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1
Hopkins, Renee Anderson. "The Public Health Movement in Victorian England, 1831-1875." Thesis, North Texas State University, 1985. https://digital.library.unt.edu/ark:/67531/metadc501199/.
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In early Victorian England, a coalition of men of Government and the local community established a centralized and uniform policy toward public health. The long and arduous campaign (1831-1875) for public health impelled the need to solve the serious social, political and economic problems spawned by the Industrial Revolution. This study concludes that Britain's leaders came to believe that Government indeed had an obligation to redress grievances created by injustice, a decision which meant the rejection of laissez-faire. Through legislation based on long study, Parliament consolidated the work of sanitation authorities, trained medical officers, and essential environmental improvements. The public sanitation program soon decreased the mortality rate by breaking the frequent cycle of cholera, typhoid, typhus, and dysentery plagues, all this notwithstanding that no doctor of that age knew that bacteria and viruses caused disease.
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Greenwood, Dona. "Measures of malnutrition in England." Thesis, University of Surrey, 1998. http://epubs.surrey.ac.uk/804888/.
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Wirrmann, Erica. "Talking about 'public health' : an exploration of the public health roles of primary care practitioners in England." Thesis, Oxford Brookes University, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.424590.
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The British Government, since 1997, have placed a strong emphasis on public health and the reduction of health inequalities. Alongside this, they have progressed a major reform of the NHS which aims to 'shift the balance of power' to the frontline. Primary care is an increasingly important aspect of the Government's new agenda, which aims to improve health for everyone, and for the worst off in particular. This thesis identifies general practice, and the core practitioners that work within it, as key potential contributors to a public health agenda. But 'public health' is a conceptually contested terrain, and as a concept, can be understood and interpreted in a myriad of ways. The impact of this lack of shared understanding is explored both for policy making and implementation, and for the development of public health practice in primary care. This research brings together public health and primary care literatures in order to illuminate the historical and organisational contexts within which current developments are taking place. It critically analyses the public health discourse of New Labour policy documents in order to explore the ways in which 'public health' is understood and talked about within recent government policy, and the government's expectations of primary care practitioners, in terms of their public health roles. Finally, the research draws on case study material from one (pre-2002) health authority area in England to examine practitioners' understandings of public health, and their perceptions of their public health roles. Using Wenger's (1998a) social theory of learning as a framework, it looks at the organisational and wider contexts in which practitioners work, and explores how varied and unclear understandings of public health, both in policy and practice, might be affecting practitioners' engagement with public health. The study highlights the dangers of vagueness surrounding the term public health, and finds a tendency both in policy and practice to regard it as a set of activities, rather than as an approach to work. Its malleability means that it can be interpreted both in a politically acceptable way, and in a way that fits within existing practice. Thus, as a concept, it loses its radical edge and is no longer something that challenges or guides policy and practice. The research finds that the ways in which practitioners interpret public health can contribute to their non-engagement in the public health agenda. This is not helped by conflicts within policy which threaten the development of stronger public health roles within general practices. The thesis concludes by recommending the development of shared understandings of public health, particularly as a valuedriven approach to work, rather than as a set of activities.
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Jayes, L. R. "Smoking and smoke-free policy in prisons in England." Thesis, University of Nottingham, 2017. http://eprints.nottingham.ac.uk/46479/.
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Background Awareness of the harmful effects of second-hand smoke (SHS) has led governments in the United Kingdom (UK) and many other countries to introduce smoke-free legislation in almost all enclosed work and public places. Her Majesty’s (HM) Prison Service, which currently holds over 85,000 offenders among whom the prevalence of smoking is high, was granted one of few exemptions from the 2007 smoke-free legislation in England, which allowed prisoners to smoke in their cells. This continued smoking impacts not only on the health of the individual smoker but also, through SHS exposure, on other smokers and non-smokers who live or work in the prison. However there is limited research evidence on levels of SHS in prison; how the current Prison Service Instruction (PSI) 09/2007 relating to smoking restrictions in prisons in England operates in practice and protects staff members and prisoners from SHS; or how feasible, acceptable or successful the extension of smoke-free policies to all areas of the prison are likely to be in preventing further exposure. Methods This thesis employs both quantitative and qualitative methods in a pragmatic mixed-methods design to investigate smoking and smoke-free policy in prisons in England. Initially, the concentrations of airborne particulate matter < 2.5 microns in diameter (PM2.5) were measured, as a proxy measure for SHS, in four English prisons. Samples were taken on wing landings and in smoking and non-smoking cells; and by ambient monitoring as a measure of personal exposure of staff working in these settings. Staff members who participated in this air quality monitoring study were then followed up to complete a one-to-one semi-structured qualitative interview exploring their views on smoking in prison and exposure to SHS, considering how the current PSI worked in practice, and the potential move to a smoke-free prison estate. A proposal to pilot test smoke-free policy in four prisons in England was announced shortly after, and in large part as a result of the findings of these first studies. A mixed methods evaluation of the new smoke-free policy was then conducted at all four sites, involving prisoner and staff questionnaires and focus groups, and air quality monitoring (sampling concentration of PM2.5 on wing landings) three months before and three months after the policy implementation date. Questionnaires and focus groups pre-policy were used to establish current smoking prevalence, investigate smoking practices and identify perceived problems and concerns regarding the move towards a smoke-free policy. Post-policy these methods were used to explore the impact of the smoke-free policy, views on its implementation alongside consideration of how it could be improved in the future. Concentrations of PM2.5 were used to determine whether going smoke-free reduced levels of SHS exposure. Results Initial air quality monitoring measured PM2.5 concentrations from 48 static locations and personal monitoring of 22 staff members. Arithmetic mean PM2.5 concentrations were significantly higher on landings where smoking was permitted in cells compared to completely non-smoking wings. Concentrations of PM2.5 on landings where smoking was permitted in cells often exceeding the World Health Organisation (WHO) upper air quality guidance limit for a 24 hour period. During personal monitoring of staff members, some of the highest concentrations of PM2.5 were recorded during duties such as locking or unlocking cells, handing out mail and cell searching. Qualitative interviews with prison officers who took part in air quality monitoring reinforced these air quality monitoring findings, confirming the times of the day and duties undertaken where they felt most at risk from SHS. Prison officers outlined how the current PSI was often unworkable day-to-day, conceding that prisoners would often ignore the smoking restrictions in place. In the evaluation of the first four pilot sites to go smoke-free in England, findings prior to the implementation reported 65% smoking prevalence amongst prisoners, and highlighted widespread concerns among staff members and prisoners that going smoke-free would lead to an increase in disorder, self-harm, drug use and trading of tobacco. After the introduction of the policy, prisoners reported an increase in disorder and drug use, but staff reports suggested that concerns were predominantly unfounded. Post-policy, 60% of smoking prisoners reported using some form of Nicotine Replacement Therapy (NRT) in an attempt to cut down or quit in advance of policy implementation, but many reported difficulty accessing cessation support, and found the electronic cigarettes purchased as a substitute for smoking unsatisfactory. Support for the future introduction of the smoke-free policy throughout the rest of the English prison estate was much higher among staff members (70%) than prisoners (23%). Only a quarter of former smoking prisoners stated that they would remain smoke-free once released or transferred to a smoking establishment. Prisoners and staff reported positive outcomes from the smoke-free policy, both reporting a cleaner and healthier environment to life and work. There was a 69% median and a 66% mean reduction in PM2.5 concentrations three months after smoke-free policy was introduced, compared to the same samples taken three months pre-policy, and these reductions were highly statistically significant in all four prisons (p < 0.001). Unintended consequences of the smoke-free policy included smoking alternative substances (such as the contents of NRT patches, tea leaves and lawn grass), the creation of a tobacco black market and related bullying and debt, and the smuggling of tobacco. Conclusions Smoking in prisons in England is a source of high SHS exposure for both staff and prisoners, and the current PSI allowing prisoners to smoke in their cells does not protect other prisoners or staff from SHS exposure. Introducing a comprehensive smoke-free policy in four prisons in England proved successful, achieving marked reductions in tobacco use, improved indoor air quality, and healthier living and working conditions. There are however lessons for wider implementation, particularly in relation to setting clear timelines, ensuring that prisoners can access cessation services in advance of policy implementation, consideration of electronic cigarette available, and other unintended factors. Where possible, these factors need to be addressed to safeguard the future successful implementation throughout the rest of the English prison estate.
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Anderson, Evan D. "The Relationship Between Laws Regulating Use of Mobile Communication Devices by Young Drivers and Crash Fatalities." Diss., Temple University Libraries, 2015. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/309849.
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Public HealthPh.D.
