing countries in relation to international development policies. Drawing on a dialectical perspective on institutional work, the thesis argues that the change and development trajectories arising from the implementation and usage of health information systems depend on how actors involved in the restructuring of health information systems – i.e. donor partners, national decision makers and local health information systems managers and users – respond to the ongoing dialectic between global and local pressures of institutional change and stability. The main findings of the research presented in this thesis point to the importance of analysing political donor relations and the institutional entrepreneurship of local actors in order to understand the change and development outcomes of health information systems and ICT in developing countries.
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Matthews, Paul. "Service user-professional interaction in health and care settings." Thesis, University of Warwick, 2014. http://wrap.warwick.ac.uk/65052/.
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This thesis is comprised of three chapters written as articles for publication. The theme linking the chapters is the focus on interaction between service users and professionals working in health and care settings. Chapter one reviews discursive research on health and care professional interaction with people with a learning disability. The focus is on how professionals talk with and about people with a learning disability. Citations are explored which describe professional talk in research interviews, interactions with people with a learning disability in everyday settings, questionnaire-based interviews, therapeutic interactions and meetings. Certain practices have been found to work well in particular contexts and some not so well. There is potential to use practices across contexts, however there is no guarantee that a particular practice will perform the same action in a different interactional setting. Future research in the area could look at the effects of trying to increase the use of some of the more successful practices through staff training. Chapter two details an empirical study on how questions are used by participants in care programme approach (CPA) review meetings in the NHS. Questions were found to be asked by the professionals at the meeting in a manner that followed the format of a semi-structured interview. Six question types are described in the paper that perform a range of actions; switching topic, prompting the service user, avoiding overt disagreement, bringing the meeting back on topic, offering the service user the opportunity to ask questions and ensuring a particular structure is followed. The analysis suggests that government guidance on CPA regarding service user participation is not being realised in the way that the process is conducted on an interactional level. Chapter three contains a reflective piece about my experiences conducting discursive research in an NHS setting. It describes the challenges faced in doing research using this methodology and makes suggestions on how some of these potential issues might be tackled.
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Frantz, José Merle. "Physical inactivity among high school learners in Belhar - a public health concern." Thesis, University of the Western Cape, 2004. http://hdl.handle.net/11394/1561.
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Philosophiae Doctor - PhDFor many decades, the World Health Organisation had highlighted the growing importance of chronic non-communicable diseases in developed and developing countries, with an increase in lifestyle-related diseases. Physical inactivity has been identified as one of the risk factors, in addition to other leading risk factors like diet, and the use of tobacco and alcohol, contributing to the occurrence of non-communicable diseases like cardiovascular diseases, cancers, obesity and type 2 diabetes mellitus. Based on the researcher's observations while living in Belhar community for more then ten years, it was hypothesized that the level of physical inactivity among adolescents could become a public health problem in the future if not addressed immediately.
South Africa
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Gafos, Mitzy. "Microbicides, sexuality and sexual health in KwaZulu-Natal, South Africa." Thesis, City University London, 2013. http://openaccess.city.ac.uk/2987/.
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There is an urgent need for additional HIV prevention options for women. Evidence supporting the benefit of microbicides in reducing the risk of vaginally acquired HIV acquisition has provided a major breakthrough. Despite the wealth of evidence supporting microbicide acceptability in Africa, there are still gaps in our understanding about how women will incorporate microbicides into their everyday lives. In this thesis I examine whether vaginal microbicides are compatible with socio-cultural norms regarding sexuality and sexual health in a predominantly rural area of KwaZulu-Natal, South Africa. Using qualitative and quantitative data collected as part of the MDP 301 clinical trial at the Africa Centre, I adopt a mixed methods approach to evaluate microbicide acceptability from a cultural perspective. I explore the compatibility of microbicides with socio-cultural norms that relate to intravaginal cleansing, intravaginal insertion, love medicines and sexual communication. I found that the desired effects of using intravaginal insertions to enhance sexual pleasure are compatible with the experiences of using microbicides; that contemporary socio-cultural norms relating to sexual communication in the context of the HIV epidemic are compatible with the introduction of microbicides; that women distanced microbicides from ‘love medicines’ in terms of separating microbicides from the supernatural; and, finally, that postcoital intravaginal cleansing practices could undermine a microbicides roll out programme if we fail to address these practices. Overall I found that microbicides are compatible with socio-cultural norms relating to intravaginal insertion and sexual communication, but they may be less compatible with norms relating to intravaginal cleansing and love medicines. While incompatibility with socio-cultural norms raises challenges for intravaginal cleansing, the fact that love medicines are incompatible with microbicides could be advantageous for their introduction. Ultimately these findings have implications for future research and service delivery, as well as offering insights into microbicides, sexuality and gender equality.
