Dissertations / Theses on the topic 'Health policy recommendations'

Since the economic reform in 1978, China’s health system moved from a commune-based system to a market-driven system. This drastic change resulted in various market failures, including cost inflation, perverse incentives for providers and supplier-induced demand for unnecessary care, increasing inequality in access across regions based on economic status, and other problems. Though China attempted to correct its policy mistakes and reform its inadequate and unjust health care system in order to provide basic universal health coverage for all over the past decade, not everyone has equal access to the same quality of affordable health care, especially the non-resident workers, the poor urban residents, and the rural population. This research uses the framework of the five intellectual tasks to assess the history of China’s health policies, the political economy factors that have driven and shaped the reform of China’s health system, the likely projections of policy options, and potential alternatives for policymakers.

Investigation of the variations in aspirant juvenile probation officers' recommendations for a juvenile offender who may suffer from a mental health disorder was the purpose of this study. Two hypotheses were developed to test this purpose: a) there was a significant difference between the recommendations of mental health evaluations and b) there was a significant difference in the recommendations for a mental health evaluation prior to and after the mental health overview administered among two groups. A survey was administered to 13 undergraduate students with an aspiration to be juvenile probation officers. The survey consisted of a pretest and posttest questionnaire following a case vignette where a juvenile offender meeting the criteria for conduct disorder was described to measure if the mental health overview would increase the participant's likelihood of recommending a mental health evaluation. A Chi Square and McNemar Test were completed. The statistical analyses and implications are discussed.

Heat stress due to ambient outdoor temperatures is a workplace hazard that has not been well studied or characterized. The incidence of occupational heat-related illness is unknown. Heat-related morbidity and mortality have been well-studied at the population level, however it cannot be determined if these findings extend systematically to workers exposed to high heat conditions. Remarkably, there is no U.S. federal standard to protect workers from the peril of elevated environmental temperatures and few states have protective regulations. This dissertation research will add to the limited knowledge base of occupational heat-related illnesses, by characterizing worker fatalities due to environmental heat stress. Three independent, but related, research strategies were designed, executed, and completed to evaluate the current research, as well as knowledge gaps, and to thoroughly describe these fatalities based on available information.

This work was initiated with a thorough literature review to summarize research findings that characterize U.S. occupational heat-related morbidity and mortality and identify gaps in the existing research literature. This review of science, health, and medical databases found that few studies examine ambient heat stress or characterize the incidence of occupational heat-related illnesses and outcomes. Significantly more research examining the heterogeneity of worker and environmental risk factors to heat exposure is needed to identify unsafe working conditions and implement practical, evidence-based heat-stress policies and interventions. The subsequent study describes the epidemiological characteristics of heat-related deaths among workers in the U.S. from 2000 to 2010. Fatality data were obtained at the Bureau of Labor Statistics from the confidential on-site Census of Fatal Occupational Injuries database. Fatality rates and risk ratios with 95% confidence intervals were calculated by year, sex, age group, ethnicity, race, state, and industry. Between 2000 and 2010, 359 occupational heat-related deaths were identified in the U.S., for a yearly average fatality rate of 0.22 per 1 million workers. Highest rates were found among Hispanics, men, the agriculture and construction industries, the states of Mississippi and Arkansas, and very small establishments. This study provides the first comprehensive national profile of heat-related deaths in the U.S. workplace. Prevention efforts should be directed at small businesses, states, industries and individuals who may be at increased risk of heat stress.

Lastly, to further characterize these fatalities, research was performed to: 1) determine the ranges of heat index and temperature at which workers fatally succumb to environmental heat; 2) identify risk factors that may influence heat-related deaths; and 3) translate these findings to policy recommendations. The Census of Fatal Occupational Injuries and the National Climate Data Center were used to identify worker heat-related deaths in the U.S., 2000- 2010, and to assign a maximum daily temperature and heat index to each case. Demographic, meteorological, and geographical variables were analyzed to evaluate any differences in fatal heat exposure. The National Weather Service temperature alert tools, the Excessive Heat Event warning and the heat index category chart, were utilized to assess community threshold suitability for workers subjected to exertional heat stress. Of the 327 cases that qualified for the analysis, there were no differences found in mean temperatures and heat indexes between the sexes, races, age groups, ethnic groups, and industries. Southern workers died at significantly higher temperatures than workers in the North. This study supports the use of heat index and temperature as a guide when evaluating environmental conditions for workers.