The use of mobile communication devices (MCDs) by drivers is a significant public health problem. Research suggests that MCD use plays a role in almost 400,000 traffic crashes each year, resulting in over 3,000 deaths (NHTSA, 2013). Drivers using an MCD are as much as four times more likely to crash as other motorists (Redelmeier & Tibshirani, 1997). Since 2001 forty-eight states have adopted one or more laws aimed at reducing the use of MCDs by drivers, many of which have been strengthened through subsequent amendments. Evaluations have yielded a mixed picture of their effectiveness (Braitman & McCartt, 2010; Highway Loss Data Institute, 2010; McCartt & Geary, 2004; McCartt, Hellinga, Strouse, & Farmer, 2010). Existing studies, however, have been limited by various design features. This study employs time-series methods to explore whether laws prohibiting use of MCDs by young drivers effectively reduce crash fatalities. The quasi-experimental design relies on an identification strategy that is common in empirical legal studies but has not yet been applied to laws regulating driver MCD use. The implementation of the identification strategy leverages the developing concept of legal epidemiology. Four state laws are ultimately evaluated. The primary analytic approach is difference-in-difference. In two of the four instances, there is some evidence suggesting a protective effect could be attributed to the law. However, this evidence was limited and differed in relation to specification choices. These findings cast doubt on some fifty state panel analyses that have suggested that laws are effectively decreasing MCD use and associated harms.
Temple University--Theses
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Macy, Jonathan T. "The impact of tobacco control policy on smoking-related attitudes and behaviors a study of smoke-free air laws in Texas cities /." [Bloomington, Ind.] : Indiana University, 2009. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3386700.
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Thesis (Ph.D.)--Indiana University, School of Health, Physical Education and Recreation, 2009.Title from PDF t.p. (viewed on Jul 22, 2010). Source: Dissertation Abstracts International, Volume: 70-12, Section: B, page: 7516. Adviser: Susan E. Middlestadt.
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Newbold, Edward John. "The geography of poor relief expenditure in late eighteenth and early nineteenth century rural Oxfordshire." Thesis, University of Oxford, 1995. http://ora.ox.ac.uk/objects/uuid:a5d69649-330d-4c60-998b-41d0969a5c3c.
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This thesis aims to explore the relationship between the geographies of law, society, economy and the physical environment in late eighteenth and early nineteenth century rural England. It uses as its exploring ground the operation of the Old Poor Law in rural Oxfordshire. This county was chosen because it was both a microcosm of the farming landscape of Southern England and was one of the counties where the problem of poor relief was most acutely felt. Chapter 1 establishes that the mapping out of spatial diversity, and the consideration of the forces moulding it, is fundamental to an understanding of the functioning of the Old Poor Law. Chapter 2 uses data contained in the parliamentary returns to demonstrate some clear regional differences in the level of poor relief and the chronology of change. Chapters 3 and 4 show that these regional averages and trends do not make intelligible the kaleidoscopic welter of local variations indicated by a closer examination of parish records. Chapters 5 and 6 consider poor relief expenditure in four parishes: Cropredy, Pyrton, Spelsbury and Stoke Lyne. These show that differences in the level of poor relief expenditure cannot automatically be taken to indicate variations in the level of what we might think of as unemployment or poverty. The generosity of disbursements, and therefore the real incomes of the poor, could also vary markedly between parishes. Thus, the Old Poor Law cannot be detached from the particular places in which it acquired its meaning and saliency. Its impact upon the daily lives of ratepayers, administrators and recipient can be established and the poor treated as individuals rather than as abstract units of labour.
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Coelho, Thiago. "Citizens policing the police an evaluation of citizens recording police officer and wiretapping laws." Honors in the Major Thesis, University of Central Florida, 2013. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/833.
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The focus of this thesis is to explore the legality, the issues, and the remedy to a controversial statute in the State of Illinois. This thesis will explain how the First Amendment relates to the Illinois statute and its desire of a citizen is right to report information that is not being granted. Moreover, this paper will further go into a recent legislative bill to amend the Illinois statute, its failure, the media surrounding the issue, and the consequences of amending or not amending the statute. It will further review state law in regard to citizens recording police officers, and explain how some states deal with the statute.B.S.
Bachelors
Health and Public Affairs
Legal Studies
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Vinci, Karen K. "All state adoption laws should be mandated at the federal level." Honors in the Major Thesis, University of Central Florida, 2003. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/333.
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This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.Bachelors
Health and Public Affairs
Legal Studies
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Chakir, Anass. "The Laws of War and the Post 9/11 World." Honors in the Major Thesis, University of Central Florida, 2006. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/1218.
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This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.Bachelors
Health and Public Affairs
Legal Studies
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Jin, Yue. "Ending Tobacco Sales in Pharmacies: A Comprehensive Evaluation on Tobacco-free Pharmacy Laws." The Ohio State University, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=osu1437563357.
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Mathekgane, Justice Mpho. "The laws regulating National Health Insurance scheme :prospects and challenges." Thesis, University of Limpopo, 2013. http://hdl.handle.net/10386/2542.
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Taylor, Rebecca Kate. "An exploration of the mechanism by which community health workers bring health gain to service users in England." Thesis, University of Birmingham, 2016. http://etheses.bham.ac.uk//id/eprint/6552/.
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This thesis presents the findings of a qualitative exploration of how Community Health Workers (CHWs) conceptualise their role in delivering health improvement. The characteristics of CHWs described in the literature, and their role in health improvement, are examined critically. Interview data from 27 CHWs and 15 others across four services is used to explore the health improvement mechanism from the perspective of CHWs. Theory from a range of disciplines is used to explain it. The literature provides incomplete accounts of the mechanism. The empirical work suggests that, in the services sampled, the mechanism may predominantly be one of social support (informational, instrumental, appraisal and emotional support). Three distinct and essential processes emerge (needs assessment, effective service provision, and client engagement). The analysis reports how who CHWs are, and what they do, appear to be important influences on the social support processes, and that CHWs may be better at delivering this kind of support than traditional professional workers, particularly to socially excluded individuals. Overall, this work suggests that CHWs may perform a unique role, as experts in social support. The proposed mechanism can be used to inform service design and evaluation, to maximise CHWs’ potential to deliver effective social support.
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Collins, Julie. "Applied Epidemiology in the Hunter New England and Western Pacific regions." Master's thesis, Canberra, ACT : The Australian National University, 2018. http://hdl.handle.net/1885/149425.
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In this thesis, I present work conducted as a Master of
Philosophy (Applied Epidemiology) (MAE) Scholar based at the
OzFoodNet sentinel site at Hunter New England Population Health.
During my placement, I was involved in a number of public health
investigations both locally and in the Western Pacific region.
The MAE core competency requirements and the epidemiological
skills that I developed through my field placement are
demonstrated in the following chapters.
I was fortunate to be at the coalface of public health in my
placement at the Local Health District and was able to be
involved in a number of outbreak investigations. I led an
investigation of an outbreak of Campylobacter in a rural
community in New South Wales. This investigation included a
retrospective cohort study with the aim of characterising cases
and identifying the source of infection to prevent further
illness. Data were collected on food and animal exposures prior
to the first onset of illness in the community. We found no
statistically significant food exposures, however this was
complicated by near universal exposure to some food items. A
review of cooking processes identified undercooked chicken as the
likely source of infection in this outbreak. I was also involved
in local outbreaks of gastroenteritis associated with a primary
school and a Salmonella Typhimurium outbreak associated with a
restaurant. In addition, I was involved in an investigation of
paediatric severe acute respiratory infections requiring
admission to intensive care units as a part of a World Health
Organization deployment to Fiji in May 2016.
I conducted an epidemiological project examining environmental
risk factors for human infection with Salmonella serovar Wangata
in north east New South Wales. I designed and administered a
case-control study in three Local Health Districts. Data on
environmental exposures were collected for cases and two separate
control groups: cases of Salmonella Typhimurium and community
controls from the neighbourhood of cases. This project included a
large data analysis component, with separate multivariable
logistic regression models developed to analyse environmental
exposures in each control group. Whole genome sequencing was used
to examine the relatedness between human isolates and
environmental specimens collected as a part of this project.
During my deployment to Fiji in May 2016, I was involved in the
surveillance of infectious diseases following Tropical Cyclone
Winston. I co-evaluated the Early Warning Alert and Response
System (EWARS in a Box) with fellow MAE Scholar, Meru Sheel. Nine
syndromes were reported to the EWARS system from 34 sentinel
sites in Fiji. The web based EWARS system utilised smartphone
reporting and was considered simple, acceptable and generally
useful for users. Recommendations were made to improve the layout
and interpretation of surveillance reports and to enhance
operating procedures and guidelines for surveillance officers.
This was the first time the EWARS in a Box system had been
implemented in a Pacific Island Country and the experiences of
the system in Fiji can be used to assist other countries in the
region who are experiencing humanitarian disasters.
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McManus, Richard Michael. "NHS arm's length bodies and health regulation in England : who regulates the regulators?" Thesis, Keele University, 2015. http://eprints.keele.ac.uk/2337/.
