To see the other types of publications on this topic, follow the link: Public health in Colombia.
Dissertations / Theses on the topic 'Public health in Colombia'
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 dissertations / theses for your research on the topic 'Public health in Colombia.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse dissertations / theses on a wide variety of disciplines and organise your bibliography correctly.
1
Quevedo, Emilio, and mikewood@deakin edu au. "El tránsito desde la higiene hacia la salud la pública en Colombia en el contexto de las interacciones internactionales." Deakin University. School of Social Inquiry, 2000. http://tux.lib.deakin.edu.au./adt-VDU/public/adt-VDU20051118.110705.
Full text
2
Dail, Adriana Marcella. "Access to Health Services and Health Seeking Behavior Among Former Child Soldiers in Manizales, Colombia." Scholar Commons, 2016. http://scholarcommons.usf.edu/etd/6489.
Full textAbstract:
Through the Colombian Institute for Family Welfare (ICBF), the Colombian government aims to provide comprehensive reintegration for children demobilized from the country’s various armed groups. The reestablishment of rights, including the right to health (guaranteed by the Colombian constitution), is a key factor in successful reintegration. This thesis explores the topic of access to health care and health seeking behavior among former child soldiers in Manizales, Colombia who are over the age of 18 and were previously in the Hogar Tutor program (foster care-based youth reintegration) in Manizales. This thesis utilizes semi-structured interviews (n=9) and body mapping (n=9) with former child soldiers, key-informant interviews, participant observation, and a review of archival and secondary sources, including survey data, which is used to complement this research. This research is focused on understanding the barriers participants are experiencing in accessing health care, how participants understand and experience health and the health care system, and how health is handled within reintegration programs. Findings illustrate the incompatibility of transitional justice and the right to health within a neoliberal health system. This research suggests that former child soldiers face significant barriers in access to health care, experience persistent health conditions related to the conflict, and may be insufficiently aware of their rights as both citizens and victims of the armed conflict. These challenges likely affect the ability of former child soldiers to successfully reintegrate. This thesis provides recommendations for future research, as well as for the implementation of- and changes to- health education efforts within the ICBF and the Colombia Agency for Reintegration (ACR).
3
González, Echeverri Germán. "A model for improving emergency services of Hospital Universitario San Vicente de Paul, Medellin-Colombia." Thesis, McGill University, 2000. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=36807.
Full textAbstract:
Colombia is a developing country with high mortality rates from trauma. The Valle de Aburra region centred around the city of Medellin has particularly high rates of intentional trauma. Improving emergency medical services could reduce mortality rates.At the time of this investigation, there was no pre-hospital emergency care services in the Valle de Aburra. Thus, this thesis examines predictors of mortality from a case series of 1395 persons presenting to the Emergency department of the Hospital Universitario San Vicente de Paul (HUSVP). Overall mortality for this series was 9.31% and 37.5% of these deaths were retrospectively identified as preventable. Mortality for injuries involving the central nervous system (CNS) was higher at 14.4%. Using the TRISS method, higher than expected death rates were noted from pedestrian-motor vehicle incidents and trauma associated with firearms use.
Determinants of mortality and length of stay were identified using logistic regression. These included factors associated with the mechanism and site of injury and also with the process of care, both pre-hospital and in-hospital.
Based on these identified determinants, policies for integrated pre-hospital and hospital emergency care in the Valle de Aburra can be developed. Regionalizing these services could be expected to reduce both mortality rates and preventable deaths.
4
Obregón, Torres Diana. "Struggling against leprosy: physicians, medicine, and society in Colombia, 1880-1940." Diss., Virginia Tech, 1996. http://hdl.handle.net/10919/39087.
Full text
5
Rodriguez-Acosta, Cristina A. "The Impact of Decentralization and New Intergovernmental Relations on Public Service Delivery: A Comparative Analysis of Colombia and Paraguay." FIU Digital Commons, 2016. http://digitalcommons.fiu.edu/etd/2470.
Full textAbstract:
The purpose of this research is to examine the factors that have influenced political decentralization in Paraguay and Colombia and how the new intergovernmental relations that result in political, fiscal and policy decentralization impact local governments and their capacity to deliver public services. The research, building on institutional theory, places particular emphasis on trying to explain and understand how intergovernmental relations shape the decentralization—and effectiveness—of public service delivery to local and regional governments, particularly in the areas of health and education.
The research method is principally a path-dependent within-cases analysis. The analysis traces how the processes of decentralization evolved from 1990 to 2010. Special attention is given to critical junctures, or special political or social circumstances, that have significantly changed the process of decentralization. Data was collected mainly through reviews of documents, journals and newspapers, and most significantly through elite interviews “tailored to the purposes of the study” (Aberbach & Rockman, 2002). Leaders of political parties, unions, non-governmental-organizations and civic movements were interviewed in both countries.
The research shows that political parties play a very important role, not only in the design and implementation of decentralization of public service delivery, but also in sustaining and furthering the process. The analysis is based on the assumption that increased decentralization of health and education to local and regional levels should positively impact basic health and education indicators. If decentralization, as argued, helps governments to be more responsive to local needs, and if more health and education programs are decentralized to the local and regional level in response to the demands of many communities, it is predicted that health and education indicators would improve, as people would have easier access to these services.
Analysis of health and education indicators in the form of infant mortality rates (deaths of children under one year old, live births) and school enrollment show mixed results for both Colombia and Paraguay.
6
Lucio, Bonilla Carlos Ernesto. "Aspectos bioéticos de la regulación de medicamentos en Colombia." Doctoral thesis, Universitat de Barcelona, 2017. http://hdl.handle.net/10803/664061.
Full textAbstract:
El problema del suministro eficiente y transparente de medicamentos en Colombia es un tema de la Bioética. Seguramente el problema es más grave en otros países del mundo, parece que la situación en Venezuela en relación a la escases de medicamentos es insostenible. Sin embargo, en Colombia, por su condición de país de ingresos medios con décadas de crecimiento económico sostenido, que el problema del suministro eficiente y trasparente de medicamentos no sea ampliamente abordado desde la academia parece inconcebible.
Pero el problema del suministro eficiente de medicamentos tiene un espectro global, casi todos los países del mundo afrontan grandes retos en sus sistemas de salud, que deberían avivar el debate público. La limitación de recursos, el crecimiento exponencial de los costos sobre las nuevas tecnologías en salud y la creciente demanda de servicios por parte de la población mundial, traen consigo, importantes preguntas sobre justicia distributiva. ¿Qué proporción de recursos públicos se debe destinar a la salud y como establecer su utilización? o ¿Como limitar los estándares de atención a las enfermedades huérfanas?. Estas preguntas requieren un debate para establecer los métodos para la asignación justa de los recursos públicos en la búsqueda de la cobertura universal (Organización Mundial de la Salud, 2010).
Para la cobertura universal del sistema de salud se requiere un método de priorización en la utilización de recursos. Uno de los grandes problemas para la eficiencia del sistema, se encuentra en el uso de medicamentos costosos, cuando se cuenta con opciones con mejores precios e igualmente eficaces. Este problema teóricamente puede ser solucionado de manera adecuada a través de la regulación del sistema. Sin embargo, el tema tiene una alta complejidad, además, hay que tener en cuenta dos factores en la regulación: el aumento desbordado en el precio de algunos medicamentos sofisticados y la crisis de la evidencia sobre su efectividad terapéutica (Kantarjian, Fojo, Mathisen, & Zwelling, 2013).
El espectro más amplio de nuestra investigación tiene que ver con la bioética y el derecho. Resulta de gran importancia para los abogados en el mundo actual reflexionar sobre los puntos de contacto y separación entre la ética y el derecho, tradicionalmente analizados desde la filosofía del derecho y de manera especial desde la teoría general del derecho.
En la bioética, como parte de la ética aplicada, encontramos la necesidad de trasformar los acentos de la ética tradicional desde los fundamentos de la norma hasta los problemas más prácticos de la sociedad contemporánea (Escríbar Wicks, 2004). Para entrar en el estudio de la bioética iniciamos nuestra investigación en las primeras definiciones del término. Para esto, se toman los dos autores que primero utilizaron el neologismo de conformidad con la bibliografía especializada. Ellos son, Hans Fritz y Rensselaer Van Potter.
La Macrobioética ha buscado nuevos estados de aplicación en las sociedades contemporáneas. Como parte de la ética aplicada, la bioética pretende adaptarse a los retos prácticos de las nuevas comunidades sociales eminentemente pluri-etnicas y pluri-culturales, con extraños morales y distintas concepciones sobre la buena vida. Por esto, la concepción de la bioética que utilizamos en este escrito es laica, amplia y flexible, alejada de dogmatismo pero basada en el desarrollo de los derechos humanos.
La nueva juridicidad que argumentamos tiene importantes puntos de encuentro con la bioética. Ambas están sincronizadas con los documentos legales que realzan los derechos humanos como el elemento indispensable de la organización en sociedad. Aquí se encuentran varios tratados sobre derechos humanos y bioética que resaltan la relación de esta nueva concepción de lo jurídico, menos preocupada por las formas y los derechos patrimoniales y más consciente de los derechos humanos y colectivos.
Claramente se evidencia esta situación en la acción de tutela o acción de amparo constitucional. Aquí se ponderan derechos encontrados en casos típicamente bioéticos como lo pueden ser la interrupción voluntaria del embarazo y la eutanasia, pero también en todos los casos en general. La misma naturaleza de la tutela nos dice que se acude a ella precisamente cuando nos encontramos ante un caso de vulneración de los derechos fundamentales donde se requiere una acción sumaria y extraordinaria de protección para evitar un daño irreparable.
Sin embargo, esta premisa tiene en el caso colombiano de la tutela en salud profundas particularidades por el número elevado de tutelas, en el año 2015 se interpusieron “151.213 tutelas que invocaron el derecho a la salud”(Defensoría del Pueblo 2016, pág. 145) y por la incidencia de estas sobre la regulación general del sistema de salud. Aunque la tutela se aplica para casos particulares, las deficiencias regulatorias en el caso colombiano han hecho que el juez constitucional se convierta en un determinante de la política pública en salud. Esta situación concibe importantes riesgos que son objeto de este estudio, con profundas consecuencias sobre la equidad del sistema de salud.
7
Krystosik, Amy Robyn. "CHIKUNGUNYA, DENGUE, AND ZIKA IN CALI, COLOMBIA: EPIDEMIOLOGICAL AND GEOSPATIAL ANALYSES." Kent State University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=kent1481111225042036.
Full text
8
O'Bryant, Adam L. "Factors associated with traffic crashes in Pasto, Colombia, 2005-2006." unrestricted, 2008. http://etd.gsu.edu/theses/available/etd-07252008-155628/.
Full textAbstract:
Thesis (M.P.H.)--Georgia State University, 2008.Title from file title page. Karen Gieseker, committee chair; Ike S. Okosun, Victoria Espitia-Hardeman, committee members. Electronic text (69 p. : col. ill., col. map) : digital, PDF file. Description based on contents viewed Sept. 29, 2008. Includes bibliographical references (p. 61-66).