Population-level heat index threshold alerts are unsuitable for preventing exertional heat stress and new warning systems should be developed. Since heat-related health hazards at work can be anticipated before they manifest, preventive measures can be implemented before illness occurs. With no federal regulatory standards to protect workers from environmental heat exposure, and with climate change as a driver for adaptation and prevention of heat disorders, it is increasing sensible and imperative for the Occupational Safety and Health Administration to take action. National leadership is needed to promulgate regulations, develop new heat alert tools using the heat index as a metric, and promote state-specific occupational heat stress prevention policies.

Throughout the Appalachian Region, smoking is a common health risk that contributes to significantly higher rates of tobacco-related disease and lower life expectancy compared to the rest of the United States. Drawing on the research presented in the health disparities and Bright Spot reports, this brief focuses on promising practices, intervention strategies, and policies aimed at reducing health disparities related to smoking. This brief: ■ summarizes statistics on smoking and related diseases in Appalachian communities, ■ discusses key strategies and resources for reducing tobacco use, and ■ provides recommendations for community leaders, funders, and policymakers. This brief discusses four recommendations in detail: 1. Prevent smoking initiation among youth. 2. Increase access to tobacco cessation interventions. 3. Launch anti-tobacco communication campaigns. 4. Reduce exposure to secondhand smoke.

Obesity, which is both a chronic disease and a risk factor for other chronic diseases, contributes to higher rates of premature mortality in Appalachia. Drawing on research presented in the health disparities and Bright Spot reports, this brief focuses on promising practices, intervention strategies, and policies aimed at reducing health disparities related to obesity. This brief: ■ summarizes statistics on obesity and related disease in Appalachian communities, ■ discusses key strategies and resources for preventing and reducing obesity, and ■ provides recommendations for community leaders, funders, and policymakers. This brief discusses four recommendations in detail: 1. Establish healthy behaviors among children and youth to prevent childhood obesity. 2. Increase the availability of affordable healthy foods and beverages in communities. 3. Create safe communities that support physical activity. 4. Increase physical activity and healthy eating among adults.

The Appalachian Region continues to experience higher rates of opioid misuse and overdose deaths than other parts of the country. While the impact of the burgeoning epidemic is being felt nationwide, states and counties within the Appalachian Region are particularly hard hit, with opioid overdose rates more than double national averages. Drawing on the research presented in the health disparities and Bright Spot reports, this brief: ■ summarizes statistics on opioid misuse and overdose deaths in Appalachian communities, ■ discusses key strategies and resources for addressing opioid misuse and overdose deaths, and ■ provides recommendations for community leaders, funders, and policymakers. This brief features promising practices, intervention strategies, and policy development and implementation ideas to reduce health disparities related to opioid misuse and overdose deaths. This brief discusses five recommendations in detail: 1. Prevent opioid misuse. 2. Increase access to treatment for opioid use disorder. 3. Implement harm reduction strategies to reduce the consequences of opioid use disorder. 4. Support long-term recovery of opioid use disorder. 5. Implement community-based solutions to prevent substance misuse.

