Thesis (M. Med. Sc.)--University of Hong Kong, 2006.

Thesis PlanB (M.S.)--University of Wisconsin--Stout, 2006. / Includes bibliographical references.

O presente trabalho tem como pano de fundo a regulação de acesso a redes de telecomunicações e os problemas relacionados ao cumprimento das respectivas regras. A partir da descrição e conjugação de literaturas especializadas, a PRIMEIRA PARTE do texto delimita um conceito de estratégia regulatória, apontando seus elementos-chave as ferramentas e abordagens passíveis de escolha e combinações pelo regulador em suas tomadas de decisões , bem como as vantagens e desvantagens associadas a cada um deles. A SEGUNDA PARTE explora as características gerais do setor e da regulação das telecomunicações com vistas a facilitar a estruturação de um conceito de estratégia regulatória de compliance em regimes de acesso a redes. Na TERCEIRA PARTE o conceito proposto é aplicado ao caso brasileiro da regulamentação da EILD (Exploração Industrial de Linhas Dedicadas), uma modalidade de contratação de redes de operadores dominantes, como forma de identificar e avaliar criticamente as estratégias de compliance dos diferentes regimes de EILD já vigentes no país. Nesse processo são apontadas limitações das estratégias de compliance instituídas pelas normativas de EILD analisadas. Ainda nessa etapa o conceito proposto é aplicado a regimes internacionais de acesso a redes de telecomunicações, o que permite comparar a estratégia de compliance do atual regime brasileiro com as estratégias de compliance de regimes de acesso a redes de telecomunicações em países que também enfrentaram dificuldades para assegurar o cumprimento das regras de acesso. Conclui-se destacando a funcionalidade do uso do conceito para delimitação e análise das estratégias de compliance de regimes de acesso a redes de telecomunicações, o que auxilia o regulador em suas tomadas de decisão relacionadas à questão. / The thesis focuses on the regulation of telecom network access and the problems of compliance arising thereof. By describing and comparing some literature on the theme, PART ONE of the research defines a concept for regulatory strategy pointing out its main elements tools and approaches that might be selected and matched by the regulator , as well as the advantages and disadvantages related to it. PART TWO explores telecom´s sector and regulation basic features in order to facilitate the construction of a concept for compliance regulatory strategies applied to network access regimes. PART THREE presents a case study by means of which the proposed concept is applied to the regulation of leased lines (EILD) in Brazil a type of contracting network from dominant operators as a way to identify and discuss the compliance strategies of the different EILD regimes within the country. At this stage of the research some failures regarding the compliance strategies are underlined. Moreover the proposed concept is applied to international telecommunications network access regimes in a way to compare the compliance strategy within the current Brazilian access regime with the compliance strategies put in force by overseas regulators who faced many difficulties to deal with non-compliance problems. The conclusion underlines that the adoption of the proposed concept is helpful to identify and evaluate compliance strategies within the telecommunications network access regimes and therefore may facilitate the regulator task when deciding on the issue at hand.

Climate change is a type of prisoner’s dilemma. Reductions in greenhouse gas (GHG) emissions are a public good and are costly to provide. Consequently, nation-states generally have done little to curb their emissions. Countries could be encouraged to reduce their emissions if the international community of states were to sanction, or the world were to shame, states that did not act. However, financial and technological aid is more likely to induce states to impose tougher restrictions on GHG emissions. In order for Copenhagen to precipitate major action on climate change the treaty must either compel countries to fulfill their obligations or assist states in transitioning their economies away from fossil fuels toward alternative energy sources. If the treaty fails to do both of these things then we can only hope that the largest producers of greenhouse gases either take steps to reduce their emissions voluntarily or are forced to take action in response to domestic pressure from their citizens and/or sub-national governments. Otherwise, we will have no choice but to adapt to an increasingly warmer planet and the consequences thereof. / Arts, Faculty of / Political Science, Department of / Graduate

This diploma thesis analyses non-compliance phenomenon incidence rate of patients diagnosed for diabetes mellitus. Theoretical part studies non-compliance phenomenon and characteristics of diabetes mellitus disease. Practical part evaluates information resulting from questionnairing.

Chronic nonadherence is the complete lack of adherence on the part of a patient to at least one aspect of their therapeutic regime for extended periods of time. Chronic nonadherence is similar to other forms of nonadherence in that it is a phenomena which is dangerous for patients, frustrating for practitioners, and costly to the health care system. However, unlike other forms of nonadherence, very little is known about this subject. In order to determine factors related to chronic nonadherence to a home exercise program, 15 male arthritis patients of varying ages underwent an in-depth structured interview. Eight of these patients were identified by the Arthritis Society as being chronic, treatment nonadherents. The other seven patients were randomly chosen from among the population of male arthritis patients in order to provide a comparison to the chronic nonadherent population. Ten variables were examined in this study in the hopes of determining factors related to chronic nonadherence. These variables were as follows: demographics, The Health Beliefs Model, patient's explanatory model, nature of the illness, satisfaction with practitioner attributes, shared responsibility, overall satisfaction, attitudes of significant others, use of unorthodox treatments, and problems with the home exercise program. Data analysis failed to produce any statistically significant findings, however the study did point to some interesting associations. One finding from this study is that nonadherence seems to be related to patient's Health Beliefs Models. Based on this finding the study then goes on to recommend an appropriate intervention which can be used by practitioners to enhance patient adherence. A second finding from this study is that a small number of the chronic nonadherent group were actually adherent to their home exercise programs. Several explanations have been provided as to how these patients might have been falsely labelled as chronic nonadherents. / Arts, Faculty of / Social Work, School of / Graduate