9
Jessen, Andrew. "Understanding Access to Essential Pharmaceuticals during a Public Health Crisis." Digital Archive @ GSU, 2006. http://digitalarchive.gsu.edu/political_science_theses/9.
Full textAbstract:
Despite the benefits of antiretroviral therapy in treating HIV/AIDS, government responses have varied substantially, from provisions guaranteeing nearly universal access to insufficient provisions providing almost no access. This research seeks to specifically examine primary explanations, such as economic capacity, and emerging explanations, such as the role of electoral accountability and the presence of stigma, and the coordination between the epistemic community and political leadership as potential causes for the variance in the government provision. By controlling for state economic capacity, this research furthers the importance of examining other explanations for state response in light of a public health crisis. While electoral accountability and the role of stigma had marginal impacts, the level of scientific coordination and understanding among the states political leadership had perceptible impacts. This research also tests broader aspects of the political economy such as the role of state capacity and subsequent government crisis response.
10
Mazars, Nadège. "Les ruses de la pratique subalterne. La santé gérée par les autochtones en Colombie, un multiculturalisme de domination et/ou d'autonomie ?" Thesis, Paris 3, 2013. http://www.theses.fr/2013PA030019.
Full textAbstract:
En 1993, la Colombie réforme son système de santé en suivant les orientations données par la Constitution politique adoptée en 1991 et les recommandations du « consensus de Washington ». Le pays entre dans une nouvelle ère politique dans laquelle la question sociale est redéfinie autour du thème de la pauvreté, tandis que la question ethnique acquière une visibilité inédite. Dans ce contexte, des Entités Promotrices de Santé Indigènes (EPSI) sont créées à partir du modèle générique des EPS, ces organismes d’administration de l’affiliation et des budgets de la santé qui jouent un rôle d’intermédiaire entre l’État et le patient. Les EPSI sont étroitement liées au monde autochtone. Elles gèrent l’accès à la santé d’une population dont la plus grande majorité doit être autochtone. Le personnel qui assure leur fonctionnement est recruté dans l’espace social et politique autochtone. Enfin, ce sont les autorités dites « traditionnelles » qui les contrôlent. Pour être des représentantes des communautés, ces autorités donnent aux EPSI une nature juridique publique, ce qui leur confère un caractère spécifique dans un système de santé où la tendance est à la généralisation de la privatisation. Quelles sont alors les conséquences de l’intégration à la gestion des affaires publiques de ces structures de pouvoir autochtones et de leurs agents. Quels sont aussi les effets de domination et/ou les expressions d’autonomie que la pratique concrète de ce multiculturalisme génère ? Analysant les enjeux qui se dessinent au sein du champ de la santé interculturelle, la thèse s’organise autour de trois moments. Il s’agit d’abord de caractériser le paradigme dans lequel sont pensés, depuis l’État, le système de santé et l’interculturalité pour comprendre comment les politiques du multiculturalisme deviennent un outil de domination par l’intégration. Le mode opératoire de cette gouvernementalité néolibérale s’appuie en particulier sur la promotion de l’empowerment, la participation autochtone au système de santé en étant l’une des expressions. On s’intéresse ensuite à la dimension dialectique des politiques du multiculturalisme à partir d’une enquête ethnographique menée sur trois EPSI dans trois départements (Cauca, César, La Guajira). La pratique de ce multiculturalisme conduit à une réinterprétation du sens qui lui est donné, en particulier au travers de la réappropriation de pouvoirs (contrôle territorial, biopouvoir) par laquelle devient possible la construction d’une autonomie de ces espaces autochtones. Mais cette autonomie n’est rendue possible, et cela constitue le troisième moment de la démonstration, que par l’existence préalable d’une dynamique sociale, collective et historiquement fixée qui a permis la formation d’un groupe d’agents capables de produire un discours et une pratique propre. Il s’agit alors d’étudier au travers de récits biographiques la formation sociale de ces possibles contre-publics autochtones en s’intéressant à la construction des habitus des agents et aux économies morales locales et globales qui ont contribué à la consolidation de ces contre-publicsIn 1993, Colombia reformed its healthcare system by following the orientations brought out by the political Constitution adopted in 1991 and the prescriptions emanating from the « Washington consensus ». The country enters a new political era in which social issues are redefined around the theme of poverty, whereas ethnic issues acquire a new visibility. In this context, Entities Promoting Indigenous Health (EPIH) are created from the generic model of EPHs, which are public administrative bodies dealing with healthcare affiliations and budgets and play an intermediary role between the State and the patient. The EPIH is closely intertwined with the native world. In fact, these entities manage the access to health care services for a population that must be of great majority native. The personnel and agents that run these entities are recruited in the native social and political realm. Furthermore, what is known as the "traditional" authority fully supervises these entities. To officially represent these native communities, these authorities give to the EPSI a public legal status, which confers them a distinctive character in the health care system more generally undergoing privatization reforms. What are the consequences of bringing in indigenous authorities and agents of these health agencies in the administration of public affairs? What are the effect on power relations and/or expressions of autonomy generated by the concrete application of this multiculturalism? Analyzing the issues that are brought out in the realm of intercultural health, this thesis is structured around three main parts. The first part will define the paradigm in which are thought out, from a state perspective, the interculturality of the health care system to understand how politics of multiculturalism, through integration, become a method of domination. The modus operandi of neo-liberal governance is based on the notion of empowerment, i.e. indigenous participation to the health care system being one of its manifestations. The second part will study the dialectical dimension of multiculturalism politics based on an ethnographic study conducted in three EPIH in three states (Cauca, César, La Guajira). The concrete application of this politics of multiculturalism leads to a re-interpretation of its meaning and an re-appropriation of social power dynamnics (territorial control, biopolitics) through which become possible the construction of autonomous indigenous space. However, the third part will analyze how this autonomy is only made possible by preexisting social, collective, and historical dynamics, which enabled a group of agents to produce a discourse and their own application of public affairs. We will thus study with the help of biographical narratives how it is possible to form counterpublics by looking at the habitus of the agents and at the local and global moral economy that helped shape these counterpublics
11
Valencia-Tobon, Alejandro. "Your love hurts down to my bones : exploring public understandings of dengue fever in Medellin, Colombia, through an anthropology-art-science investigation." Thesis, University of Manchester, 2016. https://www.research.manchester.ac.uk/portal/en/theses/your-love-hurts-down-to-my-bones-exploring-public-understandings-of-dengue-fever-in-medellin-colombia-through-an-anthropologyartscience-investigation(d3f04ff7-a8e5-47c6-ac80-d8bb54d346c8).html.
Full textAbstract:
This is a study of the creation and negotiation of different forms of knowledge about dengue fever. I explore how anthropology, in collaboration with ideas and practices drawn from science and art, may transform public understandings of dengue. Dengue is a vector-borne disease transmitted to humans by the bite of a mosquito which is infected with the dengue virus. Mosquito-borne diseases have normally been treated through vector control and the elimination of breeding sites. Until 1960, the use of the pesticide DDT allowed the virtual eradication of Aedes aegypti (Ae. aegypti) in many places of the world. DDT was banned in most of the world by 1970 and by 1980 the focus on vector-control was replaced by a discourse of sanitation, in which health authorities tried to ‘educate’ populations and ‘teach’ proper hygienic habits to avoid mosquito-human contact. At present, these practices are changing again. The World Health Organisation (WHO) suggests that dengue incidence could be reduced at least 50% by 2020 through applying health campaigns and social interventions that involve having people participating in the control of dengue outbreaks. In this thesis I explore how WHO guidelines are applied in the control of dengue in Medellín, and how we can think about the concepts of ‘knowledge’, ‘education’ and public health campaigns through ethnographic methods. My project has been about looking at how different understandings – or different forms of knowledge – are part of interactions of different ‘publics’, non-expert citizens, virologists, entomologists and artists. My argument is that health campaigns should be re-designed – privileging relations and stimulating debate – by focusing on experience and moving towards managing the disease and living with the mosquito. Contrary to the different models enacted in health campaigns – which neglect the value of everyday experiences – I advocate for interdisciplinary collaboration as a relational art strategy that can generate an intersubjective exchange of experiences.
12
Bailey, Mark S. "Febrile illnesses at the Colombo North Teaching Hospital in Sri Lanka (The Ragama Fever Study)." Thesis, University of Liverpool, 2012. http://livrepository.liverpool.ac.uk/9513/.
Full textAbstract:
Acute undifferentiated febrile illnesses in the tropics and sub-tropics are caused by a wide range of infectious diseases that often have indistinguishable clinical features. In developing countries there may also be insufficient microbiology facilities to identify these infections leading to missed diagnoses, inefficient use of healthcare resources, over-use of empirical treatments, a lack of information on antimicrobial resistance and inaccurate epidemiological data for guiding prevention strategies. These problems occur in Sri Lanka, but a prospective, systematic, representative and comprehensive study of febrile illnesses has never been performed. The Ragama Fever Study was performed at a major hospital in western Sri Lanka that served both urban and rural areas. Its aims were to identify the causes of febrile illnesses in a large sample of patients admitted to the hospital over a 1-year period, develop clinical prediction rules that could distinguish between the most common infectious diseases and assist in the evaluation of rapid (point-of-care) diagnostic tests that were appropriate to this setting. 617 (86.7%) of 711 febrile patients admitted to a quarter of the hospital medical wards were recruited. 56.4% had confirmed infections with organisms identified including dengue (22.2%), chikungunya (16.7%), leptospirosis (5.2%), various bacteraemias (4.2%), Q fever (2.9%), rickettsial infections (2.3%), tuberculosis (1.1%) and urinary tract infections (0.8%). 7.6% had confirmed infections with no organisms identified including cellulitis (2.4%), respiratory tract infections with radiographic changes (2.1%) and pulmonary tuberculosis with radiographic changes (1.6%). 4.1% had confirmed non-infectious diseases and 37.2% had unconfirmed diseases including “viral fever” (13.3%), undifferentiated fever (7.8%), respiratory tract infections (6.8%), urinary tract infections (3.4%), leptospirosis (2.8%) and gastroenteritis (1.0%). Clinical prediction rules for identifying dengue fever and chikungunya were developed using imputation, multiple logistic regression, scoring algorithms and receiver operating characteristic (ROC) curve analysis. The dengue fever rule had sensitivity = 49.6%, specificity = 93.9%, positive predictive value (PPV) = 70.8% and negative predictive value (NPV) = 86.1%. The chikungunya rule had sensitivity = 35.0%, specificity = 95.0%, PPV = 60.0% and NPV = 87.1%. ROC curve analysis could not identify any probability cut-offs that would produce clinical prediction rules with acceptable combinations of both sensitivity and specificity. A commercial (Panbio) rapid serology test for dengue fever showed sensitivity = 43.4%, specificity = 88.8%, PPV = 54.6% and NPV = 83.5% on samples from admission and significantly better diagnostic performance on follow-up. When repeated in conjunction with a PanBio rapid NS1 antigen detection test, the diagnostic performance improved with sensitivity = 89.9%, specificity = 75.0%, PPV = 69.0% and NPV = 92.3% on admission. This study confirmed the wide range of infections that present as febrile illnesses in Sri Lanka and showed the limitations of clinical prediction rules and rapid diagnostic tests in identifying these on admission. I hope that it will prove a foundation for further work on these important topics.