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Sigurgeirsdóttir, Sigurbjörg. "Health policy and hospital mergers : how the impossible became possible." Thesis, London School of Economics and Political Science (University of London), 2005. http://etheses.lse.ac.uk/461/.
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This study seeks to explain major shifts in health policy. It takes as case studies two governmentally-led hospital mergers in the 1990s - one in London and one in Reykjavik - when national governments, as part of broader administrative reforms, decided to merge teaching hospitals in their capitals. The decision to merge, and the implementation of the decision, followed a long history in both cities, in which the mergers had been repeatedly held up as highly desirable but had always been blocked or abandoned. The merger decisions in the 1990s represent “the impossible becoming possible”. And they stand out as defining moments because of the way they shape the successive course of events in the health care systems. By answering the empirical question why it was possible to merge these hospitals in the 1990s but not in the 1980s, the research aims to contribute to a body of literature that seeks to improve theoretical understanding about how health care systems are shaped by national governments. It carries out two sets of analysis: historical analysis of the main explanatory factors within the health care arenas in both cities; and political analysis of the degree of political authority and will for action of the governments of Britain and Iceland in the 1980s and 1990s. The research concludes that in both cases the merger decisions in the 1990s are best understood as resulting from a confluence of three main factors: 1) weakening cohesion inside the health care arenas; 2) national governments with a long-term hold on power providing an opportunity to consolidate political authority and will through which the wider context of the reform agenda was adopted, 3) the prolonged continuity of executive forces in the governments providing specific political actors with scope for action. In bringing these factors together, ideas which had once united and divided groups of actors in the health care arenas and caused fragmentations in the old order, became glue to the new structure. Theoretical interpretations of the findings suggest that public policies “happen”, as opposed to being made. The merger decisions can be seen more as indicative of past development within the health care systems than as directive themselves. Political interventions, however, changed the balance between groups of actors in the system resulting in strengthening of influence of particular groups of actors, who now possess ever greater control over where, how, when, how much and at what price medical services are provided.
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Baker, Stephanie. "Staff and service user experiences of forensic mental health services." Thesis, University of Warwick, 2017. http://wrap.warwick.ac.uk/90135/.
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This thesis consists of three chapters. Chapter one is a systematic review of the qualitative literature examining the experiences of clinicians working in mental health services with forensic service users (FSU). Following systematic searches and a process of quality assessment, a total of 14 articles were included and their findings were systematically compared. Staff members experienced both positive and negative emotional responses to their work, there are conflicting aspects to their role and additional challenges within the organisational context. Implications for clinical practice and further research are discussed. Chapter two uses Interpretative Phenomenological Analysis (IPA) to consider the experiences of FSUs diagnosed with Personality Disorder (PD) in Forensic Services and the meaning given to recovery within their accounts. The findings discuss the disempowered position of FSU participants and suggest that feeling safe within relationships in their environment is important for those with this diagnosis. There was evidence in their accounts of attempts to establish new identities but there also appeared to be multiple barriers to this. Chapter three offers a reflective account of the researcher’s experience of carrying out this study. It demonstrates the reflexive strategies used that allowed the competing subjective roles alongside that of ‘researcher’, to be examined and their influence on the research process explored.
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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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Khalil, Basem A. "Modern insights into the policies affecting public health in the Islamic Caliphate (622CE – 1258CE)." Thesis, University of Gloucestershire, 2016. http://eprints.glos.ac.uk/6153/.
