Background: Emergency medical admissions in the United Kmgdom have been rising for many years. This rise has resulted in increasing pressures on hospitals' resources, with consequent difficulties in coping with peaks of admissions. This rise has not been intended or planned. The epidemiology of emergency medical admissions is poorly understood. Aims: To investigate the epidemiology of emergency medical admissions in Glasgow in terms of time, person and place. To explore variations in Glasgow's general practices' and hospitals' emergency medical admission rates. Literature review: Articles relating to variations in emergency medical admission rates were identified by searching bibliographic databases, cross referencing from known articles, consulting other researchers and hand searching of journal indexes. Relevant articles were included in a systematic review of the epidemiology of varying rates of hospitals' emergency admissions. Articles that postulated causes of the rise of emergency admissions or factors associated with varying admission rates were also reviewed. A summary of mechanisms whereby hospitals might cope with pressures of emergency admissions concluded the literature review. Published evidence of variations of rates of hospital emergency admission was limited. Most articles were found to contain postulated associations with variations in hospitals' emergency admissions. While many published mechanisms for hospitals to adapt to pressures from emergency admissions were identified, only a minority of these had been formally evaluated. 3 Setting: Greater Glasgow Health Board residents (813,029 adults at June 1997). Data obtained from the Health Board's Community Health Index (CHI). Subjects: 537,798 Greater Glasgow Health Board residents admitted to Glasgow hospitals7 medical beds between 1980 and 1997 (43,236 patients in 1997). Data obtained from Scottish Morbidity Record database one (SMRl). Methods: Anonymised CHI and SMRl datasets linked by patients' general practitioners' codes, using a computer database package. Standardised emergency medical admission rates were calculated by the database. Computerised maps of standardised emergency medical admission ratios were plotted for Glasgow7s postcode sectors to show geographical variations. Correlation and logistic regression were used to explore variations in standardised emergency medical admission ratios. Outcome measures: Crude emergency medical admission rates. Standardised emergency medical admission ratios adjusted for patients7 age, sex and Carstairs7 deprivation categories. Results: The numbers of emergency medical admissions doubled between 1980 and 1997. Emergency medical admission rates increased steeply with increasing age of patients, more than doubling for every two decades. Men above 40 years had approximately 20% higher age specific emergency medical admission rates than women. Emergency medical admission rates were more than twice as high amongst patients from Glasgow's most deprived areas, compared with the most affluent. Cardiovascular disease (ICD10 chapter IX) discharge diagnoses were commonest (27.2% in 1997)' followed by the non-specific diagnoses in ICDlO chapter XVII (21.0%). The non-specific diagnoses mainly comprised chest pain (9.6%) which was the commonest reason for admission. Between 1980 and 1997, non-specific diagnoses (ICD10 chapter XVII) increased at twice the rate of all other ICDlO chapters of diagnoses. There were two areas of Glasgow that had raised standardised emergency medical admission ratios (adjusted for patients' ages, sex and deprivation). These corresponded to the catchment areas of two acute hospitals, which had substantially higher adjusted emergency medical admission ratios than had the other three. There was a 2.51 fold variation between the top and bottom deciles of Glasgow's general Practices' crude emergency medical admission rates. After adjustment for their patients' age, sex and deprivation characteristics, this reduced to a 1.87 fold variation. Additional adjustment for general practices' admitting hospitals (along with their patients' age, sex and deprivation) accounted for a total of 84% of the inter-practice variation in crude emergency medical admission rates. Fundholding general practices had modestly raised emergency medical admission rates (odds ratio 1.06.) There were no associations between practices' rates of emergency medical admissions and any other measured practices' characteristics (including numbers of partners, practices' sizes or dispersions, immunisation and cytology rates). Conclusions: This large study discovered epidemiological associations between emergency medical admission rates and patients' sex and socioeconomic deprivation that had not previously been shown. It showed that emergency admission rate variations between general practices were only partly accounted for by patient characteristics. Apart from fundholding status, difference between practices were not related to variations in their rates of emergency medical admissions. However, a substantial part of the variation between general practices could be attributed to differences between their admitting hospitals.