13
Ore, Rosa. "Framing Colombian Women's Beliefs, Values and Attitude Towards Sex and Sexual High-Risk Behaviors." Scholar Commons, 2013. http://scholarcommons.usf.edu/etd/4556.
Full textAbstract:
Hispanic immigrants constitute the largest and fastest growing groups of minorities in the United States. According to the 2010 Census, there are 50.5 million Hispanics in the United States, making up 16.3% of the total population (Passel, Cohn & Lopez, 2011). Furthermore, the state of Florida is home to 4,223,806 Hispanics (U.S. Census Bureau, 2010). Because the Hispanic population continues to grow, it is important to study their sexual health behaviors because diseases linked to risky sexual behaviors account for approximately 20,000 U.S. deaths each year, and are linked to a number of adverse reproductive outcomes (Abraido-Lanza, Chao, & Florez, 2005; Hussey, Hallfors, Waller, Iritani, Halpern & Bauer, 2006; Mokdad, Marks, Stroup & Geberding, 2004). Much of the research on risky sexual behaviors has included women of Mexican, Cuban and Puerto Rican descent (Weiss & Tillman, 2009). Therefore, to fill a gap in the current research further investigations should be conducted among other Latin subgroups such as Colombians. Conducting studies of Colombian women will contribute to the relatively unknown attitudes, beliefs and values towards sex and sexual high-risk behaviors of South American women.
This study systematically examines literature in order to build a conceptual model, which will explain the sexual behaviors of Colombian women. The study will provide a survey instrument to be used in future research.
14
Garcia, Garcia Victor Manuel. "La construction et la régulation du marché des médicaments en Colombie (1914-1971) : contribution à une histoire de la mondialisation du médicament." Thesis, Paris, EHESS, 2020. http://www.theses.fr/2020EHES0178.
Full textAbstract:
À partir de l'analyse des sources documentaires issues des archives nationales colombiennes, de la documentation des laboratoires pharmaceutiques et de la presse nationale et internationale, cette thèse étudie l’émergence de l’industrie pharmaceutique et de la régulation du marché des médicaments en Colombie au XXe siècle, entre 1914 et 1971. Ce faisant, la thèse éclaire la manière dont l’État se constitue, pendant cette période, comme un acteur fondamental pour réguler la qualité des médicaments en circulation, encourager l’industrialisation, la production pharmaceutique locale et élargir l’accès aux traitements. La première partie de la thèse examine la configuration d’un marché national des médicaments, à travers le processus de transformation des pharmacies en entreprises pharmaceutiques et avec l’émergence du médicament comme un problème de santé publique qu’il fallait réguler. Notre recherche montre l’étendue du mouvement de création de laboratoires privés dès les premières décennies du XXe siècle et analyse la création d’un laboratoire national de produits biologiques et pharmaceutiques avec l’aide de la Fondation Rockefeller en 1926, le laboratoire Samper Martínez. Cet établissement public est devenu un outil essentiel de la régulation pharmaceutique en Colombie. La thèse décrit les échanges entre les immigrants scientifiques, la philanthropie internationale, les industriels et l’État colombien qui ont permis l’émergence d’une industrie locale très active. La deuxième partie de la thèse analyse la politique de l’État dans les années 1940 pour renforcer et réguler l’industrie pharmaceutique dans le domaine de la chimie et des produits biologiques. Il s’agit en premier lieu de la politique d’expropriation des laboratoires allemands en temps de guerre. Il s’agit ensuite d’encadrer les produits biologiques controversés d’une entreprise espagnole dans le contexte d’un État sous influence des intérêts pharmaceutiques. La troisième partie de la thèse étudie la politique de l’État colombien pour créer un marché des médicaments génériques au tout début des années 1960, en relation directe avec le débat introduit aux États-Unis sur les prix des médicaments et la régulation des brevets par le sénateur Estes Kefauver. Grâce à la collecte du témoignage oral du ministre de la Santé de l’époque ainsi qu’à l’analyse du débat public en Colombie, notre travail apporte des éléments précieux sur l’histoire des médicaments génériques. La présence d’une nouvelle industrie des médicaments génériques encourage les gouvernements à s’engager, en 1971, dans une réforme du système des brevets pharmaceutiques, contemporaine des réformes conduites à la même époque au Brésil et en IndeBased on the analysis of documentary sources from Colombian national archives, documents from pharmaceutical laboratories and the national and international press, this thesis studies the emergence of the pharmaceutical industry and the regulation of the drug market in Colombia during the 20th century between 1914 and 1971. The thesis shows how, during the mentioned period, the State was a fundamental actor regarding the regulation in the quality of pharmacology, promoting industrialization and local pharmaceutical production and increasing access to treatments. The first part of the thesis examines the configuration of a national pharmaceutical market, through the process of transformation of pharmacies into pharmaceutical companies and the emergence of pharmaceuticals as a public health problem that should be regulated. The thesis shows the scope of the private laboratory creation movement since the first decades of the 20th century. It analyzes the creation of a national laboratory for biological and pharmaceutical products with the cooperation of the Rockefeller Foundation in 1926, the Samper Martínez laboratory. This public laboratory became a fundamental tool for pharmaceutical regulation in Colombia. The thesis describes the exchanges between scientific immigrants, international philanthropy, industrialists and the Colombian State that allowed the emergence of a very active local industry.The second part of the thesis analyzes the state policy of the 1940s to strengthen and regulate the pharmaceutical industry in the field of chemistry and biological products. It examines the expropriation policy of German laboratories during the Second World War and the regulation of the controversial biological products of a Spanish company in the context of a state influenced by pharmaceutical interests.The third part of the thesis studies the policy of the Colombian State to create a generic drug market at the beginning of the 1960s, in direct relation to the debate introduced in the United States on drug prices and patent regulation by Senator Estes Kefauver. The compilation of the oral testimony of Dr José Félix Patiño, Minister of Health in that period, as well as the analysis of the public debate in Colombia, provides valuable information on the history of generic drugs. The presence of a new generic drug industry encouraged governments to undertake a reform of the pharmaceutical patent system in 1971, in parallel with reforms carried out at the same time in Brazil and India
A partir del análisis de fuentes documentales provenientes de archivos nacionales colombianos, documentos de laboratorios farmacéuticos y de la prensa nacional e internacional, esta tesis estudia la emergencia de la industria farmacéutica y la regulación del mercado de medicamentos en Colombia durante el siglo XX entre 1914 y 1971. La tesis da cuenta de cómo el Estado se constituyó durante este período como actor fundamental en la regulación de la calidad de los medicamentos en circulación, incentiva la industrialización y la producción farmacéutica local y amplia el acceso a los tratamientos. La primera parte de la tesis examina la configuración de un mercado nacional de medicamentos, a través del proceso de transformación de las farmacias en empresas farmacéuticas y del surgimiento del medicamento como un problema de salud pública que debía ser regulado. La tesis muestra el alcance del movimiento de creación de laboratorios privados desde las primeras décadas del siglo XX y analiza la creación de un laboratorio nacional de productos biológicos y farmacéuticos con la ayuda de la Fundación Rockefeller en 1926, el laboratorio Samper Martínez. Este laboratorio público se convirtió en una herramienta fundamental para la regulación farmacéutica en Colombia. La tesis describe los intercambios entre inmigrantes científicos, filantropía internacional, industriales y el Estado colombiano que permitieron el surgimiento de una industria local muy activa. La segunda parte de la tesis analiza la política estatal de la década de 1940 para fortalecer y regular la industria farmacéutica en el campo de la química farmacéutica y los productos biológicos. Examina la política de expropiación a los laboratorios alemanes durante la segunda guerra mundial y la regulación de los polémicos productos biológicos de una empresa española en el contexto de un estado influenciado por intereses farmacéuticos. La tercera parte de la tesis estudia la política del Estado colombiano para crear un mercado de medicamentos genéricos a principios de la década de 1960, en relación directa con el debate introducido en Estados Unidos sobre los precios de los medicamentos y la regulación de patentes por el senador Estes Kefauver. Gracias a la recopilación del testimonio oral del Dr. José Félix Patiño, Ministro de Salud en ese periodo, así como al análisis del debate público en Colombia, la tesis brinda información valiosa sobre la historia de los medicamentos genéricos. La presencia de una nueva industria de medicamentos genéricos alentó a los gobiernos a emprender una reforma al sistema de patentes farmacéuticas en 1971, en paralelo con las reformas llevadas a cabo al mismo tiempo en Brasil y la India
15
Cardenas, Alexandra Pava. "Educação alimentar e nutricional em nível de atenção primária à saúde em São Paulo e Bogotá: cenário e temáticas." Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/6/6138/tde-17042013-110402/.