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This research uses mixed methods to critically analyse health regulation systems in England, in a macro and micro sense. The qualitative side of the research involves interviews with key staff members from four NHS Trusts and two Clinical Commissioning Groups. These semi-structured interviews offer unique specific insights from the key actors, from varying perspectives in the process. The quantitative element of the research focuses on trends and correlations of the data sets used by particular arm’s length bodies operating in the policy area. Specific arm’s length bodies operating in the health policy arena, which are assessed in the research, include the Care Quality Commission, Monitor and Dr Foster Intelligence. The findings and conclusions centre on the deficiencies that are present in the current regulatory regime, what is occurring in this area, and why this is occurring. Following the Grounded Theory Approach, the research develops inductive theory, from the data, culminating in a “Feedback Loop Theory of Regulation”. Key words: NHS, regulation, mixed methods, arm’s length bodies, feedback loop theory, grounded theory, Care Quality Commission, Monitor, and Dr Foster Intelligence.
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Merritt, Brittany J. "Developing Little England: Public Health, Popular Protest, and Colonial Policy in Barbados, 1918-1940." Scholar Commons, 2016. http://scholarcommons.usf.edu/etd/6117.
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This dissertation analyzes struggles over the development of Barbadian health and sanitation during the period between the world wars. In doing so, it examines how the British Empire tried to use development policies to maintain its power overseas during the interwar years. During this period, British policymakers sought to improve health and sanitation to pacify restive Barbadian laborers influenced by transnational pan-African and socialist ideas following the First World War. However, white Barbadian elites, influenced by ideas of eugenics and population control, opposed metropolitan efforts to develop health and sanitation in the colony. Rather than repairing the colonial relationship, British development efforts instead resulted in a protracted legislative and public battle over health reform. White creole resistance to public health policies both destabilized British reform efforts and further undermined black Barbadian understandings of imperial identity. By the 1930s, Pan-African critiques of empire, which the British government had fought to suppress following the First World War, found renewed energy in the midst of British failures to provide basic welfare services to poor black subjects. The fractures in these bonds of empire ultimately resulted in serious labor disturbances that re-emphasized the tensions of British colonialism and redirected the course of imperial policy. By focusing on these conflicts, this project reveals how struggles over colonial reforms on the ground transformed ideas of emerging nationhood, imperial identities, and British strategies of rule in the years leading up to decolonization.
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Eaton, Lisa Jean. "Policy adoption by state governments| An event history analysis of factors influencing states to enact inpatient health care transparency laws." Thesis, The Florida State University, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=3564876.
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This dissertation provides an analysis and evaluation of factors influencing states to enact inpatient health care transparency laws between 1971 and 2006 inclusive, using event history analysis. The primary research question investigates "What factors influence a state legislature to enact a health care transparency law?" To narrow the scope of study, I focus on factors influencing states to enact health care transparency laws to collect and publicly report inpatient data.
The Unified Model of State Policy Innovation, developed by F.S. Berry and W.D. Berry (1990, 1999), provides the framework for the study hypotheses and the analysis of inpatient health care transparency law enactments by states. The Unified Model of State Policy Innovation posits a unified explanation for state policy adoptions. The model unifies the internal determinants and regional diffusion approaches of analysis for state policy adoption.
This study tests eight hypotheses using event history analysis (EHA). EHA is an analytical technique that allows for the testing of a state government innovation theory that incorporates internal determinants and regional influences on state policy adoption. Although there are numerous methods to conduct event history analysis, this study uses the Cox proportional hazards model (also known as Cox regression). Cox regression is a popular method for studying time-to-event data for policy adoption and diffusion studies. This study's quantitative analysis provides support for legislative ideology and unified party control of state government acting as factors influencing inpatient health care transparency law enactments by states. Additionally, the health care crisis and neighbors variables were statistically significant, but in an opposite direction than predicted.
The findings of this research suggest that state adopters of an inpatient health care transparency law are more likely to enact an inpatient health care transparency law when the state government is increasing in liberalism and when unified political party control of the governor and the governorship of both houses of the state legislature is increasing.
To generate new insights into the enactment of inpatient health care transparency laws, I conduct a case study of a national health care data professional association using several techniques, including telephone interviews. The qualitative analysis provides support for professional associations and policy champions as diffusion agents for inpatient health care transparency law enactments by states.
This dissertation supports variables traditionally used in policy adoption research including legislative ideology and unified political party control in state government. However, it will be interesting to see whether internal determinants such as professional associations gain traction over the traditional regional diffusion influences such as states sharing borders as factors influencing state policy adoption. Meanwhile, as evidenced in this study, there continues to be support for a model incorporating both internal and regional influences to explain policy adoption by states. The theory of policy innovation and diffusion to predict the factors influencing the spread of policies and the use of Berry & Berry's (1990, 1999) Unified Model of State Policy Innovation prosper as their applicability to numerous public policy areas, including health care, are continually demonstrated. Similarly, event history analysis and specifically the Cox regression method continue to gain support as their value as analytical methods and appropriateness for use in public policy studies is repeatedly demonstrated.
The outlook for the future of the health care transparency movement looks promising. The health care transparency movement promotes improved access to information, patient empowerment, improved patient safety and quality of care, improved provider accountability, and lower health care costs. This movement is not a fad, but rather a permanent change being implemented in all health care settings across the United States. Improved health through reliable, accessible data and data-supported decisions is increasingly becoming the norm and less an idealistic scenario to be realized in the distant future.
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Hickson, Kerry. "The contribution of improved health to standards of living in twentieth century England and Wales." Thesis, London School of Economics and Political Science (University of London), 2006. http://etheses.lse.ac.uk/22/.
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The thesis will highlight both qualitatively and quantitatively that during the twentieth century the English population experienced unprecedented improvements in mortality and particularly morbidity, which has provided a substantial boost to standards of living and economic development. Despite the extensiveness of these health improvements, there have been a very limited number of attempts to evaluate and quantify these valuable improvements. None of the existing studies that quantitatively assess improved health actually measure health per se, as they all utilise mortality as a proxy. Furthermore, there have been no historical studies that aim to map the evolution of improving health from the perspective of quality of life for illness sufferers. The thesis will fill all of these voids through developing a quantitative health (mortality and morbidity) measuring tool that is capable of providing (monetary) estimates about the contribution of improved health to standards of living and economic developments in twentieth century England. This will be applied to key case study illnesses (blindness, breast cancer, stomach cancer and tuberculosis) and then extrapolated forward to include all illnesses which will be combined with mortality in order to provide an aggregate health index for twentieth century England. The results of this exercise provide a significant contribution to the twentieth century health and economic history of England. The thesis findings that, at a most conservative estimate, the value of twentieth century health improvements is in excess of 33 billion (1990 international $) substantially adds to a new view of the economics of health and provides very valuable historical detail. This new view is that improvements in health have been a major contributor to economic welfare in twentieth century England. Put another way: the thesis will highlight that during the twentieth century increases in life expectancy and improvements in the quality of life associated with morbidity have provided a considerable contribution to standards of living and the growth of GDP defined on a utility, 'Fisherian' basis, whereby economic growth nearly doubles, from 1.4 percent for GDP only versus 2.6 percent when GDP is adjusted for improved health.
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Szabados, Tibor. "Krankenhäuser als Leistungserbringer in der gesetzlichen Krankenversicherung." Berlin : Springer, 2009. http://www.zhbluzern.ch/emedien_info.htm.
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Seifert, Ulrike. "Gesundheit staatlich verordnet : das Arzt-Patienten-Verhältnis im Spiegel sozialistischen Zivilrechtsdenkens in der DDR /." Berlin : BWV, Berliner Wiss.-Verl, 2009. http://d-nb.info/996165002/04.
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Wright, Jennifer Mary. "Public health women doctors in England 1965 to 1991 : "A perfect place for strategic butterflies"." Thesis, Oxford Brookes University, 2016. https://radar.brookes.ac.uk/radar/items/56248ff8-244b-426f-b0aa-3c4778bc5db6/1.
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This thesis contributes to the historiography of women in medicine by exploring, in-depth, one small specialty, public health, which, from 1974, offered women doctors working within it equality of opportunity with men for career development. At that time, most women doctors working in the English health service were relegated to junior or support roles, their particular needs for family-friendly working environments being largely ignored. This research examines the reasons behind the development of these equal opportunities and the subsequent rapid trajectory of women doctors in public health, comparing it with the much slower progress made by female colleagues in hospital medicine and general practice. In considering the factors helping or hindering women’s advance in medicine from 1974, it proposes that these changes occurred in public health because the specialty was not tied to the pyramidal model of medicine, developed in the 1930s by senior male doctors for male doctors, which dominated other specialties and which stifled progress. An innovative feature of this research, following women’s entry to consultant and training posts in proportions equal to men in public health, is to highlight their subsequent move into major strategic roles within the health service management structure from the late 1980s. Interviews with senior public health men and women doctors help shed light on how this move was achieved and how women in strategic positions were able to combine high profile careers with domestic responsibilities. Also includes five transcipts of interviews : The five interviewees, whose career stories are presented here - Professor Sian Griffiths, Professor Sheila Adam, Professor Mala Rao, Dr Sue Atkinson and Professor Fiona Sim - were selected, with the help of the Faculty of Public Health, for their considerable achievement in strategic leadership roles in public health practice, whether in leading complex organisation, chairing national policy committees, leading international work, promoting education and development.