Many diseases can be prevented or mitigated through behaviour change, but we lack a quantitative model that can accurately predict these changes and inform policies designed to promote them. Here we introduce a quantitative model of health behaviour that takes into account individual-level barriers, the health system, and spread between individuals. We investigate limits of the model where each of these determining factors is dominant, and use them to predict behaviour from data. We apply the model to individual-level geographic barriers to mothers giving birth in a health facility, and find evidence that ease-of-access is a major determinant of delivery location. The geographic barriers allow us to explain the observed spatial distribution of this behaviour, and to accurately predict low prevalence regions. We then apply the model to the role of the health system in determining health facility usage by mothers of sick children. We show that local health facility quality does predict usage, but that this predictive power is significantly less than that gained by including unaccounted-for spatial correlation such as social influence. We also show evidence that results-based funding, rather than traditional input-based funding, increases usage. We develop a psychologically-motivated ‘complex contagion’ model for social influence and incorporate it into a general model of behaviour spread. We apply this model to short-lived behavioural fads, and show that ‘nudges’ can be very effective in systems with social influence. We successfully fit the model to data for the online spread of real-world behaviour, and use it to predict the peak time and duration of a fad before the peak occurred. Finally, we discuss ways to incorporate disease state into the model, and to relax the limits used in the rest of the thesis. We consider a model which links health behaviour to disease, and show that complex contagion leads to a feature that is not present in traditional models of disease: the survival of an epidemic depends non-trivially on the initial fraction of the population that is infected. We then introduce two possible models that include both social influence and an inhomogeneous population, and discuss the type of data that might be required to use them predictively. The model introduced here can be used to understand and predict health behaviours, and we therefore believe that it provides a valuable tool for informing policies to combat disease.

The main areas considered within this qualitative study are the extent to which the Adult Support and Protection (Scotland) Act (2007) (ASPA) impacts upon the civil and human rights of adults’ by exploring the “problem” it was developed to resolve, the reality of implementation and the construction of thresholds for intervention in practice. Despite a level of clarity about the need for this legislation inconsistencies of understanding about where the ASPA should be targeted created challenges for implementation, particularly around the issue of capacity. The scope of the population for whom the ASPA was intended remains sizeable and broadly unformed. The vision of the framers that the ASPA would provide support and protection for a range of adults at risk of harm without being overly intrusive in their lives appears, at least partly, to have been realised. Challenges to implementation have largely focused on; the parameters of the ASPA and the population it aims to protect, the conceptualising of what an adult protection referral might consist of and the impact of this understanding on thresholds for intervention. Procedural challenges identified were specifically related to the involvement of health and the understanding of adult protection of other stakeholders, for example the police, inconsistent recording of data and information sharing. The interaction between formal and informal knowledge and consideration of a range of key concepts drawn upon by practitioners to determine thresholds for intervention creates a built in inconsistency of approach with a clear element of subjectivity. The rights based approach integral to all intervention under the ASPA, was well applied by the practitioners in the study and could be considered to have protected the citizenship of the adults to some extent. Perhaps more accurately it could be said that the already conditional citizenship experienced by many of the adults was not further eroded.

M.Tech. (Somatology) / Osteoarthritis (OA) is considered a degenerative form of arthritis that affects the smooth cartilage covering the ends of bone (Sharma, 2006; Flynn & Ohnson, 2007). It is currently estimated to be the leading cause of musculoskeletal disability and pain amongst those 65 years and older (McKay et al., 2012; Vuolteenaho et al., 2013). Disease progression is slow as smooth cartilage at the ends of bone is worn away causing painful bone on bone friction. Any joint may be affected, the hips, spine, knees, small bones of the fingers and the base of the thumbs are commonly affected. Massage therapy is an age old practice that may be dated back to the ancient Roman, Geek and Egyptian dynasties (Braun & Simonson, 2008). Massage once formed a significant part of mainstream medical and nursing occupations, forming the basis for present day physiotherapy. To this day, numerous occupations still incorporate various aspects of massage (Casanelia & Stelfox, 2010). Swedish massage or Remedial massage, as still used today, found its origins in the early 19th century during the “Swedish Movement Cure”. Henrik Ling coined the phrase “Swedish Massage” when he developed a series of movements that he used in the treatment of various conditions and ailments. Ling did however not intend for these movements to be done for extended and frequent periods of time, which is necessary when it is ones occupation, and by the conclusion of the 19th century it was found that therapists were already presenting with strain injuries (Prichard, 2007). Western massage has been adapted into numerous forms over the past 100 years. Pyves (2001) explains that the early techniques were not intended to be used for prolonged and frequent sessions. Such massage sessions, he feels, may be to the detriment of the therapist. Prichard (2007) explains that the massage therapist experiences physical problems that arise mostly from cumulative effects. Cumulative joint stress may be caused by the awkward, physically stressful and/ or repetitive movements whilst applying pressure. Individual injuries or strains may over months or years accumulate into an overuse injury (Prichard, 2007). Many other occupations have been identified as inducing a greater risk for the development of OA, such as the agricultural sector (Thelin et al., 2004), the housekeeping industry (Caspi et al., 2001; Rossignol et al., 2003 and Vingard et al., 1991), the construction industry (Dillon et al., 2002; O’Reilly et al., 2000 and Sandmark et al., 2000), the clothing industry (Rossignol et al., 2005) and the occupation of physiotherapy (Snodgrass & Rivett, 2002)...