Full textAbstract:
Introdução: a Educação Alimentar e Nutricional (EAN) é parte fundamental da promoção da alimentação saudável dentro do conceito de Atenção Primária à Saúde (APS). A priorização das temáticas abordadas nos grupos de EAN guarda correspondência com o modelo dos serviços de APS e as políticas públicas relacionadas. Objetivo: comparar as temáticas, processo de determinação e referencial técnico utilizado nos grupos de EAN do nível da Atenção Primária à Saúde das cidades de São Paulo e Bogotá, levando em consideração a configuração da EAN dentro do cenário das políticas públicas de saúde do Brasil e da Colômbia. Métodos: fez-se revisão documental sobre o contexto dos países e o cenário das políticas de alimentação, APS e Promoção da Saúde (PS), nessas incluindo o propósito, foco, atores e articulação de cada uma com a EAN. Coletaram-se dados em São Paulo e Bogotá por meio de três aproximações: questionário online, entrevista semiestruturada e observação sistemática. Para a observação realizou-se análise da atividade em torno da mensagem identificada por grupo e para a entrevista usou-se a técnica do Discurso do Sujeito Coletivo (DSC). Participaram 54 nutricionistas e observaram-se 41 grupos. Resultados: existe um espaço em potencial para a realização de ações encaminhadas à EAN dentro do cenário das políticas públicas com variação no processo de formulação, enfoque teórico e articulação. As temáticas trabalhadas nos grupos de EAN estiveram em concordância com a estrutura de APS, PS, nível de descentralização, conformação dos grupos e referenciais técnicos. Em São Paulo, a liberdade do profissional permite um alto nível de especificidade no direcionamento dos temas, mas é focado principalmente na doença. Em Bogotá, a decisão sobre os temas é centralizada, porém dirigida especialmente à PS. Considerações finais: a configuração da EAN nos cenários das políticas publicas das duas cidades, influencia as temáticas, o processo da sua determinação e referencial técnico utilizado, incluindo os facilitadores potenciais para o suporte das políticas públicas, entre eles a autonomia dos profissionais, a participação da população e o seguimento do processo dos grupos de EANBackground: Nutrition Education (NE) is a fundamental part of promoting healthy eating within the concept of Primary Health Care (PHC). The prioritization of the themes addressed in EN groups keeps correspondence with the model of PHC services and concerning public policies. Objective: to compare themes, process of obtaining and technical reference used in development EN groups conducted by nutritionists in APS level in São Paulo and Bogotá cities, assuming of EN configuration on public policies context of Brazil and Colombia. Methodology: a literature review was conducted about the country context and policy scenario in relation with food, PHC and Health Promotion (HP), considering the purpose, focus, actors and articulation with EN. Information was collected in São Paulo and Bogotá through three approaches: online questionnaire, semi-structured interview and systematic observation. For analysis was used reported activity around the message from the observation of a group meeting and Collective Subject Discourse (CSD) technique from semistructured interview. Fifty-four interviews and forty-one observations were conducted. Results: there is a potential space for performing actions directed to NE in public policy context, although at different level of formulation, but with increasing recognition by governments. Themes identified were in accordance with structure of PHC, HP, level of decentralization, formation groups and technical reference. In São Paulo, freedom of professional allows a greater level of specificity in addressing content, but focused mainly on the disease. In Bogotá, the decision of topics was centralized, however directed especially to HP. Final comments: the configuration of EAN on public policies context in the two cities, influencing the themes, process of determination and technical reference used, including potential facilitators for the support public policies, for instance professional autonomy, community participation and monitoring of NE groups process
16
Moreno, Luis Ferney. "Regulation for the accomplishment of public purposes: the case of public utilities in Colombia." Pontificia Universidad Católica del Perú, 2016. http://repositorio.pucp.edu.pe/index/handle/123456789/116617.
Full textAbstract:
Since the 1990s, several countries in Latin America liberalized and privatized the public utilities business. As a consequence, there was a transit from the Entrepreneur State to the Regulatory State, the latter being traditionally understood as a model of regulation for competition, with a mayor concern only on economic objectives. Notwithstanding, the socioeconomic reality of Latin American countries, in particular Colombia, presented the fact that competition cannot be the only priority, and that regulation of the public utilities business must also achieve social objectives. Public purposes, understood as economic and social objectives, are the cornerstone of State intervention.Desde los años noventa, ciertos países de América Latina liberalizaron y privatizaron el sector de los servicios públicos. Como consecuencia, se pasó del Estado empresario al Estado regulador, el cual era tradicionalmente entendido como un modelo de regulación para la competencia, centrado principalmente en objetivos económicos. Sin embargo, la realidad socioeconómica de los países de América Latina, en particular Colombia, demuestra que la competencia no es la única prioridad, sino que la regulación en los servicios públicos también debe atender a la consecución de objetivos sociales. Los objetivos públicos son el pilar de la intervención del Estado, entendido esto como objetivos económicos y sociales.
17
Castaño, Echeverri Alejandra. "Media work and public value : producing public service television under state control in Colombia." Thesis, University of Leicester, 2017. http://hdl.handle.net/2381/40039.
Full textAbstract:
This project, based on a study of television producers in Colombia, is an ethnographic exploration of the working conditions of cultural production within a highly contextualized environment such as public service television under state control, using Señal Colombia TV channel as case study. I examine how cultural production is affected by governmental structures and dynamics, whilst exploring the conditions and processes of public service television production, and how television producers experience these processes at an individual level. My primary question is to determine how the production of public service television under state control impacts producers’ practices and perceptions regarding the value and outcomes of their work. In this context, precariousness, autonomy, good work, power and public value have emerged as central areas of constant tension. I link issues regarding cultural work and public value in a media production analysis, obtaining direct empirical data that provides an in-depth description of the current public media production context under state control in Colombia. To explore these intersections, the project brings together interviews, focus groups, and participant observation. The findings exposed that the internal dynamics of both the nation and the organisation significantly affect the concept of public value, making it an ambivalent, uncertain and ill-defined notion. Where governance is state-driven, workers, regardless of their role, subscribe to dominant narratives and discourses that justify their work, and thus contribute to keeping themselves under prescribed creativity. In general, the present study provides a holistic account of cultural work study, focusing on what occurs to cultural work in various contexts of control, and the individual reactions to these contexts. The analysis of cultural work in this context, also broadens current knowledge on the concepts of network sociality and good work under clientelism, and in a non-free-market.
18
Cabrera, Marta Jimena. "Writing civilisation the historical novel in the Colombian national project /." Access electronically, 2004. http://www.library.uow.edu.au/adt-NWU/public/adt-NWU20050307.143257/index.html.
Full text
19
Hincapie, Diana Patricia. "Essays on Education Policy and Student Achievement in Colombia." Thesis, The George Washington University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3617172.
Full textAbstract:
The main objective of this dissertation is to analyze the impact that two notable school reforms have had on student achievement in Colombia. The dissertation consists of three essays. The first essay lays out the conceptual framework for the dissertation. It describes the education production function that underlies most analyses in the economics of education, and reviews the main evidence on the impact of school resource policies on student outcomes.
The second essay analyzes the impact of longer school days on student achievement in Colombia, where primary and secondary students attend schools that have either a complete (7-hour) or a half-day (4-hour) schedule. Using test score data from 5th and 9th graders in 2002, 2005, and 2009, along with school administrative data, this study identifies the effect of longer school days by implementing a school fixed effects model. The main model compares variation in average test scores across cohorts for schools that switched from a complete schedule to a half schedule and vice versa. I find that among schools that switch schedules between 2002 and 2009, the cohorts exposed to complete schedules have test scores that are about one tenth of a standard deviation higher than cohorts that attended half schedules. The impact of a complete schedule is larger for math test scores than for language test scores, and it is larger for 9th grade test scores than for 5th grade test scores. Effects are largest among the poorest schools in the sample, and those in rural areas. The results suggest that lengthening the school day may be an effective policy for increasing student achievement, particularly for the lowest-income students in Colombia and other developing countries.
The third essay analyzes the impact of the "Escuela Nueva" (EN) model (New School) on student achievement, using test score data from SABER 2002 and 2005, a national standardized test administered to 5th and 9th graders in Colombia. EN is an educational model originally designed to improve the effectiveness of rural schools. It is characterized by multigrade classrooms (i.e., one instructor teaches students in various grades in the same classroom), a child-centered curriculum, flexible systems of grading and promotion, intensive teacher training, and parental involvement. To mitigate the concerns about systematic selection of schools into EN that might bias the estimations of the EN impact, this study implements a school fixed effects model that controls for time-invariant characteristics within the school. Results show that among schools that switched models between 2002 and 2005, the cohorts of 5th grade students exposed to EN have on average 0.135 of a standard deviation higher language test scores than cohorts exposed to other models, while there is no statistically significant impact on switching to EN for 9th graders. The impact of EN is largest among rural schools and the poorest schools in the sample.
20
De, Costa Ravindra Noel John, and decosta@mcmaster ca. "New relationships, old certainties : Australia's reconciliation and treaty-making in British Colombia." Swinburne University of Technology, 2002. http://adt.lib.swin.edu.au./public/adt-VSWT20050627.092937.
Full textAbstract:
This thesis investigates the search for new relationships between indigenous and settler peoples in Australia and Canada. Both reconciliation and the treaty-making process in British Columbia are understood as attempts to build such relationships. Yetthese are policies that have arisen in response to the persistence of indigenous claims for recognition of rights and respect for identity. Consequently, I consider what the purpose of new relationships might be: is the creation of new relationships to be the means by which settlers recognise and respect indigenous rights and identities, or is
there some other goal? To answer this, I analyse the two policies as the opening of negotiations over indigenous claims for recognition. That is, the opening of new political spaces in which indigenous people�s voices and claims may be heard. Reconciliation opened a space to rethink Australian attitudes to history and culture, to renegotiate Australian identity. Treaties in British Columbia primarily seek to renegotiate ownership and control of lands and resources. Both policies attempt to relegitimise the polities in which they operate, by making new relationships that provide for mutual recognition. However, the thesis establishes that these new spaces are not nearly as expansive or inclusive as they are made out to be. They are in fact defined by the internal struggles of settler society to make life more certain: to resume identities that are secure and satisfying, and to restore territorial control and economic security. This takes place with little regard for the legitimate claims of indigenous peoples to be recognised as people and to enjoy dynamic, flourishing identities of their own. Building new relationships becomes the path to entrenching old certainties.
21
Forde, I. "Impacts of a conditional cash transfer scheme on health in Colombia." Thesis, University College London (University of London), 2012. http://discovery.ucl.ac.uk/1356888/.
Full textAbstract:
Conditional cash transfer schemes (CCTS) are increasingly popular interventions aiming to improve the welfare of the worst off: Families receive regular cash as long as they comply with behavioral conditions concerning uptake of preventive healthcare and schooling. Literature Review, however, finds that associated health impacts are often small or inconsistent and are occasionally adverse. The aim of this thesis is to advance understanding of the impact of CCTS on health and on health equity. It does this by examining the effect of Familias, the Colombian scheme, on outcomes little discussed in the literature, namely rates of obesity in women and in children (an unintended outcome), and women’s healthcare knowledge. It sets findings within a conceptual framework that sees health as being co-produced between individuals and society. Co-production requires investment in individuals’ human capital, material resources and creation of fairer socioeconomic environments, somewhat resembling the underpinning philosophy and structure of CCTS. Multiple regression on a range of individual, household and community level covariates using an intention-to-treat protocol on prospectively collected data with matched controls finds that Familias is associated with increased odds of obesity in women (O.R.=1.41, 95% C.I. 1.09, 1.82; p=0.01) and odds of overweight or obesity in girls aged 2-7 at baseline (O.R.=2.13, 95% C.I. 1.23, 3.69; p<0.01). Furthermore, Familias fails to improve healthcare knowledge, a marker of human capital, in women despite being a core objective of the programme (logit coefficient= -0.20, 95% C.I. -0.41, 0.01; p=0.06). Given these negative findings, a number of policy recommendations are made emphasising the importance of social determinants of health: balancing imposition of behavioural requirements with the realisation of rights to high-quality public services, considering the potential for universalising aspects of the schemes and exploring a greater role for the health sector in CCTS design, operation and evaluation.
22
Lloreda, Francisco. "Public Policies for Reducing Violence, with particular reference to Youth Violence in Colombia." Thesis, University of Oxford, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.519786.