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McGowen, Catherine R. "Frustration of purpose : public health and the future of death investigation in England & Wales." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2012. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.758090.
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Aguiar, Magda Francisca Calás Oliveira Carvalho. "Decision analytic modelling of the prevention of vitamin D deficiency in England and Wales." Thesis, University of Birmingham, 2018. http://etheses.bham.ac.uk//id/eprint/8120/.
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Vitamin D deficiency (VDD) is widespread in England and Wales, affecting both children and adults by increasing their risk of poor bone health. In order to inform public decisions on the prevention of VDD, a decision analytic model was developed to compare four alternatives to prevent population VDD: wheat flour fortification, supplementation of at-risk groups, a combination of wheat flour and supplementation, and no intervention. Methods used to inform the model development stage included literature reviews, expert consultation, and preference-based questionnaires to elicit proxy utility values. An individual-level simulation Markov model was chosen to simulate the costs and benefits of each alternative. A cost-effectiveness and cost-utility analysis were undertaken for the base case analysis, using a 90-year time horizon. A societal perspective was chosen to account for private and public costs of implementing each of the alternatives. Parameter uncertainty was tested through deterministic and probabilistic sensitivity analyses. Moreover, in order to inform decisions under uncertainty, a value of information analysis was undertaken. The model results support the decision to implement interventions to prevent VDD, namely a combined strategy of at-risk groups supplementation and wheat flour fortification. Furthermore, this thesis contributes evidence on methodological considerations for modelling micronutrient interventions.
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Evans, David Thomas. "Sexual health matters! : learning for life : mapping client need and professional sexual health education for nurses in England." Thesis, University of Greenwich, 2011. http://gala.gre.ac.uk/8071/.
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Sexual health matters! This motif underpins the entire thesis. With survey responses from university educators and focus group encounters with clinical professionals undertaking the UK-wide Sexual Health Skills course, the study explores ways in which specific discourses pertaining to sexual health and illness inform the need for, and provision of, professional education for nurses in England. Through using a Foucauldian ‘lens’ and a novel process called crystallisation in sexualities and gender epistemologies (S&GE), it was possible to shed new light on some old problems hindering nurse education. The methodologies facilitated a discursive engagement between the power / knowledge of sexual health sciences (scientia sexualis), the orthodox ‘regimes of truth’, and various silenced voices. The silenced voices pertain to wider, socially and clinically ‘invisibilised’, needs of clients or patients in relation to the provision of nurse education. Set against the backdrop of England's first ever Government strategies on teenage pregnancy, sexual health and HIV, statistics on narrow definitions of sexual ill-health are still considered the worst in western Europe. Nurses acknowledge these poor facts, and witness to additional neglect related to sexual well-being in the wider, holistic, domains of a person's life, health and relationships. Respondents recount a lack of formal sexual health education in pre- and post qualifying curricula, including incidents of critical, experiential, ‘on the job’, learning which are capped and thwarted by clinical and educational staff who are unable and / or unwilling to explore the full learning potential through reflection and analysis of practice. Respondents acknowledge how their professional education frequently ill-equips them to deal with requirements in practice as well as newer, public health, demands on their roles to increase preventative education and effective health promotion. This thesis gives them a voice in expressing such concerns. The outcome of this work has led to the conceptualisation of a model of ‘learning for life’ across a curricular triptych for professional education which supports client care. Panels of this triptych relate to the foundational or holistic dimensions of sexual health matters; ancillary aspects secondary to other health conditions, and finally, the specifics, those formally defined in epidemiology and strategies of sexual ill-health and associated stigmas. Whether someone qualified twenty-five years ago or within the last three months, the quality and quantity of formal sexual health learning across the curricular triptych model remains negligible and incommensurate with clinical demands on professional nursing care.
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York, Sarah Hayley. "Suicide, lunacy and the asylum in nineteenth-century England." Thesis, University of Birmingham, 2010. http://etheses.bham.ac.uk//id/eprint/801/.
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Suicidal patients constituted a significant proportion of the annual admissions to nineteenth-century public lunatic asylums. They formed a distinct patient category that required treatment and management strategies that were capable of frustrating their suicidal propensity and alleviating their mental affliction. Yet despite being relatively large in number, the suicidal population of public asylums has received only nominal attention in the history of nineteenth-century psychiatry. This thesis examines the admission, discharge, treatment and management of suicidal lunatics over the course of the nineteenth century. It locates suicide and suicidal behaviour within the context of the asylum and uncovers the experiences of patients, their families and asylum staff. There is a distinct appreciation of the broader social and political context in which the asylum operated and how this affected suicide prevention and management. This thesis argues that suicidal behaviour, because of the danger associated with it, triggered admission to the asylum and, once admitted, dangerousness and risk continued to dictate the asylum’s handling of suicidal patients. Rather than cure and custody, it was protection and prevention versus control that dominated the asylum’s treatment of suicidal lunatics. Conclusions are drawn based on evidence from five asylum case studies and contemporary publications.
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Zhang, R. "Preparing an educated nurse : past and future trends in England and mainland China." Thesis, University of Southampton, 2012. https://eprints.soton.ac.uk/351926/.
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This cross-national comparative study aims to explore previous changes and future trends in nursing in England and mainland China, and the impact that reform has had on the way in which nurses are currently and prospectively educated in the two countries. Nursing education in both countries has experienced considerable development related to societal, health care, and technological advances, alongside economic growth. In England, there is a policy imperative to shift nursing to an all-graduate discipline and a need to look at the balance of the health care workforce. In mainland China, there is a goal to educate nurses who are fit for the changing healthcare system, during a period of health care reform which attempts to improve primary health care delivery in rural and urban areas. A case study design has been adopted in two settings, one nursing school in England and one in mainland China. Participants are those involved in the provision of nursing education – the nurse teachers. In-depth data were collected by interviews from 11 people in the English site and 10 in the Chinese site. Thematic analysis was used to analyse the data. These data are set within the historical and contemporary contexts, through an analysis of the literature. Findings indicated that the trajectories of the development of nurse education in the two countries are varied, but with interesting similarities and differences. For example, the professionalisation of nursing in the two countries has followed a pathway that is comparable in some senses but not others. This is related to such issues at the inter-relationship of medicine and nursing and views about the status of nurses. Main conclusions of this study include the increasing emphasis on community care and the linked need for further curriculum development to prepare nurses in both countries for such changes.
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Lawana, Andiswa. "South African patent law : developing a balance between the rights of the patients and promoting innovation within the pharmaceutical industry." University of the Western Cape, 2015. http://hdl.handle.net/11394/4749.
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Magister Pharmaceuticae - MPharmBackground: In South Africa many patented medicines are either unavailable or carry prices that most patients cannot afford. The effects of the patents systems on patient access could greatly depending on how the burden of a disease is distributed across least-developed, developing and developed countries. Method: The study based on a qualitative research method. The sample was based on a non-probability approach. The study used both primary and secondary data collection. The secondary data was critically evaluated and collected from scientific articles, company reports and internet sources, in order to obtain some better insight into the patent situation of pharmaceuticals. Interviews were conducted and analysed by selective ad open coding. Results: The South African patent system needs an examination process to evaluate patent applications. The Patent Act of 1978 meets the minimum TRIPS requirements. The South African market is unique and a small market for innovator companies therefore does not influence innovation by these companies. Conclusion: The study concluded that the key sections of the Patent Act that need further evaluation and aligning more with TRIPS flexibilities are: Compulsory License, “Evergreening”. Data Protection and Establishing an examination system. The study also concluded that the current South African Patent Act sufficiently promotes innovation within the pharmaceutical industry.
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Haji, Mohamad Tuah Anni. "Evaluation of Public Health approaches of obesity prevention and management in England : lessons learned for Brunei." Thesis, Imperial College London, 2011. http://hdl.handle.net/10044/1/24932.