Street children are a population highly at risk of HIV/AIDS/STIs, which is becoming an overriding concern. Due to the critical importance of the problem under investigation, this study focuses on the causes and consequences of risks involved in the dynamics of HIV/STIs transmission and the occurrence of AIDS. The study utilised a qualitative paradigm, with two methods of data collection from children and young people in the street; these were observation and in-depth interviews, which emerged as the most appropriate methods for investigating the HIV/AIDS risks and vulnerability of street children. The study was guided throughout by a public health theoretical framework. The study revealed that children leave home due to parental mistreatment; they engage in risky sexual behaviour living in the street, they have little or no understanding of HIV, AIDS and STIs or of the respective relationship between these, and they have negative attitudes towards HIV/ STIs treatment and people affected by HIV/AIDS. Four domains of HIV/STIs and AIDS risks and vulnerability of street children were identified: parental mistreatment (causing vulnerability to exposure and thus the likelihood of acquiring HIV and STIs); high risk-taking sexual behaviour (creating vulnerability to infection); lack of knowledge regarding HIV, AIDS and STIs (vulnerability to re-infection); negative attitudes towards HIV/STIs treatment and people affected by HIV/AIDS (resulting in denial, failure to seek treatment and contributing to the perpetuation of the problem); and the effects of living in the street (increasing vulnerability to progression from HIV to AIDS). By exploring the prime and subsequent root risk factors, these complex interlinking risks have been analytically conceptualised, providing a model which explicates the complete phenomenon of risks and vulnerability to HIV/STIs and AIDS for street children, as well as for broader society, in a cyclical manner. Hence, HIV/STIs and AIDS is not a health problem among street children only, it is a public health problem in the broader society in Nepal. Having identified these problems for street children, this study offers an intervention plan, the CAP model. This model extends previous public health approaches and argues for targeted action to prevent risk and vulnerability for children in the street, and suggestions for policy and legislation which would enable the implementation of the model are offered.

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Master of Public Health - MPH / The worsening humanitarian situation in Angola and the great lakes due to protracted wars, led to an influx of refugees in Namibia since 1992. The peak of the influx was between 1999-2002 when the camp population reached 25,000 people. Among the many challenges faced by these refugees was their health and nutrition. Malnutrition accounted for high levels of morbidity and mortality among the refugees. This study covered a review of health and nutritional situation of children less than five years of age in Osire refugee camp. It proposed that prevalence of malnutrition among this age group is a proxy for the nutritional status of the refugee population. It also considered the factors prevalent in the camp that affect the nutrition of the children. / South Africa

Magister Psychologiae - MPsych / This study explored women's perceptions of how their illness (Rheumatoid Arthritis- RA) affects their relationship with their intimate life partner. RA is a chronic, inflammatory, auto-immune illnes, which mainly affects the synovial membranes of multiple joints. This highly inflammatory poly-arthritis may lead to joint destruction, chronic pain, deformity and loss of functioning as unfortunate outcomes of the established illness. RA affects key life domains such as psychological well-being, social well-being, family and couple relationships, employment, loss of independence and restrictions in daily functioning. / South Africa

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