There is an increased need for complete medical device traceability in the healthcare industry. The two main reasons are the healthcare industry's global supply chain and decentralised adverse events reporting, where different laws apply for each country and where each country has their own database for incidents without international governance. The idea of improving traceability procedures in the surgical department at Karolinska University Hospital was formed in the light of a near miss event where guidelines regarding incident management of a Single-Use Medical Device (SUMD) were not followed properly. Hence, this thesis project will investigate the issue of finding an effective way to trace SUMDs at Karolinska University Hospital, in order to improve the incident management process and suggest improvements of patient safety at other Swedish hospitals as well. The collection of data consisted of different data sources; observations at the research site and interviews with relevant participants. By employing multiple sources to this study, a more holistic approach could be achieved. In addition to observing the current situation of device registration, it was of importance to ask individuals with competence and different perspectives on the issue of traceability of SUMDs. To answer the research questions, the acquired data was categorized into the different identified cornerstones of traceability of SUMDs. These were registration process, perioperative supply chain and incidents management. Each section was divided into an investigation of the current process, issues and suggested improvements, in order to clearly answer to the research questions. Furthermore, these acquired answers and insights, from observations and interviews, were translated and summarized to form a basis for the results. Based on the data acquisition and compilation from the different perspectives, key findings and themes are presented in the results. The thesis proposal include a visual representation that show the physical flow of a SUMD from the point of being delivered to the hospital by the distributor, through different entities where registration occur, until it is either discarded or saved for incidents reporting. In order to avoid many of the current issues and to realize the acquired suggestions from this thesis, interoperability between the systems within the healthcare organization as well as between the different entities throughout the entire supply chain is an essential part of the solution, which should be further studied.

Background: With almost 80,000 Europeans estimated to die annually from the consequences of exposure to second-hand smoke (SHS) and over a quarter of all Europeans being exposed to the toxins of cigarette smoke at work on a daily basis, SHS is a major European public health problem. Smoke-free policies, i.e. policies which ban smoking in public places and workplaces, are an effective way to reduce exposure. Policy options to reduce public exposure to SHS were negotiated by European Union (EU) decision makers between 2006 and 2009, resulting in the European Council Recommendation on smoke-free environments. A variety of stakeholders communicated their interests prior to the adoption of the policy. This thesis aims to analyse the engagement and collaboration of organisational stakeholders in the development of the Council Recommendation on smoke-free environments. Methods: The case study employs a mixed method approach to analyse data from policy documents, consultation submissions and qualitative interviews. Data from 176 consultation submissions serve as a basis to analyse the structure of the policy network using quantitative network analysis. In addition, data from these submissions, selected documents of relevance to the policy process and 35 in-depth interviews with European decision makers and stakeholders are thematically analysed to explore the content of the network and the engagement of and interaction between political actors. Results: The analysis identified a sharply polarised network which was largely divided into two adversarial advocacy coalitions. The two coalitions took clearly opposing positions on the policy initiative, with one coalition supporting and the other opposing comprehensive European smoke-free policy. The Supporters’ Alliance, although consisting of diverse stakeholders, including public health advocacy organisations, professional organisations, scientific institutions and pharmaceutical companies, was largely united by its members’ desire to protect Europeans from the harms caused by SHS and campaign for comprehensive European tobacco control policy. Seemingly coordinated and guided by an informal group of key individuals, alliance members made strategic decisions to collaborate and build a strong, cohesive force against the tobacco industry. The Opponents’ Alliance consisted almost exclusively of tobacco manufacturers’ organisations which employed a strategy of damage limitation and other tactics, including challenging the scientific evidence, critiquing the policy process and advancing discussions on harm reduction, to counter the development of effective tobacco control measures. The data show that the extent of tobacco company engagement was narrowed by the limited importance that industry representatives attached to opposing non-binding EU policy and by the companies’ struggle to overcome low credibility and isolation. Discussion: This study is the first that applies social network analysis to the investigation of EU public health policy and systematically analyses and graphically depicts a policy network in European tobacco control. The analysis corroborates literature which highlights the polarised nature of tobacco control policy and draws attention to the complex processes of information exchange, consensus-seeking and decision making which are integral to the development of European public health policy. The study identifies the European Union’s limited competence as a key factor shaping stakeholder engagement at the European level and presents the Council Recommendation on smoke-free environments as an example of the European Commission’s successful management of the policy process. An increased understanding of the policy network and the factors influencing the successful development of comprehensive European smoke-free policy can help to guide policymaking and public health advocacy in current European tobacco control debates and other areas of public health.