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Tackling obesity is a major public health challenge. Obesity strategy and policy in England has been heavily criticised for being ineffective in tackling the problem of obesity. Although many studies have evaluated interventions for obesity, there is no clear evidence about which interventions are effective in the prevention and management of obesity in primary care and community settings. The main purpose of the study was to evaluate the effectiveness of current public health approaches for obesity prevention and management, in particular focusing on behaviour change models as intervention and also policy actions implemented at local level (primary care trusts) in England. It also intended to identify obesity strategies relevant to Brunei as lessons learned from England. The methods used were systematic review, policy analysis and validation. The main finding of this study had shown that the 'Transtheoretical model stages of change' used in combination with diet and physical activity has limited impact on weight loss (about 2 kg or less) and there was no conclusive evidence for sustainable weight loss beyond 12 months. In addition, there were significant variations found in obesity strategies implemented by primary care trusts in north-west London based on analysis using the Imperial College Obesity Strategy Assessment Framework. The key lesson learned for Brunei from England's experiences was the development and application of Brunei-IC-OSAF that contributed to the formulation of 'comprehensive obesity policy' for Brunei. The tool had identified strengths and weaknesses of the existing obesity strategies implemented in the country. The outcomes of the study contributed to the existing evidence about what works in tackling obesity in public health settings, informing better pathway development and commissioning decisions.
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Kelsey, Amanda. "The evolving and uncertain role of health visiting in England and Wales in the twentieth century." Thesis, London School of Economics and Political Science (University of London), 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.313047.
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Loff, Beatrice. "Health and human rights : case studies in the potential contribution of a human rights framework to the analysis of health questions." Monash University, Dept. of Epidemiology and Preventive Medicine, 2004. http://arrow.monash.edu.au/hdl/1959.1/5291.
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Shabat-Love, David. "An examination of the history and effect of American sex offense laws and offender registration." Honors in the Major Thesis, University of Central Florida, 2012. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/621.
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America's Sex Offense statutes and cases are some of the most controversial sections of modern law, both for the extreme sensitivity of their subject matter as well as the scope and application of those laws. This thesis is an analysis and overview of both the objective and subjective issues posed by the current state of those very laws: the subjective portion explored the development of current laws and the diverse attendant legal issues such as over-broadness and excessive or misdirected effect as compared to the Legislative and public intent which directly led to the development of these laws. Additionally a more objective study of their efficacy was conducted through the use of data regarding offense rates by locality. This objective data was procured from both the United States Census and Bureau of Justice statistics, which contained national averages such as the overall violent crime rate, and from the Florida Department of Law Enforcement Statistics and was supplemented with additional data from other academic sources. It is both the subjective conclusion and the interpretation of objective data that while the rate of sex offenses has lowered in recent decades this effect is a part of the overall trend of reduction in all violent offenses, and that the extreme stance of modern sex offense laws have arguably resulted in the net-negative of creating a class of individuals ostracized from all but other sex offenders who are virtually incapable of supporting themselves or at times of even finding legal habitation post-release. With little to no chance of a productive life, there is the strong possibility of recidivism and little incentive to avoid re-offending.B.A. and B.S.
Bachelors
Health and Public Affairs
Legal Studies
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Jones, Joseph Timothy. "The Association between Medical Marijuana Laws and Maternal Marijuana Use." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3530.
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Marijuana is the most common illicit drug that is abused by pregnant women, and recently many states have adopted various levels of relaxed marijuana policies. The purpose of this study was to evaluate a potential association between residing in a state that allows medical marijuana use and maternal marijuana usage. Grounded in the theory of planned behavior, this study evaluated the prevalence and extent of maternal marijuana use in states that allow and states that do not allow medical marijuana use using the National Survey of Drug Use and Health (NSDUH). It was anticipated that more lenient subjective norms toward marijuana use and increased availability would support an increase of maternal marijuana use. The 2014 NSDUH was queried and analyzed using chi-square and logistic regression. The study revealed an increase of maternal marijuana use in states where medical marijuana was allowed, but the increase was not statistically significant. An increase of heavy users was observed in states where medical marijuana was allowed (54% versus 37%). Consistent with other research findings, this study revealed that young (OR = 3.56; 95% CI: 1.379, 9.213; p = 0.009) and unmarried (OR = 6.81; 95% CI: 2.485, 18.661; p < 0.001) pregnant woman were at higher risk for past month maternal marijuana use and had similar results for past year use. The unintended consequences of increased in utero marijuana exposure and its subsequent negative public health effects have been missing from the discussion of the relaxation of statewide marijuana policies. This study will provide policy makers responsible for changing marijuana policy with useful evidence on the unintended consequences of increased maternal marijuana use in areas where medical marijuana is allowed.
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Jones, Sarah L. "Management risk factors associated with foodborne disease outbreaks in the catering industry in England and Wales." Thesis, Cardiff University, 2008. http://orca.cf.ac.uk/54107/.
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Despite structured enforcement of food safety requirements known to prevent foodborne disease outbreaks, catering businesses continue to be the most common setting for outbreaks in England and Wales. Limited published evidence suggests that the way catering businesses are managed and operated may contribute to food safety control failures which in turn can result in an outbreak. The purpose of this study, funded by the Food Standards Agency1,2 was to identify the underlying management factors that may contribute to or prevent outbreaks in the catering industry. A matched case control study compared the management and operational practices of 148 catering businesses associated with foodborne outbreaks with 148 control catering businesses. High response rates were achieved: case businesses 90%, and control businesses 93%. To minimise false inferences from chance associations analysis followed a predefined hypothesised causal pathway. Hazard analysis critical control point systems and formal food hygiene training were found not to be protective and food hygiene inspection scores were not useful in predicting which businesses were likely to be associated with outbreaks. Larger small medium sized (SME) businesses were more likely to be associated with outbreaks compared to micro SME businesses. Operational and management practices did not differ significantly between case and control businesses when adjusted for SME size. SME size was not explained by other staff employment and management variables. However, businesses associated with Salmonella outbreaks were significantly more likely to use regional egg suppliers, the only significantly independent operational practice associated with Salmonella outbreaks. Regional egg suppliers were also more likely to supply businesses associated with outbreaks that were attributed to food vehicles containing eggs. Businesses associated with egg outbreaks were less likely to use eggs produced under an approved quality assurance scheme suggesting that the underlying risk associated with using regional suppliers may relate to the use of contaminated eggs.
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Kelly, Paul Thomas. "The strategic role of innovation in addressing oral health inequality in primary care organisations in England." Thesis, University of Birmingham, 2015. http://etheses.bham.ac.uk//id/eprint/6159/.
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This research investigates the interplay between strategy, innovation, oral health inequalities, and the Primary Care Organisation (PCO). There has been little previous consideration of the interplay between these four factors, which this research addresses through a mixed-methods approach combining interviews, secondary-data analysis, and an investigation into the availability of oral health strategies. Analysis was supported by dialectic and functionalist approaches and suggested that structural and process difficulties affected the ability of PCOs to address inequalities in oral health through strategy and innovation. The role of PCOs and consultants in dental public health in relation to strategy and innovation was characterized by contradictions and inconsistencies, some of which appeared to be dysfunctional. The findings raise a number of considerations regarding the role PCOs adopted with regard to oral health inequalities. In particular, this thesis demonstrates that local and macro-level structures and processes may be inadequate to ensure reductions in oral health inequality through strategy and innovation. Integration of strategy and innovation in this thesis leads to a suggested innovation-strategy complex.
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Kerr, Judith. "A Survey of Georgia Adult Protective Services Staff Regarding Elder Abuse Laws and Policies: Determining Training Needs." Digital Archive @ GSU, 2010. http://digitalarchive.gsu.edu/iph_theses/151.
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Abstract Background: The aging population is a rapidly growing demographic. Isolation and limited autonomy render many of the elderly vulnerable to abuse, neglect and exploitation. As the population grows, so does the need for Adult Protective Services (APS). This study was conducted to examine current knowledge of Georgia older adult protection laws and to identify training opportunities to better prepare the APS workforce in cases detection and intervention. Methods: A primary survey was developed in partnership with the Georgia Division of Aging Services’ leadership to identify key training priority issues APS caseworkers and investigators. A 47-item, electronic questionnaire was delivered (using Psychdata) to all APS employees via work- issued email accounts. Descriptive analyses, t-tests, and chi-square analyses were used to determine APS employees’ baseline knowledge of Georgia’s elder abuse policies, laws, and practices as well as examine associations of age, ethnicity, and formal education level with knowledge. A p-value of <0 >.05 and 95% confidence intervals were used to determine statistical significance of the analyses performed. Results: In total, 92 out of 175 APS staff responded to the survey (53% response rate). The majority of respondents were Caucasian (56%) women (92%). For over half the survey items, a paired sample t-tests revealed significant differences between what APS staff reported as known and what APS staff members indicated they needed to know more about in terms of elder abuse and current policies. Chi-square tests revealed that non-Caucasians significantly preferred video conferencing as a training format (44% compared to 18%), [χ2 (1) = 7.102, p < .008] whereas Caucasians preferred asynchronous online learning formats (55% compared to 28%) [χ2 (1) =5.951, p < .015]. Conclusions: Results from this study provides the Georgia Division of Aging with insights into specific content areas that can be emphasized in future trainings. Soliciting input from intended trainees allows public health educators to tailor and improve training sessions. Trainee input may result in optimization of attendance, knowledge acquisition, and intervention practices regarding APS service delivery. This in turn can enhance APS staff efficiency and response to cases of violence against older adults.