Full text
23
Heeb, Alexis. "Violent crime, public perceptions and citizen security strategies in Colombia during the 1990s." Thesis, University of Oxford, 2002. http://ora.ox.ac.uk/objects/uuid:9aa285b1-15e6-402f-a4e8-2f7322c9adc3.
Full textAbstract:
This research deals with the topic of violent crime in urban Colombia. Although many references are made to the conflict between the State, guerrilla groups and paramilitary organisations in rural areas, and to the problem of drug-cartels and illegal-drug production, the main aim of the thesis is to show recent trends in violent crime and discuss citizen security strategies followed during the decade of the 1990s. Chapter 1 focuses on urban homicides. In Colombia, 40 percent of the 25,000 annual homicides are committed in the ten largest cities. The cities of Medellin, Bogota and Cali account for almost 30 percent of this total. Although the victims are mainly young men from the poorest socio-economic levels, homicides are not necessarily correlated to the areas where the poor live. The probability of getting involved in a homicide, either as a victim or as victimiser, is significantly higher in places where access to economic resources is greater. Chapter 2 analyses the problem of kidnappings. The chapter looks at recent progresses in Colombian anti-kidnapping legislation and focuses on the authors, the victims and the riskzones where most cases take place. Although these crimes affect mainly the rich and the middle class, kidnappers have recently started to target victims from all social backgrounds. This strategy creates fear among citizens and permits kidnappers to extort more fees from people who could be at risk of being kidnapped. Chapter 3 looks at the issue of perception and fear of crime. This question provides a better understanding of the concept of risk and the subjectivity of decision-making when facing insecurity. If citizen security strategies have had little impact during the last decade, it has been partly because of poor levels of co-operation and communication with the population. The consequence of this has been an increasing perception of insecurity and distrust among citizens. Chapter 4 assesses citizen security strategies followed during the administrations of Presidents Gaviria (1990-1994), Samper (1994-1998) and Pastrana (1998-2002). The reforms implemented since the adoption of a new Constitution in 1991 have had important impacts on security strategies as they have given more discretionary powers to civilian authorities, especially at the municipal level. Larger cities like Bogotá, Cali and Medellin, implemented a series of successful programmes that have reduced the levels of violent crime, notably homicides. Other crimes, like kidnappings, have not decreased since the government has lacked a coherent strategy to combine its peace negotiations with insurgent organisations with its legitimate right to fight violent crime.
24
Montoya, Benítez Andrés. "A proposal for universal access to basic telecommunications services in Colombia." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape9/PQDD_0022/MQ50951.pdf.
Full text
25
Santiago, Denise L. "Assessment of public health infrastructure to determine public health preparedness." Thesis, Monterey, Calif. : Springfield, Va. : Naval Postgraduate School ; Available from National Technical Information Service, 2006. http://library.nps.navy.mil/uhtbin/hyperion/06Mar%5FSantiago.pdf.
Full textAbstract:
Thesis (M.A. in Security Studies (Homeland Security and Defense))--Naval Postgraduate School, March 2006.Thesis Advisor(s): Anke Richter. "March 2006." Includes bibliographical references (p. 75-81). Also available online.
26
Salazar, Ligia de. "Assessment of health students performance by the community using perceived quality of care model." Thesis, McGill University, 1996. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=40337.
Full textAbstract:
The trend in medical education and in general, among health professionals, is based, on the current changes of health systems aimed to improve relevance equity, and cost effectiveness of health care. With respect to human health resources, there is lack of agreement among the competence level, performance and the needs of both the system using them and the target population. Therefore, it is important and necessary to consider both the community and health services as partners in the task of defining these changes and in the provision of health services to meet the above mentioned criteria.The main purpose of this partnership is to encourage efforts to promote, oversee, and apply the actions in each one of the instances in order to improve training of human resource, strengthen local health systems, and empower the communities. Human resource competence and performance, the capacity to provide services, and the degree of community participation and commitement to health, are key elements in improving service quality.
The philosophy of current curricula reform at the Valle University stresses the partnership relationship between academic institutions, services centers, and the community, in the training of health professionals. The proposed investigation focuses on the community-based training aspect of student performance assessment and its relation to the health care system and academia. Specifically, the study will focus on designing valid and reliable instruments for community assessment of student performance, using both qualitative and quantitative aspects of data collection and analysis to assess "patient satisfaction" as an indicator of quality of care.
The results of this study demonstrate that the proposed assessment activity will allow the educational and health services institutions to have relevant and dynamic information as feedback for planning and adjustment of their programs. At the same time, it will allow the community to participate in an effective way in aspects related to their health care. The results of this study will be used as a basis for producing guidelines for involving communities (users) in the health care students evaluation process.
27
Gonzalez-Rossetti, Alejandra. "The political dimension of health reform : the case of Mexico and Colombia." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2001. http://researchonline.lshtm.ac.uk/834547/.
Full textAbstract:
This thesis analyses the state's capacity to pursue health reform. It argues that the feasibility of health reforms, as well as their final content, are in great part determined by their political context, and the political strategies reformers resort to when pursuing their policy agenda. The analysis is framed in the political context in which a reform initiative evolves, the political dynamics of and around the health reform process, and the characteristics and strategies of the teams in charge of leading policy change (change teams). The research aims to contribute to existing knowledge in the health policy field by furthering the analysis and explanation of the political feasibility of health reforms. A two case study comparative analysis is used based on primary and secondary sources and in-country interviewing. Colombia and Mexico, challenged by the need to attain universal coverage, and faced with large inefficiencies, set about to transform their health systems in the 1990's. While Colombia was successful in passing legislation and initiating implementation, Mexico made a series of similar attempts, but its reform was brought to a near halt. The analysis of these contrasting outcomes given the similar choice of political strategies in comparable political contexts, allows for a greater understanding of the factors at play. Key findings demonstrate the relevance of the political context in determining the potential of interested actors within and outside the state, to influence health reforms. The study also reveals the remarkable resemblance between the political strategies used by health reform teams, and those used by economic adjustment teams in the 1980's. While these strategies enabled the latter to introduce major policy change, they helped health reform teams only partially. As a result, health reformers were successful in enabling the creation of new private health financing and provider organisations, but the transformation of the old public health service institutions remains a challenge.
28
Odhiambo, Joseph A., Hywel C. Williams, Tadd O. Clayton, Colin F. Robertson, M. Innes Asher, Pascual Chiarella, and ISAAC Phase Three Study Group. "Global variations in prevalence of eczema symptoms in children from ISAAC Phase Three." Mosby Inc, 2009. http://hdl.handle.net/10757/625751.
Full textAbstract:
El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.Background: In 1999, The International Study of Asthma and Allergies in Childhood (ISAAC) Phase One reported the prevalence of eczema symptoms in 715,033 children from 154 centers in 56 countries by using standardized epidemiologic tools. Objective: To update the world map of eczema prevalence after 5 to 10 years (ISAAC Phase Three) and include additional data from over 100 new centers. Methods: Cross-sectional surveys using the ISAAC questionnaire on eczema symptoms were completed by adolescents 13 to 14 years old and by parents of children 6 to 7 years old. Current eczema was defined as an itchy flexural rash in the past 12 months and was considered severe eczema if associated with 1 or more nights per week of sleep disturbance. Results: For the age group 6 to 7 years, data on 385,853 participants from 143 centers in 60 countries showed that the prevalence of current eczema ranged from 0.9% in India to 22.5% in Ecuador, with new data showing high values in Asia and Latin America. For the age group 13 to 14 years, data on 663,256 participants from 230 centers in 96 countries showed prevalence values ranging from 0.2% in China to 24.6% in Columbia with the highest values in Africa and Latin America. Current eczema was lower for boys than girls (odds ratio, 0.94 and 0.72 at ages 6 to 7 years and 13 to 14 years, respectively). Conclusion:ISAAC Phase Three provides comprehensive global data on the prevalence of eczema symptoms that is essential for public health planning. New data reveal that eczema is a disease of developing as well as developed countries.
Revisión por pares
29
Bührer, Sabine. "Public Health im Wandel : eine vergleichende Bestandsaufnahme dreier Schools of Public Health /." Konstanz, 2004. http://www.public-health-edu.ch/new/Abstracts/BS_07.03.05.pdf.
Full text
30
Osorio, Mejía Ana María. "Socioeconomic determinants of early childhood health in Colombia: exploring the role of context." Doctoral thesis, Universitat de Barcelona, 2013. http://hdl.handle.net/10803/117064.
Full textAbstract:
The overall aim of this thesis is to contribute to an understanding of the pathways through which structural and intermediary determinants influence child health in Colombia and how they operate through the context where children live in a more comprehensive way than has been determined to date.
Colombia has made significant progress in child health in the last few decades and it is currently on track to meet the Millennium Development Goals (MDG). Nearly 90% of the goals on global malnutrition, infant mortality rate and under-five mortality rate have been achieved. However, despite the progress, national averages remain masking huge territorial disparities. While some regions present figures similar to those of a developed country, others report indicators similar to those of a very poor African country. Some municipalities, for example, record no stunted children, whereas in others, the prevalence of chronic malnutrition is greater than 50%. In this context, empirical research that enhances our understanding of socioeconomic determinants of child health and guide policy-making is crucial in order to reduce place-based health inequities in Colombia.
This thesis is based on three research articles. The data used in these studies are drawn from the 2010 Colombian Demographic and Health Survey (DHS). The DHS is a large survey programme designed to collect high-quality nationally representative data on population, health and nutrition for developing countries. The DHS are widely recognised as the most important source of information for the analysis of health inequities in the developing world.
Firstly, intermediary determinants of early childhood health have been analysed through the construction of a composite index (Chapter 3). The intermediary determinants are the most immediate mechanisms through which socioeconomic position influence child health inequities. Therefore, their identification should contribute to the drafting of intervention policies at this level, given the importance of these factors in programmes aimed at improving maternal and child care. The index allowed us to identify key immediate determinants of child health and their relative importance among Colombian departments (administrative subdivisions). The index was constructed using a more sophisticated methodological approach than that commonly used in the literature, termed polychoric principal component analysis (PCA). A hierarchical cluster analysis was also carried out in order to identify how departments cluster based on the health of their children rather than their geographic proximity. The results showed that the largest differences in intermediary determinants of child health are associated with health care before and during delivery. Furthermore, the departments that perform relatively better in the most immediate determinants of child health are located in the centre of the country. In contrast, those departments that perform worse are located in the peripheral region. This region has a per capita gross domestic product (GDP) well below the national average, little state presence, a hostile environment and a large proportion of the ethnic minorities. Our index provides very useful information in terms of public policy since it facilitates measuring, visualizing and monitoring of child health indicators, and may, therefore, help identify potential intervention strategies for improving the well-being of Colombian children.