Backgrounds: Receive seasonal influenza vaccination is the most safe and effective way to prevent seasonal influenza and its complications. According to the WHO, the number of hospitalizations among older people due to influenza could be reduced by a ranged from 25% to 39% as a result of vaccination. It has also been revealed to reduce overall mortality rate of the influenza seasons by a range from 39% to 75%. Moreover, influenza vaccination protects almost 90% healthy adults against clinical disease in industrialized countries, under the precondition that the vaccine antigens and circulating viruses are well matched with each other. However, the prevalence of elderly Chinese people undertaking influenza vaccination is still sub optional, the percentage of which is 62.4%. Previous researches reveal that there are a number of reasons for non-compliance to influenza immunization, including the unfavorable side-effects, doubt to the effectiveness of the vaccine, the fear of needles, as well as unawareness of the seriousness of flu. These are all factors associated with personal willingness. Aims and objectives: The aims of this paper are to explore factors that influence vaccination rate in older people and to examine other countries’ experience to identify useful policies. The specific objectives are: 1. To identify from the published literature factors which contribute either positive or negative impacts on vaccination rates in older people. 2. To group these factors into appropriate categories. 3. To make suggestions on policies to improve vaccination rates based on the identified factors and other countries’ experience. Methods: Relevant publications were achieved through PUBMED. Search strategies as well as criteria for inclusion and exclusion had been predetermined and applied. Analysis includes both community perception factors and interpersonal factors. Results: 17 English literatures were reviewed, revealing predictors of seasonal influenza vaccination for and against, which could be grouped into four categories: Factors relate to demographic, factors relate to Health Belief Model, factors relate to social support, factors relate to advice and information being provided. Conclusion: According to this literature review, demographic factors, factors relate to Health Belief Model, social support and information being provided are revealed to be associated with the elders’ inclination to get influenza vaccination.
published_or_final_version
Public Health
Master
Master of Public Health

In 2011, the United Kingdom (U.K.) physical activity (PA) guidelines were updated. The adult moderate-to-vigorous intensity PA (MVPA) recommendation changed to reflect that different frequency and intensity permutations lead to equivalent health benefits. New recommendations were added for muscle strengthening activities (MSA) and the reduction of sedentary time (ST). Those over 65 years were also recommended to undertake balance and co-ordination activities (BCA). Despite these new additions, Scottish PA policy still concentrated on MVPA, with considerable resources allocated to sport and some exercise activities. Since 2012, the Scottish Health Survey (SHeS) has collected data relating to these new recommendations annually, but few analyses have been undertaken. This thesis contains the most comprehensive analyses of the 2012-15 SHeS PA and ST data to date, and a review into whether the method produces valid and reliable estimates. The aim of this thesis was to inform Scottish PA and sedentary behaviour policy by producing research to support the incorporation of these new recommendations and the promotion of non-sport-related MVPA policies. It also aimed to inform any future developments to PA and ST surveillance in Scotland. The first three studies of this thesis are cross-sectional analyses of the updated recommendations for adults in Scotland. They present prevalence and participation data in specific domains, activities, and behaviours by age and sex. The main findings were that (1) sport was a minority contributor to the total MVPA of adults in Scotland, regardless of sex, age, or activity status (never more than 20%), (2) compliance with the MSA recommendation was approximately half that of the MVPA recommendation (31% of men and 24% of women), and compliance with the BCA recommendation amongst those over 65 years was very low (19% of older men and 12% of older women), and (3) middle-aged adults in work reported a comparable amount of weekday ST to adults over 75 years (7-8 hours per day). The fourth study was a review of the available evidence into whether the PA and ST estimates produced by the 2012-15 SHeS were valid and reliable. The SHeS was found to be fit for purpose, but recommendations were made regarding the analysis and interpretation of the data to minimise areas of concern. These were (1) analyse MVPA data with and without the domain of occupational MVPA, (2) make it clear that only sport and exercise activities can contribute to achieving the MSA and BCA recommendations under the SHeS method, and (3) focus on the comparisons between groups in relation to ST, rather than on the absolute values. The fifth study used the findings from the previous four to inform the design of a prospective cohort study that will investigate the joint effects of MVPA and total ST on all-cause mortality, cardiovascular disease, cancer, and diabetes. This thesis contains the results of the preliminary analyses. This study is designed to inform policy by providing novel information on how the combination of these behaviours affects health outcomes in a representative sample of Scottish adults. There is clear evidence that this work has already informed policy and surveillance. The work on the relative contribution of the domains of MVPA is regularly cited in evidence briefings for the Scottish Government and the Scottish Parliament. This has increased the awareness amongst key policy-makers that sport is not a major contributor to the total MVPA of adults in Scotland. The work on MSA, BCA, and ST was a catalyst for a proposal to include indicators relating to these recommendations on the national PA monitoring framework. The work on MSA and BCA has also been a key reference text in preparation for the next update to the U.K. PA guidelines, stressing the need to consider surveillance at an early stage. In summary, the novel analyses of SHeS data undertaken for this thesis have demonstrably informed PA and sedentary behaviour policy and surveillance in Scotland.