Student Number : 9411363J - PhD thesis - School of Medicine - Faculty of Health Sciences / This study on non-compliance with chemotherapy in the oncology patient with a good prognosis was done in the Johannesburg Hospital in South Africa. 114 compliant and 33 non compliant oncology patients with a good prognosis showed significant differences (at the 5% level) on the MCMI2 on the following scales: Disclosure, Debasement, Avoidance, Passive Aggressive, Self-defeating, Schizotypal, Anxiety, Dysthymia, Alcohol Dependence and Major Depression. In a Linear Discriminant Function Analysis . two variables, Debasement and Schizotypal were selected that linearly affected compliance significantly. A linear discriminant model was constructed from the two variables which could predict non compliance in these patients 72.5% of the time. The next step was to construct a treatment model , an intervention which would have some impact on improving compliance. After trial and error with various methods, a Medical Trauma Debriefing Model was worked out and used, based on the Wits Trauma Intervention Model, which up to this time had been used for trauma debriefing of people who had experienced trauma due to violence and abuse on a criminal or political level. This is in accordance with recent studies which are beginning to show the link between PTSD and medical non-compliance. It is suggested that Medical Trauma Debriefing, as a preventative measure, be incorporated automatically and routinely into the treatment of certain medical and surgical conditions, especially in Oncology.

Indiana University-Purdue University Indianapolis (IUPUI) / Chronic kidney disease (CKD) places a high personal and economic burden globally on individuals, families, and society. Although kidney protective medications slow the progression of CKD to end stage kidney disease, adherence to these medications is inadequate. The primary purposes of this study are to: 1) describe the illness and treatment beliefs of CKD patients in stage 3 guided by the Common Sense M model (CSM); and 2) examine the relationship of those beliefs with adherence to renal protective medications, ACE-I. Secondary purposes of this study include determining adherence levels of ACE-I among patients with CKD stage 3; examining relationships between individual and clinical characteristics with patient beliefs and medication adherence with ACE-I; and examining the relationship between the Medication Adherence Report Scale (MARS) and the Medication Possession Ratio (MPR). Using a descriptive cross-sectional design, a convenience sample of 92 individuals with Stage 3 CKD was obtained from a Midwestern VA medical center. Data were collected through self-administered mailed surveys and medical record reviews. Data analyses were performed using descriptive statistics, correlation, t-tests and ANOVA. Seventeen symptoms experienced were perceived as related to CKD by at least one respondent with most reporting legs/feet swelling (n=31). Top perceived cause of CKD was aging (60%). Revised Illness Perception Questionnaire (IPQ-R) items were scored from 1 to 5 with higher scores indicating perceptions of higher personal and treatment control of chronic, cyclical illness with serious consequences and negative emotional reactions. In this study, the CKD timeline was perceived as a long-term chronic rather than short-term acute condition (M = 3.8), with minimal cyclical exacerbations (M = 2.7), and moderate severity of consequences (M = 3.1). Respondents perceived having both, but more personal control than treatment control of CKD (M = 3.5 v 3.2). Participants did not perceive CKD as related to a great negative emotional response (M = 2.8). Illness Representations were not found to be significantly correlated with self-reported medication adherence. Medication adherence levels by self-report (M = 4.8 [5 = perfect adherence]) and pharmacy refill records (73% had perfect refill ratio of 1:1) reveal highly adherent levels among this sample.

Bakgrund: Distansmonitorering möjliggör fjärrutbyte av medicinska data mellan patienter och vårdpersonal vilket kan öka patientens tillgång till vård och ge effektiv sjukvård på distans. Det kan skapa goda förutsättningar vid upprätthållande av egenvård genom att patienten blir en aktiv deltagare i hanteringen av sin sjukdom, vilket är en väsentlig del för compliance. Syfte: Att beskriva på vilket sätt distansmonitorering kan påverka patientens compliance. Metod: En integrativ litteraturstudie. Databassökningar efter relevanta artiklar har gjorts i PubMed och CINAHL vilket resulterade i 17 artiklar. Artiklarna är granskade utifrån SBU:s granskningsmallar. Analysen har skett enligt Whittemore och Knafls analysmetod. Resultat: Tekniken står inför utmaningar där patienten har ett högre förtroende för det fysiska mötet med vårdpersonalen. För att patienten ska använda sig av distansmonitorering är det viktigt att tekniken är enkel och bekväm att använda. Distansmonitorering gör informationen mer lättillgänglig och ökar patientens kunskap och medvetenhet om sitt hälsotillstånd, vilket bidrar till bättre compliance. Patientens grad av drivkraft för följsamhet ökar med distansmonitorering och möjligheten till egenvård förbättras och leder till en personlig utveckling.  Slutsats: Distansmonitorering ökar patientens kunskap om sin sjukdom och behandlingsrekommendationer vilket ger en större medvetenhet kring hälsotillståndet och ökar compliance. Huvudsakliga faktorer som påverkar compliance är att distansmonitoreringen är användarvänlig och personcentrerad.

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