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Iacovelli, Gianpiero. "The Ideology of Mental Illness in Ghana : A Discourse Analysis of Mental Health Laws (1972-2012)." Thesis, Högskolan Dalarna, Afrikanska studier, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:du-28168.
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In 2012, Ghanaian government promulgated a new mental health law aimed at setting up a community-based health care system in order to solve several problems that are affecting mental health facilities and people with mental disorders. The new law was also thought to overcome the limitations of the previous law, which was promulgated in 1972. This study provides an analysis of the mental health laws promulgated by the government of Ghana from 1972 to 2012. Through the methodological tools offered by Critical Discourse Analysis (CDA), the aim of the thesis is to trace the ideological background of mental health laws and its changes over time. The analysis is particularly focused on themes such as the issue of public safety, the construction of the “mentally ill subject” and the conceptualisation of mental illness in the legal texts.
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Wells, Katharine M. "Evaluating the implementation of the New Medicine Service in England." Thesis, University of Nottingham, 2014. http://eprints.nottingham.ac.uk/27942/.
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Community pharmacies in England provide a variety of services including essential services such as the dispensing of medicines, advanced services such as Medicine Use Reviews, and enhanced and locally commissioned services, for example the minor ailments scheme. In October 2011 a new advanced service called the New Medicine Service (NMS) was introduced. It aimed to improve adherence to newly prescribed medicines for patients with certain long term conditions and reduce medicines wastage. This thesis aims to evaluate the implementation of the NMS by exploring how the service was developed and implemented, identifying both potential and actual barriers and facilitators to NMS implementation, investigating the proportion of prescription items that are eligible for the service, and examining the uptake and provision of the service. In order to achieve this several studies were carried out. Interviews were conducted with stakeholders involved in the service’s development and implementation. Focus groups were conducted with community pharmacists complimented by interviews with superintendent pharmacists both before and after the introduction of the NMS. Data regarding the number of prescription items eligible for the service were collected in community pharmacies, and an analysis of service records for a large national chain of pharmacies was carried out. The studies determined that there were four stages to the development and implementation of the NMS; pre-negotiation, negotiations, the launch phase, and post-implementation. Both community pharmacists and superintendent pharmacists were enthusiastic about the potential of the service prior to the introduction of the service and anticipated good uptake of the service which was confirmed by post-implementation results. Several barriers were identified prior to implementation, the most important of which was the payment structure. Post-implementation results confirmed that the payment structure had affected NMS implementation, and direct observations in pharmacies, that the opportunity rate to provide the service was nearly half of the payment structure’s theoretical rate. Analysis of service data showed the uptake of the NMS was greater than the uptake of MURs in 2005. The findings of this thesis provide policy makers, pharmacy stakeholders, community pharmacists, and researchers with knowledge of how pharmacy services are developed. It also provides insights about factors that can facilitate or hinder service provision, including pharmacist attitudes towards a service, certain service and pharmacy characteristics (such as the ability to carry out telephone consultations), company encouragement to provide the service, the experience of conducting other pharmacy services, pharmacist workload, the accreditation procedure, and the services payment structure. These insights can be used to improve future pharmacy services’ implementation.
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Mook, Piers A. N. "Redefining the population at risk of listeriosis in England and Wales." Thesis, University of Warwick, 2012. http://wrap.warwick.ac.uk/58071/.
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Listeriosis is a rare but severe food‐borne disease caused by the opportunistic, bacterial pathogen Listeria monocytogenes. The elderly, those who are immunocompromised and pregnant women and their unborn or newborn infants are disproportionately affected. Listeriosis has a high case fatality ratio (up to 44%) and is the commonest cause of death ascribed to a food‐borne pathogen in the United Kingdom (UK). The number of cases of listeriosis in England and Wales reported to the Health Protection Agency (HPA) ‐ the arms length governmental body mandated with protecting the health of the population ‐ increased from an average of 110 cases per year between 1990 and 2000 to an average of 192 cases per year between 2001 and 2009. The epidemiology of listeriosis appeared to change with the observed increase almost exclusively among non‐pregnancy related cases, aged ≥60 years presenting with bacteraemia in the absence of central nervous system infection (CNS). Given the potential severity of listeriosis and that, as a predominantly foodborne disease, these infections are largely avoidable, there was a public health imperative to investigate the observed increase. Disease presentation, concurrent conditions, medications, deprivation, diet and mortality risk factors amongst non‐pregnancy related listeriosis cases and ethnicity amongst pregnancy related cases were investigated using national surveillance data. The increased incidence of bacteraemic cases occurred in those with cancer, particularly digestive organ malignancies (Odds ratio (OR) [95% confidence interval (CI)]: 16.7 [3.8 – 73]) and, to a lesser degree, those with conditions that necessitate treatment with stomach acid inhibiting medication (3.2 [1.5 – 6.6]). Ethnicity and/or deprivation were found to be important drivers for infection. Compared to the most affluent areas, disease incidence was 38% (95% CI: 16 to 65) higher in the most deprived areas of the country. Cases were more likely than the general population to purchase foods from convenience stores (OR [95% CI]: 5.37 [3.53 – 8.17]) or from local services ‐ bakers (3.40 [2.39 – 4.86]), butchers (1.62 [1.11 – 2.34]), fishmongers (5.05 [3.19 – 7.99]) and greengrocers (1.92 [1.32 – 2.78]) ‐ and their risk profile changed with increasing deprivation. The proportion of pregnancy related cases classed as ethnic increased significantly from 2001 to 2008 (chi‐square test for trend; p=0.002). The increase in the proportion of pregnancy related cases that were ethnic was most marked in 2006, 2007 and 2008, when the incidence was higher than expected given the underlying population (Relative risk (RR) [95% CI]: 2.38 [1.07 – 5.29], 3.82 [1.82 – 8.03] and 4.33 [1.74 – 10.77], respectively). A wide range of underlying conditions appeared to increase the risk of infection, most notably diseases of the liver (RR [95% CI]: 22.4 [17.7 – 28.4]), systemic connective tissue disorders (18.3 [12.6 – 26.6]), neoplasms of the lymphoid, hematopioetic, and related tissues (17.6 [15.1 – 20.6]), psychoactive substance (alcohol related in 96% of reports; 12.3 [9.4 – 16.1]) and renal failure (12.2 [9.8 – 15.1]). Associated medications, including cytotoxic drugs (RR [95% CI]: 320.9 [228.5 – 450.7]), drugs affecting the immune response (18.5 [11.6 – 29.5]) and corticosteroids (11.1 [8.5 – 14.6]), and food groups, most notably smoked salmon (OR [95% CI]: 4.82 [2.99 – 7.76]), other cold cooked fish (22.32 [15.85 – 31.44]), camembert (4.80 [2.32 – 9.90]), hard cheese other than cheddar (2.37 [1.69 – 3.30]), blue cheese (2.24 [1.47 – 3.43]), also appeared to be associated with increased risk of infection. Underlying conditions, particularly malignancies of the breast (OR [95% CI]: 3.2 [1.7 – 6.2]) and respiratory and intrathoracic organs (3.9 [2.2 – 7.1]), alcoholism (2.7 [1.6 – 4.3]), cardiovascular diseases (1.4 [1.01 – 1.9]), treatment to reduce stomach acid secretion (1.6 [1.1 – 2.3])and increasing age (cases ≥80 years versus less than 60 years; 3.1 [2.3 – 4.2]) increased the risk of death amongst cases. This cohesive body of work redefines the population at risk of listeriosis and indicates that there is added value in actively targeting appropriate food safety advice at a range of vulnerable groups other than pregnant women, to whom information has previously been routinely and preferentially disseminated.
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Page, Nicholas. "Investigating trends and determinants of violence-related injury in England and Wales." Thesis, Cardiff University, 2015. http://orca.cf.ac.uk/75581/.