碩士
國立交通大學
科技法律研究所
105
Whether drugs are recognized as a rare disease medication, and whether health insurances reimburses the drugs, often depend on the mechanisms of scientific and medical expert review meetings. The policymaking for rare diseases is often based on insufficient evidence such as small number of small trials, incomplete data, unclear efficacy, and chronic degeneration process, etc. If we do not pay attention to the minority of disease groups and only make judgments by single factors, the decisions might violate the human rights of the minor disease groups. This article intends to protect the right to health insurance from the collection of relevant international laws , the British and Indian court judgments, the interpretation of the Judge of the Court of Justice, and the opinions of the scholars. Medicinal insurance reimbursement is a complex political issue involving a range of medical technology, scientific evidence, costs and other factors. The lack of a single and universally accepted health gain threshold is a major obstacle to the current assessment and the allocation of health resources. We hope the Taiwan's health insurance system will change to set a clear threshold based on a cost-benefit analysis approach, that is, the decision-makers will gradually achieve a consensus on the acceptable range for the yearly expense by a person or a healthy person (QALY). The views of new drugs reimbursement policy from some Japanese scholars are referential for Taiwan to make a better healthcare system which can balance the use of limited public health resources and the sufficient access to drugs for rare disease patients. One of the main ideas of the second-generation NHI is to expand the social diversity participation policy into the NHI. How to make the policies of NHI more in line with the principles of democracy is the primary concern. This research will analynize the impact of before-and-after implementation of health insurance policies in United Kingdom’s NICE, Canada’s CADTH, especially in the aspects that involving patient’s participation. In hope that it can improve patients and patient’s relatives’ experience by substantially involving them in the decision-making process, as such, patients can exercise the most of their basic human rights. This research also adopts a qualitative research method through intensive interviews with relevant institutions and staffs to understand the current situations in reimbursing rare disease drugs, and proposes suitable reformative recommendations. We hope that by combining academic theory and practice, the outcome of this research will provide significant contribution into our country’s healthcare system policy.

Street-involved women with co-occurring disorders experience distinct and overwhelming health and social issues, while facing considerable barriers to appropriate and helpful services. Street Connections, a Population and Public Health program, provides services to this and other street-involved aggregates using Harm Reduction and mobile outreach to prevent sexually transmitted infections and blood borne pathogens. Three conceptual frameworks, Gender-based Analysis, the Comprehensive, Continuous, Integrated System of Care, and Harm Reduction guided the practicum. The purpose of the practicum was to develop policy/practice recommendations for Street Connections regarding service enhancement for this aggregate. Literature-based best-practices were compared to three agency case studies of programs providing services to this aggregate including Street Connections, the Program of Assertive Community Treatment, and Dream Catchers. Data, consisting of agency documents and person-centered interviews with nine staff, were analyzed using open coding to identify themes. Recommendations incorporate gender-based analysis, recovery, access, engagement, screening, integrated services, and staff development/support.
October 2007