Secondly, this thesis examines the effect of individual, family and community socioeconomic conditions on different indices representing intermediary determinants of child health, using a coherent conceptual framework (Chapter 4). Using a weighted multilevel approach, the results indicate that whilst community socioeconomic context can exert a greater influence on factors linked directly to health, in the case of psychosocial factors and parent’s behaviours, the family context can be more important. In addition, the results indicate that a significant percentage of the variability in the overall index of intermediary determinants of child health is explained by the community context, even after controlling for individual, family and community characteristics. This study provides evidence that community socioeconomic context is a key component for improving child health in Colombia. However, the role played by context may vary according to the category of the intermediary determinants of child health analysed, highlighting the importance of distinguishing between community and family intervention programmes.
Thirdly, the influence of education of other women in the community and family socioeconomic characteristics on child nutrition outcomes, as well as their interactions, was investigated (Chapter 5). The contextual effects of education on child health were studied using weighted multilevel models. This study takes into account important methodological issues such as sample weights and second level endogeneity in multilevel modelling, which have not been addressed in the empirical literature and can lead to biases in the estimates. Different ways through which community education can substitute for the effect of family characteristics on child nutrition were found, suggesting that child care programmes should focus not only on individuals but should also target the broader context of communities. In particular, those communities with less educated mothers and with low female autonomy are those that could benefit more from intervention policies that focus on encouraging female education.
To conclude, previous studies on the social determinants of child health in Colombia are limited. Most of them have covered the issue from the perspective of the individual and little attention has been paid to the effect of context. In this vein, understanding the structural and intermediary determinants of child health inequities, as well as the role played by community socioeconomic context, is essential for the design, monitoring and tracking of public child care policies in Colombia.El objetivo de esta tesis es contribuir a un entendimiento de los mecanismos a través de los cuales los determinantes estructurales e intermediarios de la salud influencian la salud de los niños en Colombia y como estos operan a través del contexto donde los niños viven, de una manera más completa que la que se ha hecho hasta ahora. Esta tesis se base en tres artículos de investigación. Los datos usados en estos estudios son de la “Demographic and Health Survey” (DHS) para Colombia en el año 2010. En primer lugar, los determinantes intermediarios de salud infantil se analizan a través de un indicador compuesto. El indicador permite identificar determinantes intermediarios claves de salud infantil y su importancia relativa entre departamentos colombianos. En segundo lugar, esta tesis examina el efecto de las condiciones socioeconómicas de la comunidad, la familia y los individuos sobre diferentes índices que representan determinantes intermediarios de salud infantil. Por último, se analiza la influencia de la educación de otras mujeres en la comunidad y de características socioeconómicas de las familias sobre la nutrición infantil, así como sus interacciones. Se utilizan diferentes enfoques metodológicos. Para la construcción de los indicadores compuestos se utiliza un análisis de componentes principales usando correlaciones policóricas, con el fin de analizar cómo se agrupan los departamentos de acuerdo a la salud de sus niños se hace un análisis de cluster jerarquico. Finalmente, con el fin de medir efectos contextuales se utilizan modelos multinivel de regresión lineal ponderados. Los resultados de esta tesis demuestran que el contexto de la comunidad es un componente clave en la determinación de determinantes intermediarios de salud infantil, así como de indicadores de nutrición de los niños, tanto en el mediano como en el largo plazo en Colombia. Por lo tanto, es necesario que los gobiernos municipales y departamentales involucren no sólo a los individuos, sino que también tengan en cuenta el contexto de las comunidades para el desarrollo, ejecución, monitoreo y evaluación de las políticas de cuidado infantil.
31
Molina, Gloria. "An examination of the process of decentralisation of the health sector in Colombia." Thesis, University of Birmingham, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.397426.
Full text
32
Dalén, Annika. "Communicating abortion. How sexual and reproductive rights organizations in Colombia communicate to the public opinion." Thesis, Malmö högskola, Fakulteten för kultur och samhälle (KS), 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-23374.
Full textAbstract:
This degree project examines the question of how Colombian NGOs communicate sexual and reproductive rights issues to the public opinion, and how this has changed over time. The research is carried out through a case study of two Colombian organizations that work with sexual and reproductive rights, particularly the implementation of legal abortion.The analysis parts from a gender perspective, understanding gender as a constitutive element of social relationships as well as a primary way of signifying relationships of power.One of the main findings in the study is that the historical point of departure for this research, the LAICIA campaign that accompanied the strategic litigation that led to the partial legalization of abortion in Colombia in 2006, represents a paradigm shift in how communications were managed by civil society organizations in Colombia. Today, communications is seen as a strategic tool to help obtain a certain objective, and mobilize public opinion support, rather than as a way of convincing opponents to change their positions. LAICIA also changed the terms of the debate, introducing new parameters lifting out the issue from the traditional private sphere – delimited to a moral and religious issue, and into the public sphere, as an issue of general concern for society – not just for individual women.Today, however, much of the communication efforts are directed at impeding backlashes rather than advancing positions, and communicating reactively rather than proactively. The two organizations studied have some convergences in their work with communications, in spite of certain ideological differences, and the impact of their communication efforts could be reinforced if these were coordinated to a greater extent between organizations.
33
Faust, Linda A. "AIDS Public health implications /." Instructions for remote access. Click here to access this electronic resource. Access available to Kutztown University faculty, staff, and students only, 1991. http://www.kutztown.edu/library/services/remote_access.asp.
Full textAbstract:
Thesis (M.P.A.)--Kutztown University of Pennsylvania, 1991.Source: Masters Abstracts International, Volume: 45-06, page: 2940. Abstract precedes thesis as [2] preliminary leaves. Typescript. Includes bibliographical references (leaves 94-100).
34
Emmelin, Maria. "Self-rated health in public health evaluation." Doctoral thesis, Umeå : Univ, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-226.
Full text
35
Panopoulou, Panagiota. "Health insurance and the use of health care services : the case of Colombia after the reform of 1993." Thesis, University of Sussex, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.368450.
Full text
36
Aristizabal, Gilberto. "The utilization of health care services in a regional health unit of Cauca Valley, Colombia : a behavioral model /." The Ohio State University, 1988. http://rave.ohiolink.edu/etdc/view?acc_num=osu1487596307357324.
Full text
37
Fernandez, Juan Gabriel. "Three essays on competition and health insurance markets." Thesis, Boston University, 2012. https://hdl.handle.net/2144/31552.
Full textAbstract:
Thesis (Ph.D.)--Boston UniversityPLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.
Health care systems are complex organizations. Multiple agents interact in different settings to provide health care, each one of them with different objectives and information. How markets are organized and which actions are allowed, has a direct impact on the incentives agents face when making health care choices. In this dissertation, I study the determinants and effects of these choices on market outcomes, focusing on private health insurance markets. The first chapter provides insights about health insurance markets in which workers, rather than firms , choose insurance plans in an imperfect competition setting. Using a unique dataset that includes every person enrolled in private plans in Chile in 2009, I estimate underlying preference parameters over health insurance features. I find large heterogeneity in the valuation of t hese features across age-sex-groups and individual types. Individual characteristics play an important role on health plan choices and therefore, can be used by insurers to design plans targeted to specific groups and for patient selection. The second chapter presents a theoretical model where private insurers compete with a free public alternative to attract clients. Using a two-type model I show that if private insurance companies offer a non-rationing alternative and the public system rationing is done through random selection, an efficiency trap may exist. A marginal increase in the budget allocated to the public system can potentially reduce the expected welfare for all types. This result extends to a model with multiple types, but the negative welfare impact is offset by a crowding-in effect among the rich. Finally, the third chapter provides a general analytical framework that can be used to evaluate risk selection under different health care models. The model is based on the interactions between the four key agents present in every health care system: sponsors, health plans, providers and customers. This framework is used to review risk selection in four countries in the Americas - Canada, Chile, Colombia, and the U.S.-, showing how regulatory policies both create and ameliorate it, and in some cases are as important as risk adjustment, risk sharing and risk selection strategies for reducing risk selection.
2031-01-01
38
Jaramillo, Betancur Ernesto. "Evaluation of a mass media health education campaign for tuberculosis control in Cali, Colombia." Thesis, University College London (University of London), 1998. http://discovery.ucl.ac.uk/10021866/.
Full textAbstract:
Tuberculosis is a world-wide problem in less developed countries. In this thesis I report the evaluation of impact, process and objectives of a mass media health education campaign for tuberculosis control developed in Cali, Colombia. The campaign aimed at reducing levels of prejudice against people with this disease and at increasing demand for diagnostic tests. I assessed impact on levels of prejudice using two cross sectional surveys as sources of data. I assessed impact on demand for diagnostic tests with a quasi-experimental evaluation design relying on epidemiological data. I used qualitative and quantitative techniques for assessing the process of the campaign. I used text analysis for assessing the objectives of the campaign, and for identifying the values underpinning these objectives. The results show that the campaign significantly reduced the prejudice, and increased the demand for tests. Process evaluation shows that the campaign managers applied satisfactorily the programme theory of the intervention, that around half of the population was exposed to the campaign, and that it aimed exclusively at reinforcing a medical approach to tuberculosis control, which promoted compliance with medical surveillance, instead of contributing to the creation of an educated public regarding this disease. Assessment of objectives showed that the values underpinning the campaign are Utilitarian which define the worth of human life in terms of its economic productivity. This thesis demonstrates that current evaluation models of health education, which draw only on impact and process, are inappropriate for all those who have an interest at stake in the programme in order to judge its worth and to take policy decisions. Health education programmes are responses to social problems based on a specific idea of what is worthwhile to be pursued by individuals and society. Thus, evaluation research in health education should include not only assessment of impact and process but also assessment of their objectives in order to unveil the values underpinning such responses.
39
Mosquera, Méndez Paola Andrea. "Evaluation of a primary health care strategy implemented in a market-oriented health system : the case of Bogota, Colombia." Doctoral thesis, Umeå universitet, Epidemiologi och global hälsa, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-86996.