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Background/aim: In the Western world, the emergence of historical research on the effects of the social determinants of health has provided the discipline of public health with new insight into this aspect of population health complementing the more traditional focus on the history of medicine. The Islamic Caliphate was a dominant power in its time and little is known about its public health history. This thesis aims to provide a chronologically historical account of the policies taken in this period and analyse them in the light of modern theories of public health. Materials and Methods: This thesis employed a qualitative research technique. Known primary and secondary historical sources were examined and data translated and presented in a chronological order. Modern historical sources analysing the historical accounts of that era were also used. Policies affecting health were retrieved and analysed using modern day research into the same policies. Results: The analysis has resulted in a revisionist argument that policies affecting public health in a positive way did exist in a sophisticated manner in the Islamic Caliphate albeit in an inconsistent manner. The study complements the works of medical historians who identified a “Golden Age” in the later era of the Caliphate with advancements in medical science with a potential “Golden Age” in the early era related to the social determinants of health. Conclusion: This thesis provides for the first time a chronological study of policies affecting public health in an era of public health history that has not been studied before. In addition it provides for the first time a modern analysis of these policies.
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Osborne, Nicholas John Thomas. "Investigation of the toxicology and public health aspects of the marine cyanobacterium, Lyngbya majuscula /." [St. Lucia, Qld.], 2004. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe18107.pdf.
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Pritchard, Jacqueline Edith. "Public, private and personal : a qualitative study of the invisible aspects of health visiting." Thesis, University of Warwick, 2001. http://wrap.warwick.ac.uk/3103/.
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This thesis shows how it was possible to listen to health visitors relate their personal views about their work in such a way that new insights on being a woman as a health visitor have been identified. This contributes to the debate about the 'invisibility' of health visiting as a reality and also shows invisibility to be a metaphor for care and the caring aspects of the work, for the management of personal lay knowledge rooted in experience and for gender blindness in client relations based on surveillance. It shows health visiting operating on three levels that represent the public face of the work, the private lay knowledge and the hidden personal feelings. The thesis highlights the importance of remaining open to new ways of viewing and interpreting practice and makes suggestions for educational changes in the preparation of health visitors. The study draws upon qualitative data from semi-structured interviews with 35 health visitors. It examines ways in which professional and personal experiences contribute as resources to the activity of health visiting in a public work arena where the emphasis on identifying targets and measurable outcomes increased during the 1990s. The health visitors who participated in this research all identified private and personal experiences which contributed to the process of their work but without any model to validate these as legitimate resources for their clients. The findings suggest that without a transformed outlook these potential resources will continue to be hidden and undervalued. The analytical tools, drawn from feminist theories of care, epistemology and power relations were each applied to the data and demonstrated ways in which feminist understandings could lead to a heightened sense of being a 'woman worker'. It is suggested that becoming more aware of gender in client interactions can lead to a model of practice which values the needs of women and would enable health visitors to improve their practices with women.
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Anifalaje, Adebusoye. "Exploring the role of health management information systems in improving accountability arrangements for primary health care delivery in less developed countries : a case of Northern Nigeria." Thesis, London School of Economics and Political Science (University of London), 2012. http://etheses.lse.ac.uk/384/.
Full textAbstract:
Health management information systems (HMIS) are implemented in less developed countries (LDCs) with the expectation that they will contribute to improving primary health care (PHC) delivery. Information generated through these systems is conceived as an imperative for better decision making processes and strengthening accountability arrangements that underpin the delivery of PHC. Despite strong rhetoric and significant investments to support these systems, most HMIS implementation in LDCs face challenges of poor data quality and weak accountability arrangements that limit their impact on health status. This constitutes a divergence from the instrumentality of predetermined indicators measuring health status performance that do not necessarily reflect the complex reality underlying how poor communities define their health priorities. We therefore highlight that accountability for performance management may indeed detract from the objective of improving the health of the poor and needs to be understood more broadly. This study illuminates the challenges and potential of HMIS implementation through accountability arrangements that are socially embedded in institutions, interactions and interpretations of global and local actors. As such, our primary research question is, “To what extent can HMIS improve accountability arrangements of PHC delivery?” Employing an interpretivist research methodology, we provide perceptions of how interactions between citizens, service providers, bureaucratic and political agents dynamically construct, contest and navigate accountability arrangements underpinning the provision of health care. This understanding has hitherto been limited in the HMIS literature. As a central theme in ICT for Development literature, illuminating these interactions furthers our understanding regarding the potential of HMIS in improving the lives of the poor. National governments, donors and HMIS practitioners will benefit from the practical insights derived from this study especially in relation to reconceptualising HMIS analysis to incorporate contextual and developmental notions of PHC. With relatively limited HMIS research, Northern Nigeria as the empirical context of this study also constitutes a useful contribution to the body of knowledge.