Occupational Health and Safety focuses on the well-being of individuals or groups of people in the workplace. Barnett-Schuster (2008:1) states that Occupational Health and Safety is a concept compiled from many different disciplines. Among others, it includes: biological hazards, physical hazards, chemical hazards, mechanical/electrical hazards and psycho-social hazards. The employer has to understand that Occupational Health and Safety should follow a holistic approach. Occupational Health and Safety is a Constitutional imperative – a command, - not a request. Chapter 2 of the Constitution of South Africa no. 108 of 1996, The Bill of Rights provides protection to such an extent that human dignity may remain intact. Therefore, compliance with Occupational Health and Safety legislation is of cardinal value to any organization or business. An organization or business can also improve their financial standing and public image by complying with Occupational Health and Safety legislation. Occupational Health and Safety in the workplace is guided by the Occupational Health and Safety Act of South Africa no. 85 of 1993, which was implemented in 1994. The Occupational Health and Safety Act further aims to present clear explanations on concepts related to Health and Safety and enables both employers and employees to gain an understanding of their distinct responsibilities. Occupational Health and Safety is a concept that has been around for decades – especially focusing on the mining sector of South Africa. Occupational Health and Safety is observed in the South African technical schools. Statistics from the Children’s Institute show that 350 000 of these children are currently not attending school. In most cases, many parents/guardians do not take the time to assess the safety of their children at school before enrolling their child. This assessment should not only be looking at security measures applied in the school, but if and how true Occupational Health and Safety measures are in place. Occupational Health and Safety (OHS) is measures put in place so that learners/children are free from risk, injury, disease or harm. The lack of Occupational Health and Safety in South African schools is in direct conflict with the Constitution of South Africa. As stated earlier, Occupational Health and Safety is a Constitutional imperative which is the responsibility and the right of each individual in South Africa. The lack of Occupational Health and Safety in South African schools is a human rights issue based on the dignity of children. The lack of Occupational Health and Safety in South African schools can be seen as a policy flaw. This study intends to create a holistic view of the managing and implementing Occupational Health and Safety in the South African school environment. Occupational Health and Safety is an integral part of teaching and learning. The research problem addressed in this study is: “How School Management Teams (SMT) experience, manage and implement Occupational Health and Safety policies in South African schools?”. The main aim of the research is to investigate how School Management Teams (SMT) experience, manage and implement Occupational Health and Safety policies in South African schools. By exploring Occupational Health and Safety in South African schools, this study would strive to obtain clarity on whether enough is being done to ensure the health and safety of learners in the school environment by means to explore the current Occupational Health and Safety management in the South African schools, identify the guidance provided on the Occupational Health and Safety implementation policy, investigate provisions for continual assessment of the process of the Occupational Health and Safety policy and provide recommendations for the lack of Occupational Health and Safety in South African schools.
Educational Leadership and Management
M. Ed. (Education Management)

As a social worker practising in long-term residential care for people living with dementia, I am alarmed by discourses in the media and health policy that construct persons living with dementia and their health care needs as a threatening “rising tide” or crisis. I am particularly concerned about the material effects such dominant discourses, and the values they uphold, might have on the collective provision of care and support for our elderly citizens in the present neoliberal economic and political context of health care. To better understand how dominant discourses about dementia work at this time when Canada’s population is aging and the number of persons living with dementia is anticipated to increase, I have rooted my thesis in poststructural methodology. My research method is a discourse analysis, which draws on Foucault’s archaeological and genealogical concepts, to examine two contemporary health policy documents related to dementia care – one national and one provincial. I also incorporate some poetic representation – or found poetry – to write up my findings. While deconstructing and disrupting taken for granted dominant crisis discourses on dementia in health policy, my research also makes space for alternative constructions to support discursive and health policy possibilities in solidarity with persons living with dementia so that they may thrive.
Graduate
0452
0680
0351
macsuz@shaw.ca