Full textAbstract:
Introduction: Despite Colombia having adopted a health system based on an insurance market, Bogota in 2004, as part of a left-wing government (elected for first time in the city), decided to implement a Primary Health Care (PHC) strategy to improve quality of life, level of population health and reduce health inequities. The PHC strategy has been implemented through the HomeHealth program by three consecutive governments over the last eight years in the context of continuous political tension stemming from differences between national and district health policies. This thesis is an attempt to provide a better understanding of the overall experience of implementing a PHC strategy in the context of a market-oriented health care system. The research aimed to evaluate results of the PHC strategy through the intervention of the Home Health program and to identify factors that have enabled or limited the on-going PHC implementation process in Bogota. Methods: This study used a combination of quantitative and qualitative methods. A descriptive analysis was performed to assess direct results of the PHC strategy in terms of progress in the Home Health program coverage and increases in health personnel ratios reaching out to poor and vulnerable groups in Bogota. A cross sectional analysis was carried out to evaluate qualities of the delivery of PHC services through the attainment of PHC essential dimensions in the network of first-level public health care facilities. An ecological analysis was performed to estimate the contribution of the PHC strategy, through the Home Health program, to improve child health outcomes and to reduce health inequalities. A qualitative multiple case study was conducted to identify contextual factors that have enabled or limited the on-going PHC implementation process in Bogota. Results: The descriptive analysis showed a notable initial increase and rapid expansion in the development of the PHC strategy between 2004 and 2007, followed by a period of slower growth and stagnation between 2007 and 2010. The cross-sectional analysis suggested that the Home Health program could be helping to improve the performance of first-level public health care facilities. Ratings assigned to PHC dimensions by different participants pointed out the need to strengthen family focus, community orientation, financial resources distribution, and accessibility. The ecological analysis showed that localities with high PHC coverage had a lower risk of under-five mortality, infant mortality and acute malnutrition as well as a higher probability of being vaccinated than low PHC coverage localities. The belonging to a high-coverage locality was significantly associated with risk reductions of under-five mortality (13.8%) and infant mortality by pneumonia (37.5%) as well as increases in the probability of being vaccinated for DPT (4.9%). Concentration curves and concentration indices indicated inequality reductions in all child indicators betwen 2003 and 2007. In 2007 (period after implementation), the PHC strategy was associated with a reduction in the effect of the inequality that affected disadvantaged localities in under-five mortality (24%), infant mortality rate (19%), acute malnutrition (7%) and DPT vaccination coverage (20%). The main facilitators of the results achieved so far by the PHC strategy were all related to the commitment and good will of actors at different levels. Longterm political commitment, support by local mayors and hospital managers, organized communities historically active in the process of social participation, as well as extramural work carried out by community health workers and health care teams were highly valued. Barriers to the implementation included the structure of the national health system itself, lack of a stable funding source, unsatisfactory working conditions, lack of competencies among health workers regarding family focus and community orientation, and limited involvement of institutions outside the health sector in generating intersectoral responses and promoting community participation. Conclusion: Despite adverse contextual conditions and limitations imposed by the Colombian health system itself, Bogota’s initiative of a PHC strategy has helped to improve the performance of first-level public health care facilities in the essential dimensions of PHC and has also contributed to improvement of child health outcomes and reduction of health inequalities associated with socioeconomic and living conditions. Significant efforts are required to overcome the market approach of the national health system. Structural changes to social policies at the national and district level are needed if the PHC strategy is expected to achieve its full potential. Specific interventions must be designed to have well-trained and motivated human resources, as well as to establish available and stable financial resources for the PHC strategy.
40
Chavarro, Alvarez Marcela. "Formalizing Street Vendors in Bogotá, Colombia: The Network of Provision Services to Public Space Users (REDEP)." Thesis, Stockholms universitet, Kulturgeografiska institutionen, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-113519.
Full textAbstract:
This thesis aims to describe in depth the Network of Provision Services to Public Space Users (REDEP), which is a new formalization program for street vendors in Bogota. The development of this study contributes to the research about street vending policies in Bogota, which have been studied little by the academy. To achieve a depth description of this program, this study approached three important aspects of the REDEP: the rationale behind its creation, its legitimation and its outcomes. In order to do this, this thesis has used Foucault’s concept of Discipline and the policy approach Aestheticization of Poverty described by Roy. In addition, Bogota’s street vending policies between 1990 and 2005 has been analyzed. Finally, 22 vendors working in REDEP’s kiosks and two officials working in REDEP’s management were interviewed. This thesis concludes that the creation of the REDEP has as main cause the negative perception of peddlers as threatening population to development of the Bogota as a “democratic” and ”equalitarian” city. Like other formalization initiatives, the program has aimed to formalize and discipline street vendors through the construction of kiosks and points of sale. REDEP’s outcomes according to vendor’s perceptions have not been completely positive in aspects like sales, working conditions and levels of participation.
41
Heimburg, Dina von. "Public health and health promotion: a salutogenic approach." Thesis, Norges teknisk-naturvitenskapelige universitet, Institutt for sosialt arbeid og helsevitenskap, 2010. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-12094.
Full text
42
Shah, Rebecca Sonul. "Global health inequality : Justice and public health ethics." Thesis, Keele University, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.535801.
Full textAbstract:
This thesis is motivated by the intuition that current extremes of global health inequality and deprivation constitute moral problems of the utmost importance. It aims to advance our understanding of how we should think about and be morally guided in our responses to global health inequality by engaging critically with literature and arguments at the intersection of global health, public health and social justice. Part I addresses the more conceptual question of how we should think about global health inequality. I suggest that we reject international empirical, operational and normative accounts of global health inequality in favour of genuinely global approaches. I suggest five core features of public health practice and ask whether they are meaningful at the global level. I find no argument for why the features of public health may not relate to the global sphere convincing and therefore tentatively conclude that we might think of global health inequality as a matter of public health. Part II addresses the more normative question of how we should be morally guided in our responses to global health inequality. Through engagement with the public health ethics literature I propose two roles for justice as a core public health value. First, justice may be an ethical principle guiding how public health is practiced, and second justice may provide the normative justification for why public health is practiced. I identify existing accounts of public health ethics and theories of justice reflecting these twin justice roles and evaluate how well they can morally guide our responses to global health inequality. I conclude by suggesting that public health may be a social institution governed by the principles ofjustice at the global level and that public health may be a human right which should be globally fulfilled as requirement of justice.
43
Bunten, A. "The application of health psychology to public health." Thesis, City, University of London, 2017. http://openaccess.city.ac.uk/20309/.
Full textAbstract:
Background: There is strong evidence linking obesity to health issues and long term conditions such as high blood pressure, type II diabetes, heart disease and some cancers (NICE, 2006). Despite this growing evidence base, the prevalence of obesity continues to rise and rates have more than doubled in England in the last 25 years (Public Health England, 2014). Currently 26% of adults are obese (Health Survey for England, 2014), and the proportion of women that are classified as overweight and obese has risen to 57% (Health Survey for England, 2014). Weight loss can reduce the risk of an individual developing these conditions and can increase their healthy life expectancy. It is estimated that approximately one in every two adults in England are actively trying to lose weight, the majority of which are over-weight or obese women (Piernas, Aveyard and Jebb, 2016). This indicates that over-weight and obese women are motivated to lose weight but are struggling to achieve or maintain a healthy weight. To-date potentially effective weight management interventions have been identified as long term multi-component interventions including diet and exercise components along with behavioural strategies. However, weight changes have been small and weight regain has been found to be very common (Loveman, Frampton, Shepherd, Picot, Cooper et al, 2011; Dombrowski, Knittle, Avenell, Araújo-Soare & Sniehotta, 2014). Despite the primary focus on weight loss being to improve health, research suggest that people’s prime motivation to lose weight is unrelated to health (Piernas, Aveyard and Jebb, 2016). Aim: This study aims to improve the understanding of the challenge of achieving and maintaining a healthy weight in overweight and obese young women. In particular, it aims to i) better understand the barriers and facilitators to achieving and maintaining a healthy weight as experienced by these young women, ii) further understand the relationships and influences of these factors, to iii) inform and develop a new theoretical framework in which to capture this social phenomena and societal challenge. Recruitment: This study recruited 14 female participants aged 18- 35 years, with a BMI over 30 (or 28 with co-morbidity), actively seeking support to lose weight. Participants were recruited through purposive sampling in two primary care practices in East London as part of the ‘Peer Support Weight Action Programme’ (SWAP). This was a Randomised Controlled Trial run by Barts Health NHS Trust and Queen Mary’s School of Medicine and Dentistry, funded by the National Institute for Health Research, Health Technology Assessment fund. Design: The research is qualitative in design utilising in-depth semi-structured interviews. Interviews took place with women recruited to take part in a weight loss programme before commencing the intervention, and follow up interviews took place approximately six months after completion of the weight management programme. Grounded Theory Analysis was used to analyse the data. Results and Findings: An overarching theoretical framework is presented from the findings of the data analysis of the pre and post weight loss attempt interviews. A new ‘Emotion and Mindset’ model is presented to explain the challenge of achieving and maintaining a healthier weight in young women. It includes the core categories of sense of self, emotion and mindset, self-efficacy, and stress and conflicting priorities and has been theoretically framed around the concept of Finding the Health Enhancing Equilibrium - maintaining a positive sense of self whilst generating action to achieve and maintain a healthy weight. It describes the balancing act required between these key contributing elements to engage in positive health behaviour which contributes to achieving and maintaining a healthy weight. Recommendations: Based on the findings from this study, and supported by previous findings (Cochrane, 2008), weight management interventions targeting young women need to build in coping strategies to support individuals cognitively, behaviourally and emotionally. These should include building self-efficacy (NOO, 2011; Ashford, Edmunds, French, 2010), sense of self and re-aligning identity (West & Brown, 2013). Individuals need to be taught how to identify, address and re-orient dysfunctional thoughts, to identify potential stressors such as triggers and environmental cues to prevent relapse. Consideration needs to be given to weight loss maintenance and ongoing tailored support. Further research is needed to identify what type and method of support is most effective and for whom.
44
Wallace, Maria. "Public Health Nurses’ Perceptions of High School Dropout Rates as a Public Health Issue." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7766.
Full textAbstract:
Education is one of the strongest predictors of health, and well-being. Early termination of education can lead to poorer health, shorter lifespans, and increased stress on the healthcare system. Improving overall high school graduation rates has been debated and discussed by the Toronto District School Board (TDSB) and the Ministry of Education, however, there is a paucity of research on increased graduation rates as they relate to public health in the Canadian context. The purpose of this phenomenological qualitative study was to explore the perceptions of liaison public health nurses (PHNs) who worked directly with the TDSB regarding their roles in terms of influencing students in Toronto, Ontario to complete high school. Bronfenbrenner’s ecological model was the underlying conceptual framework for the study.Purposive sampling was used to select 10 PHNs who were interviewed regarding their role and involvement in high schools. The data was subjected to triangulation and analyzed to identify commonalities, trends and patterns. Findings from this study indicated that liaison PHNs believe that high school dropout rates are a public health issue and collaboration between the Ministry of Education and Public Health is needed to take action. Recommendations include more Canadian research that explores connections between health and school achievements and the expanded role of PHNs in Canadian high schools. Social change implications for this research include highlighting high school dropout rates as a public health concern in Canadian schools, particularly in communities of lower socioeconomic status. With increased research and resources, the Toronto public health system may work toward making improving graduation rates among their core mandate.
45
Bosworth, Ryan Cole. "Demand for public health policies /." view abstract or download file of text, 2006. http://proquest.umi.com/pqdweb?index=0&did=1192186841&SrchMode=1&sid=1&Fmt=2&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1176749188&clientId=11238.
Full textAbstract:
Thesis (Ph. D.)--University of Oregon, 2006.Typescript. Includes vita and abstract. Includes bibliographical references (leaves 127-130). Also available for download via the World Wide Web; free to University of Oregon users.
46
Petersen, J. "Social marketing and public health." Thesis, University College London (University of London), 2009. http://discovery.ucl.ac.uk/18925/.