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Interpersonal violence is a public health concern in England and Wales. Nationally, over half of all victims of interpersonal violence sustain physical injuries, whilst approximately one-fifth suffer injuries serious enough to require medical treatment. Interpersonal violence therefore places a considerable burden on criminal justice and health service resources. Accurate and reliable data on the extent and correlates of violence at both national and local level are required in order to inform prevention strategies. Despite this, police and crime survey measures of violence have reported contradictory national trends, whilst few studies in England and Wales have examined either correlates of violence-related injury or the mechanisms explaining how such correlates increase risk of sustaining violence-related injury. This thesis presents findings from three studies which aimed to remedy these deficiencies. Firstly, Emergency Department (ED) attendance data were collected from 100 EDs across England and Wales and time series statistical methods employed to detect both national and local trends. Secondly, regional price indices for alcohol were calculated and associations with regional rates of violence-related injury and socioeconomic measures examined. Thirdly, potential mechanisms linking deprivation with increased risk of violence-related injury among adolescents and how these differed according to gender were examined qualitatively. Findings revealed violence-related injury decreased nationally by 6.4% between January 2005 and December 2012. Rates of violence-related injury were shown to be highest among men, 18-30 year olds and those living in the North West of England. Modelling revealed a significant negative association between violence-related injury and the real price of on-trade and off-trade alcohol; in so that a 10% increase in real alcohol price would reduce violence-related ED attendances in England and Wales by over 60,000 per year. Modelling also revealed that poverty and income inequality had the largest impact on rates of violence-related injury. At micro level, adolescent females were shown to be particularly sensitive to the effects of deprivation; poor alcohol regulation by parents and a lack of structured and appealing leisure activities may potentially increase risk of violence-related injury among this cohort. This thesis has shown ED data to be an invaluable tool for investigating trends and determinants of violence-related injury in England and Wales by clarifying national and local trends and identifying risk factors at both macro and micro level. Implications for violence prevention policies that can be drawn from these findings include targeting regions where violence is higher, raising the price of alcohol above inflation, and improving alcohol regulation and leisure opportunities among deprived adolescent females.
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Snape, Stephanie A. "The implementation of social policy in England in the 1930s : a case study of Cheshire County Council and Birkenhead County Borough." Thesis, University of Bristol, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.319198.
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Minetti, Corrado. "The epidemiology and molecular epidemiology of Giardiasis in North West England." Thesis, University of Liverpool, 2014. http://livrepository.liverpool.ac.uk/2006698/.
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Giardiasis, cause by the parasitic protozoan Giardia duodenalis, is one of the most common infectious gastrointestinal diseases in humans worldwide. However, its true population burden and epidemiology and in particular its zoonotic transmission potential are still poorly understood. Furthermore, G. duodenalis is not a uniform parasite but a complex of seven genetic assemblages or cryptic species (named A to G) that infect humans and a variety of domesticated and wild animals, and that can only be distinguished using molecular genotyping methods. Although there is some evidence that the two Giardia assemblages infecting humans (namely A and B) may differ in their virulence and major transmission routes, data are still scarce. In the UK, several studies suggested that giardiasis is considerably under-diagnosed and a few data are available on the genetic diversity of the parasite causing infection and disease in this country. We investigated the burden, clinical outcomes, risk factors and molecular diversity of giardiasis in North West England using both a descriptive and analytical approach. In Chapter 2, we analysed the self-reported clinical and exposure data collected over four years from clinical cases of giardiasis in Central Lancashire, as part of an enhanced surveillance program on the illness. The resulting average disease rate of 22.5 cases/100,000 population was high when compared to the available national figures. Giardiasis was particularly abundant in adults in their 30s and children under five, and the disease rate in males was significantly higher than in females. Furthermore, the clinical picture of the cases confirmed the high morbidity associated with this infection particularly in terms of the length of illness and severity of symptoms. Only 32% of the cases reported foreign travel during the exposure window. The results suggested the presence of a hidden burden of disease in adults and males, and indicated that local transmission of Giardia can be more common than expected. In Chapter 3, we performed a case-control study to determine the significant risk factors for symptomatic giardiasis in North West England, by recruiting clinical cases of Giardia and age and sex matched controls from Central and East Lancashire and Greater Manchester. The multivariable logistic regression analysis done on 118 cases and 226 controls revealed that overall travelling abroad (particularly to developing countries) was an important risk factor for the illness (OR 9.59). Following the exclusion of participants that reported foreign travel, four risk factors were significant for the acquisition of giardiasis: going to a swimming pool (OR 2.67), changing nappies (OR 3.38), suffering irritable bowel syndrome (OR 3.66) and drinking un-boiled water from the tap (OR 8.17). The results indicated the important role of swimming pools and contact with children in nappies for the transmission of the parasite. In Chapter 4, whole faecal DNA was extracted from the faecal samples of the cases part of the surveillance and case-control studies and the Giardia assemblages and sub-assemblages causing infection were determined using PCR amplification and DNA sequencing of up to four parasite genes (beta-giardin, glutamate dehydrogenase, triose-phosphate isomerase and small-subunit ribosomal RNA). The majority of infections (64%) were caused by assemblage B, followed by assemblage A (33%), whereas mixed-assemblage infections were rare (3%). The majority of the assemblage A isolates belonged to the sub-assemblage AII and showed completed identity with previously described isolates, and six multi-locus genotypes were identified. The level of genetic sub-structuring as revealed by phylogenetic analysis was significantly higher in assemblage B isolates compared with A isolates: a higher proportion of novel assemblage B sequences was detected compared to what was observed in assemblage A isolates. A high number of assemblage B sequences showed heterogeneous nucleotide positions that prevented the unambiguous assignment to a specific sub-assemblage. Up to 17 different assemblage B multi-locus genotypes were found. The molecular genotyping results showed that Giardia assemblage B was responsible for the majority of the clinical infections and confirmed the occurrence of a high diversity of parasite multi-locus genotypes. In Chapter 5, we integrated the epidemiological and the molecular data generated by the enhanced surveillance and case-control studies and we studied the clinico-epidemiological differences between cases infected with Giardia assemblage A or B. Our results showed a difference in the age prevalence between the two assemblages, with assemblage A being more common in older cases. Cases infected with assemblage B reported a series of symptoms more frequently than cases infected with assemblage A, as well as reporting a longer illness. Although the exposure profile of the cases largely overlapped between the two assemblages, two different types of exposures were reported more frequently in the two groups of cases: keeping a dog in assemblage A cases and the presence in the household of children and children at nursery in assemblage B cases. The results suggested that assemblage A could have a major zoonotic reservoir, whereas assemblage B could be transmitted more commonly via the human-to-human route.
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Nurse, J. "The public health contribution to the development of policy for the prevention of violence and abuse in England." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2016. http://researchonline.lshtm.ac.uk/2548626/.
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Introduction: The aim was: “To document the process of policy development to prevent interpersonal violence in England, and explore the implications and potential role of public health”. Research gaps addressed include: an insider perspective of the policy process in general, and on the formulation process in particular. Violence and abuse are complex and challenging public health issues and wider lessons were drawn for public health. Methods: Qualitative research methods of documentary review, mapping and observation were used in the context of a case study of development of policy for violence prevention at regional and national levels in England from 2005- 2010. The research was based upon participatory observation methods as a public health advisor contributing to the policy process. In total 44 documents were reviewed and 157 meetings attended. Content and thematic analysis was conducted with violence, public health and policy frameworks followed by triangulation. Results: From initiation to publication, the policy process took ten years to complete (2003- 2012). Regional policy implementation contributed partially to national policy development. Networks and embedding within wider policy maintained the agenda. Evidence-based public health contributed to the policy, whilst, collaborative working, persistence and communication skills influenced uptake. Internal actors had the most power, especially the Prime-Ministers Office and the Home Office, whilst the Department of Health ensured development of the final policy. Senior leadership and champions drove the policy process and media reporting created windows of opportunity. Policy formulation revealed the importance of consensus and cyclical decision-making. Conclusions: Lessons include strengthening the art of public health: with clear leadership, communications and collaborative relationships, contributing to the uptake of evidence. Taking advantage of windows of opportunity and creating consensus is important for external actors. An integrated model of policy and the formulation process are presented to enhance understanding between policy and public health.
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Schölin, L. A. "Absolute abstinence? : a mixed methods study of alcohol use during pregnancy among parents and midwives in England and Sweden." Thesis, Liverpool John Moores University, 2017. http://researchonline.ljmu.ac.uk/5255/.
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This thesis explores alcohol use during pregnancy in relation to guidance, attitudes and social norms. The research was conducted in England, where at the time of the study pregnant women were advised to abstain but limit their intake if they chose to drink, and Sweden, where complete abstinence was endorsed. Alcohol use during pregnancy can have harmful effects on the developing foetus, yet there is an unsettled debate as to whether a safe limit exists. In some countries more than half of pregnant women report drinking and while factors such as age, socio-economic status, and pre-pregnancy drinking habits may influence continued drinking, there is a lack of research addressing wider socio-cultural factors, drinking occasions, and partner drinking. A greater understanding of why women drink during pregnancy can inform policy and practice to prevent alcohol-related birth defects. A mixed methods research study was undertaken, comprised of a survey, completed by 347 parents, and interviews with 44 parents and 16 midwives, aimed at exploring cross-cultural differences in prenatal alcohol use from a socio-ecological perspective. Data from the three strands were synthesised and contrasted using triangulation and mapped into meta-themes. The findings showed that English women were significantly more likely to drink during pregnancy than Swedish women. Partner drinking did not appear to influence women’s decisions around alcohol. Moral values underpinned the discourses of whether prenatal alcohol is acceptable; Swedish parents advocated for the rights of the foetus whilst English parents weighed that right against the woman’s right to autonomy. Consistent communication of an abstinence message was evident in Sweden, whereas English parents’ experiences varied, some even reported conflicting advice. In contrast, all midwives advised pregnant women to abstain. The findings suggest that clear communication of an abstinence message may contribute to shared social norms against drinking during pregnancy. However, a lack of clear evidence as to the effects of low level drinking was interpreted differently in the two countries.