Full textAbstract:
The public health field exists to safeguard the general public from health risks by controlling risk factors, classically through immunization programmes that prevent or control epidemics, or through actions such as monitoring the quality of drinking water. In our post-industrialised society, risk factors other than the environment, such as diet, exercise, tobacco and alcohol use, have grown in importance. The policy response to the growing demand upon healthcare services arising from chronic diseases caused by changing lifestyle factors has taking different forms, and these include targeting vulnerable groups using health promoting campaigns. This thesis addresses some of the challenges and opportunities in public health campaigns and healthcare planning that arise from the growing repositories of data that can be made available for targeting at the individual and small area level in a public health setting. The first part sets the scene by describing the concepts of health, public health and social marketing. The intention is to pave the way for broader discussions – in the progress of the thesis – about healthcare planning, population health, and social processes in the light of targeted public health interventions. Part two addresses the problems and possible solutions to a number issues in healthcare planning, starting with studies at the individual, then moving to organisations and ending with area classifications. The thesis draws on a number of case studies for targeting in a public health context including frequent accident and emergency users, teenage users of abortion services, women’s breast screening uptake, GP registration, and the neighbourhood characteristics of chronic disease patients. Finally, part three provides a synopsis of both context (part one), results (part two) and future perspectives on how routinely collected healthcare data can be used to create evidence for the planning of new cost-effective interventions.
47
Polyakova, Maria A. (Maria Alexandrovna). "Regulation of public health insurance." Thesis, Massachusetts Institute of Technology, 2014. http://hdl.handle.net/1721.1/90128.
Full textAbstract:
Thesis: Ph. D., Massachusetts Institute of Technology, Department of Economics, 2014.Cataloged from PDF version of thesis.
Includes bibliographical references (pages 147-150).
The first chapter takes advantage of the evolution of the regulatory and pricing environment in the first years of a large federal prescription drug insurance program for seniors - Medicare Part D - to explore interactions among adverse selection, switching costs, and regulation. I document evidence of both adverse selection of beneficiaries across contracts and switching costs for beneficiaries in changing contracts within Medicare Part D. Using an empirical model of contract choice and contract pricing, I show that in the present environment, on net, switching costs help sustain an adversely-selected equilibrium with large differences in risks between more and less generous contracts. I then simulate how switching costs may alter the impact of "filling" the Part D donut hole as implemented under the Affordable Care Act. I find that absent any switching costs, this regulation would have eliminated the differences in risks across contracts; however, in the presence of the switching costs that I estimate, the effect of the policy is largely muted. The second chapter (co-authored with Francesco Decarolis and Stephen Ryan) explores federal subsidy policies in Medicare Part D. We estimate an econometric model of supply and demand that incorporates the regulatory pricing distortions in the insurers' objective functions. Using the model, we conduct counterfactual analyses of what the premiums and allocations would be in this market under different ways of providing the subsidies to consumers. We show that some of the supply-side regulatory mechanisms, such as the tying of premiums and subsidies to the realization of average "bids" by insurers in a region, prove to be welfare-decreasing empirically. The third chapter studies two competing systems that comprise the German health insurance landscape. The two systems differ in the ability of insurers to underwrite individual-specific risk. In contrast to the community rating of the statutory insurance system, enrollees of the private plans face full underwriting and may be rejected by the insurers. I empirically assess to what extent the selection of "good risks" dominates the interaction between the two systems, using a regression discontinuity design based on statutory insurance enrollment mandates. I do not find compelling evidence of cream-skimming by private insurers from the statutory system. Motivated by this finding, I quantify the change in consumer welfare that would result if the government relaxed the statutory insurance mandate to lower income levels.
by Maria A. Polyakova.
Ph. D.
48
Wettstein, Gal. "Essays on Public Health Insurance." Thesis, Harvard University, 2016. http://nrs.harvard.edu/urn-3:HUL.InstRepos:33493442.
Full textAbstract:
Over the last ten years there have been dramatic changes in the health insurance environment in the United States, spurred on by broad reforms in the public health insurance sector. In 2006 the Medicare Prescription Drug, Improvement and Modernization Act went into effect, providing broad access to prescription drug insurance for millions of elderly Americans. In 2014 the main provisions of the Patient Protection and Affordable Care Act began to be felt, dramatically changing health insurance markets, particularly for those seeking non-group coverage. These legislative changes both raise questions regarding how well the policy changes meet their goals, as well as offering new variation with the potential to answer questions of fundamental economic significance.
This dissertation addresses such important questions surrounding the effectiveness of public health insurance in meeting policymakers’ goals, and the implications of public health insurance for private markets. In the three chapters of this dissertation I utilize the policy changes of Medicare Part D and the Affordable Care Act to provide quasi-experimental estimates of retirement lock, of the correlation of risk aversion and crowd-out of private insurance, and of the effectiveness of the individual health insurance mandate in expanding coverage.
The first part studies the implications of public drug insurance for labor markets. This part examines whether the lack of an individual market for prescription drug insurance causes individuals to delay retirement. I exploit the quasi-experiment of the introduction of Medicare Part D, which provided subsidized prescription drug insurance to all Americans over age 65 beginning in 2006. Using a differences-in-differences design, I compare the labor outcomes of individuals turning 65 just after 2006 to those turning 65 just before 2006 in order to estimate the causal effect of eligibility for Part D on labor supply. I find that individuals at age 65 who would have otherwise lost their employer-sponsored drug insurance upon retirement decreased their rate of full-time work by 8.4 percentage points due to Part D, in contrast to individuals with retiree drug insurance even after age 65 for whom no significant change was observed. This reduction was composed of an increase of 5.9 percentage points in part-time work and 2.5 percentage points in complete retirement. I use these estimates to quantify the extent of the distortion due to drug insurance being tied to employment, and the welfare gains from the subsidy correcting that distortion. The results suggest that individuals value $1 of drug insurance subsidy as much as $3 of Social Security wealth.
The second part of this dissertation considers the effect of public drug insurance on private drug coverage, with a focus on the correlation of crowd-out and risk aversion. I utilize Health and Retirement Survey data around the time of introduction of the Medicare Part D prescription drug insurance for the elderly in order to estimate crowd-out of private prescription drug insurance. I use individuals between the ages of 55 and 64, who are not eligible for the program, as a control group relative to individuals aged 65 to 75, who are eligible. I take a differences-in-differences approach to estimation by comparing outcomes before and after 2006, when Medicare Part D went into effect. I construct measures of risk aversion by exploiting unique questions eliciting risk preferences in the Health and Retirement Survey, as well as information on whether individuals have other kinds of insurance, or engage in risky behaviors. I find substantial differential crowd-out by risk aversion: every standard deviation increase in risk aversion was associated with about 5 percentage points less crowd-out, over a base crowd-out rate of 50%-60%. More risk averse individuals also saw greater reductions in out-of-pocket spending on prescription drugs due to Part D, particularly at high levels of spending: at the 85th percentile of spending an individual one standard deviation more risk averse than the average experienced a decline of $110/year due to Part D eligibility, above and beyond the gains for an averagely risk averse individual of $382/year.
The third part of the dissertation estimates the effectiveness of the individual mandate in the Patient Protection and Affordable Care Act in expanding health insurance coverage. This paper studies the impact of the individual health insurance mandate in the Patient Protection and Affordable Care Act (PPACA) on health insurance coverage. This mandate went into effect in 2014, alongside various other elements of the PPACA. I focus on individuals ages 26-64 who are ineligible for the subsidies or Medicaid expansions included in the PPACA to isolate the effect of the mandate from these other components. To account for changes unrelated to the PPACA that occur over time and affect insurance coverage I utilize a control group of residents of Massachusetts who were already subject to mandated insurance following the 2006 health care reform in their state. Employing a differences-in-differences design applied to data from the American Community Survey, I find that the mandate caused an increase of 0.85 percentage points in health insurance coverage, or a 17% decline in the uninsurance rate. This increase was concentrated in coverage purchased directly by individuals, rather than acquired through an employer, and predominantly affected younger individuals. Both these observations are consistent with the mandate ameliorating adverse selection in the individual health insurance market.Economics
49
French, Martin Andrew. "Picturing public health surveillance : tracing the material dimensions of information in Ontario's public health system." Kingston, Ont. : [s.n.], 2009. http://hdl.handle.net/1974/1689.
Full text
50
Pankaj, Vibha. "Mobilising knowledge in public health : analysis of the functioning of the Scottish Public Health Network." Thesis, University of Edinburgh, 2014. http://hdl.handle.net/1842/9440.
Full textAbstract:
The extent to which the knowledge mobilisation potential of public health networks is actually achieved in their functioning has not been previously studied. There are prescriptions from policy documents and from research literature as to the form networks in health should take and the way they should operate. However, there has been little research connecting the nature of the networks and the manner in which they function to their knowledge mobilising ability. Constituted in 2006, the Scottish Public Health Network (ScotPHN), which is the primary vehicle in Scotland for mobilising public health knowledge and informing policy and practice, constitutes the location for this study investigating this knowledge mobilisation and how networks function in public health. Feedback from the consultation conducted prior to the formation of ScotPHN was obtained. Interviews were conducted with the members of the ScotPHN steering group, a project group and the stakeholder group. Two ScotPHN steering group meetings were also attended by the author as an observer. The consultation feedback, transcripts of the interviews and those of steering group meetings were analysed using the constructivist version of the grounded theory approach. The process involved coding and abstracting codes to categories and themes. The emerging themes were reviewed in the light of existing literature on networks and knowledge mobilisation. These themes were then used to develop a model to understand how the network operates and consequently mobilises knowledge. The study shows that prior to its formation ScotPHN was expected to address the fragmentation of the public health workforce; significantly enhance links amongst existing public health networks; support ground level knowledge exchange amongst practitioners and significantly enhance multisectorial working. None of these expectations appear to have been met. ScotPHN has, however, managed to fill the gap left by the demise of the Scottish Needs Assessment Programme (SNAP). ScotPHN’s structure and the manner in which it is controlled lead to it being akin to a policy community rather than an issue network. The generic public health concerns of the steering group and the selective nature of the project group prevent it from functioning as an issue network. The dominance of people from the medical profession also causes a social closedness in the ScotPHN steering group. The limited multisectorial participation in its activities results in: a lack of constructionist learning; limited inclusion of the social context of knowledge; and a deficit of Mode 2 knowledge mobilisation. In the context of knowledge conversion there is some evidence of externalisation but no socialisation. ScotPHN is not a network that can be classed as a community of practice. This study highlights how health policies, which have advocated the establishment of networks, could derive considerable guidance from research into how networks actually function. With respect to the knowledge mobilisation activity of these networks the study finds that top-down and prescribed structures are unable to capture the transdisciplinarity and diverse intellectual frameworks that contribute to public health knowledge. It is seen that the hierarchical network structures can undermine the engagement of actors from the less represented sectors. Additionally the study finds that the established patterns of professional power and control further hinder multisectorial engagement.