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Enga, Kameni Innocent. "TRIPS and the WTO August 2003 deal on medicines: is it a gift bound in a red tape to developing countries." Thesis, University of the Western Cape, 2005. http://etd.uwc.ac.za/index.php?module=etd&.
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Faulkner, Amanda Ellen. "Do Variations in State Mandatory Child Abuse and Neglect Report Laws affect Report Rates among Medical Personnel?" Digital Archive @ GSU, 2009. http://digitalarchive.gsu.edu/iph_theses/58.
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Each state and territory within the United States is required by the Child Abuse Prevention and Treatment Act [42 U.S.C. 5101 et seq.] to maintain a mandatory suspected child abuse and neglect reporting law, requiring certain professionals who regularly see children to report any suspicions of child maltreatment to child protective services. It is well documented that mandatory reporters fail to report each case of suspected child maltreatment they witness. This study sought to determine whether differences in three specific variables within the mandatory report laws had an effect on the frequency with which medical personnel report suspected child abuse and neglect. The three variables analyzed were: definitional scope of emotional abuse; standard of knowledge required for a report; and severity of penalty imposed on those who knowingly fail to report cases of child abuse and neglect. Data was obtained from the Child Maltreatment 2006 annual report printed by the Health and Human Services Administration of Children, Youth and Families. Of the three variables assessed, only severity of penalty yielded a significant association with report rate. States with lower report rates were significantly more likely to have lenient penalties for failure to report compared with those who had report rates above the national average (O.R. = 5.0, 95% C.I. = 1.165-21.465). It is recommended that states consider increasing the severity of the sanctions enforced for failure to report suspected child abuse and neglect. Although standard of knowledge requirements were not significantly associated with report rates, the literature suggests that standardization of this portion of the mandatory report laws could improve report rates, particularly among physicians.
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Errington, Gail. "An investigation of factors contributing to the sustainability of home safety equipment schemes in communities at higher risk of injury : a multiple case study based on a national programme in England." Thesis, University of Nottingham, 2015. http://eprints.nottingham.ac.uk/30881/.
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Background: Unintentional injury in the home setting is the leading cause of mortality and morbidity among pre-school children in the UK. Multi-component, community-based intervention programmes are a recommended means of addressing injury. England operated a national home safety programme based on this approach from 2009 to 2011. The programme was targeted at high risk families and supported through national government funding. Little is currently known about the sustainability of injury prevention programmes, despite its relevance to public health planners and policy makers. Studies of programme sustainability in the global public health literature reveal an over-reliance on self-reported data from a single source and often under represent the target group perspective. Aim and setting of the current study: The current study aims to explore influences on the sustainability of a multi-component injury prevention programme targeted at high risk communities in England. Study design: The multiple case study design used qualitative methods to explore programme and contextual influences on sustainability in five sites. Multiple perspectives were considered including those of families in the target group and professionals involved in scheme delivery. Local, national and global public health policy documents were reviewed to understand the wider context for scheme sustainability and to corroborate research findings. Interviews with stakeholders in injury prevention policy at national and international level were undertaken to explore the conceptualisation of sustainability. Framework analysis was conducted within-case and to identify cross-case over-arching themes. The analytic framework, display matrices and production of case study profiles documented the analysis stages. ‘Thick description’ assists the consideration of transferability of findings to other settings. Principal findings: Little consensus was apparent in the conceptualisation of sustainability among policy makers. Although programme sustainability was seen as relevant to those agencies influential in policy development, this was not reflected in policy documents. Funding availability and a supportive local context for scheme delivery were identified as the two main conditions required for sustainability. Ongoing change within the national political and economic context in England challenged sustainability efforts of local schemes. Three key strategies to actively encourage sustainability were identified: programme adaptation; presence of a co-ordinator or champion and extending collaborative networks. The adoption of these varied in response to contextual changes over time. Ongoing benefits of the scheme were identified in all sites. These included improved safety practices reported by the target group and increased access to harder-to-engage families for scheme professionals. Programme components displayed differential levels of fidelity between and within sites over time. Based on the study findings, a conceptual framework for promoting the sustainability of community-based child injury prevention programmes is presented. Conclusions: This is the first study to comprehensively explore the sustainability of a community-based injury prevention programme in England. It has identified influences on sustainability that contribute to and support findings from other areas of public health. The proposal of a conceptual framework to promote sustainability within community-based child injury prevention programmes makes an original contribution to the field. Potential transferability of study findings suggests that public health gain may be increased by sharing the knowledge base between topics. The study identified considerable challenges to sustaining local public health initiatives amidst ongoing change in the wider political and economic environments. Educating practitioners and policy makers could improve understanding of sustainability and enhance the future prospects for local initiatives. It is therefore recommended that sustainability should form an integral part of the programme planning cycle for public health initiatives.
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Tucker, Helen Jean. "Integrated care : the presence, nature and development of integrated care in community health services in England and Ireland." Thesis, University of Warwick, 2012. http://wrap.warwick.ac.uk/56879/.
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Background: Integrated care is a policy imperative in health and social care services globally, and yet there are reported difficulties in defining, developing and sustaining this way of working. Research Question: This research explores staff views and experiences of the presence, nature and development of integrated care in two programmes of community services. Method: A case study approach was adopted using secondary analysis of qualitative data from staff questionnaires using themed content analysis and pattern matching, with findings triangulated with documentary sources. The study considers the presence and nature of integrated care using the conceptual framework “to what extent integrated care is for everyone (inclusive) and not just for some (exclusive)” as interpreted from the literature. The development of integrated care was explored using systems theory for the management of change in a complex environment. Findings: A meta-analysis of the two case studies demonstrated that integration was present in all 66 services within the two programmes. The nature of integrated care varied and was demonstrated as multiple types (in community hospitals) and processes (in community services). The most frequently reported type was multidisciplinary working. The processes most teams chose to develop were information sharing systems. The development of integration within the case studies was affected by a number of factors, such as commitment and staffing. Conclusion: This study provides new evidence of the presence, nature and development of integration within a wide range of established services spanning all ages. From this and other measures, the extent to which integrated care is presented as “exclusive” can be questioned. These findings have informed the development of a framework of five principles, reflecting whether integrated care is: for everyone, extensive, enduring, can be enabled and essential. The implications and application of this research for policy, service development and training are discussed, and proposals for further research include testing the applicability of this framework and widening this study.
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Quinn, John. "Patient and prisoner : mainstreaming NHS primary care and public health in the male prison estate in England and Wales." Thesis, Durham University, 2008. http://etheses.dur.ac.uk/1849/.
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Rice, Brian. "How is the epidemiology of heterosexually-acquired HIV infection evolving, particularly among black Africans, in England, Wales and Northern Ireland?" Thesis, City University London, 2016. http://openaccess.city.ac.uk/14936/.
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In the United Kingdom (UK), an estimated 107,800 people were living with HIV in 2013, of whom 55% were heterosexual men and women. Black African men and women accounted for the majority of heterosexuals living with HIV in the UK in 2013. In this PhD by prospective publication my research question is “How is the epidemiology of heterosexually-acquired HIV infection evolving, particularly among black Africans, in England, Wales and Northern Ireland?”. I conducted a quantitative analysis of national surveillance datasets and undertook literature searches. Most of my analysis was based on data from the three national HIV surveillance systems which constitute the HIV and AIDS Reporting System (New HIV Diagnoses database; Survey of Prevalent HIV Infections Diagnosed; CD4 Surveillance Scheme). I published the results of my analyses in six peer-reviewed papers between 2007 and 2014. My key findings were as follows: over the last decade an increasing proportion of black African heterosexuals born abroad but diagnosed with HIV in the UK acquired HIV whilst living in the UK; outward migration from the UK may explain why some black African heterosexuals were lost to follow-up from HIV care; the proportion of black African heterosexuals diagnosed late with HIV has not changed substantially; the uptake of HIV testing among black African heterosexuals has increased over time but remains low compared with that among MSM. To minimize the risk of HIV transmission and to maximise the benefits of earlier detection my key recommendation is to promote regular HIV testing among black African women and men in a range of healthcare and community settings in E,W&NI, particularly in primary care.
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Shuster, Jaime Lynn. "EXPLORING THE IMPACT OF TEXTING WHILE DRIVING TEXT BAN LAWS IN OHIO AND PENNSYLVANIA: A CASE STUDY." Kent State University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=kent1532442009056945.
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