Multi-purpose Mobile Young Child Clinics were developed following a Comprehensive Mass -immunisation Campaign in the Ankole district of Uganda. Combining curative and preventive functions, and run entirely by teams of medical auxiliaries, the Clinics were designed as an expedient until basic health services are developed widely enough to cover all rural areas. The effective coverage of each clinic was shown to be a radius of 6 km (3.5 miles).

This thesis is a study of the daily working routine of a hospital X-Ray department, and it describes the empirical variation observed in a real department by the use of mathematical models| these models may be used to predict the effects of changes in departmental operating policy, thereby leading to a more effective use of the available resources* An outline is made of the working procedures of a typical X-Ray department, and there is also a survey of the literature. The various types of variability to be observed are described, together with some efficiency measures which may be adopted* In Chapter k the results of survey work in the Royal Infirmary, Edinburgh are presented in the form of an analysis of the work-load on the X-Ray department, with respect to its constitution, origin and distribution over the X-Ray facilities* An investigation is made into the relationship between the time to perform a given examination, and the age, sex and mobility of the patient* It was found that considerable differences exist between the service time distributions of patients with different characteristics, and these were later used to consider if improvements in efficiency might result by dealing with patients in homogeneous groups* A number of comments are made on particular problem areas in the Royal Infirmary.

No description available.

No description available.

This thesis consists of personal observations made during the two years, 1973 and 1974 when I was Chief Medical Officer on the Turks and Caicos Islands. These Islands are a British Colony of 6,000 people. They are located in the West Indies. Their History and Geography are briefly described. The problems of defining health are discussed in detail and there is a brief historical review of the methods of assessing Health. The different methods currently available for assessing Health are described in detail and the literature on this subject is reviewed. Mention is made of the difficulty of attempting to create a comprehensive Health Index. The Health of the people of the Turks and Caicos Islands was therefore assessed by looking at as many parameters of Health as possible. This includes an historical review of medicine on the islands; an evaluation of mortality statistics, hospital and out-patient consultations; several population surveys; assessment of the status of environmental health; and an analysis of the Islands medical resources and manpower. The entire population of 6,000 was included in the study. A single record folder was created for each person to include his total medical care - hospital and outpatient. The study is believed to be one of the most comprehensive studies of the total health of a complete community. Over 10,000 deaths on the Turks and Caicos Islands during the past 100 years were analysed by me. The results of cause of death and age at death are presented. Birth and death rates for the past 50 years have been calculated and the resultant graph analysed. All deaths during the years 1973 and 1974 have similarly been analysed. Over 25,000 out-patient consultations during 1973 and 1974 have boon classified by me, by diagnosis and age of patient. The results have been compared with the 1971 General Practice Survey in England. In addition, over 1,000 hospital discharges during 1973 and 1974 have been analysed, by diagnosis, age, sex, duration of stay and Island of origin of the patient. A wide range of population vital statistics has been presented. This includes population size and age distribution, movement between Islands and type of home. Birth, death and infant mortality rates have been calculated and discussed. Numerous population surveys have been carried out, and the results analysed. These include studies on chronic illness, visual problems, auditory problems, nutrition, infectious diseases and genetic abnormalities. The impact of a successful family planning programme is discussed. The Health of the Environment has been evaluated. A household survey was carried out to assess water, sewage and refuse status. Household pests were assessed. The Aedes aegypti was identified as a potentially harmful mosquito on the Islands. Water shortage was shown to be a major environmental health problem. The Islands social services and preventive medicine programmes are assessed and described. Throughout the study, comparison has been made with other regional West Indian Territories, with other small communities throughout the world, and with a developed nation represented by the United Kingdom. Differences between the Turks and Caicos Islands and other countries have been analysed and discussed. Finally the implications of being a small community are discussed as well as the impact of recent economic development on the Health of the Turks and Caicos Islanders.

No description available.

The thesis reports on a two-year study which looked at decision-making in two Scottish health boards. The research was prompted by: (1) a dearth of knowledge concerning the dynamics of decision-making in the National Health Service (NHS) at local .level; and (2) a desire to understand the factors at local level which might help to explain the persistence of resource imbalances between different sectors of health care despite numerous attempts to remove them. The case study, which forms the core of the thesis, has two aims: (1) to describe decision-making in the two boards in the area of development fund allocations (ie growth monies) in order to discover the process by which priorities are set; and (2) to provide insights into the operation of the management structure introduced when the NHS was reorganised in 1974. Reform was largely about improving the rationality of decision-making and the case study aims to show what this involved in practice. Rational and incremental theories of decision-making are reviewed for their usefulness in understanding events, although no single theoretical perspective is favoured over others. The main study findings were: (1) that, contrary to much popular opinion, decision-making in the NHS is, to a significant degree, decentralised - both boards possessed a large measure of influence over the services they provided; (2) that, despite this discretion, the emphasis in allocation decisions was on policy maintenance rather than on policy change; (3) that part of the explanation for this resided in a number of constraints, both external and internal, operating on decision-makers; and (4) that a number of coping strategies were adopted by decision-makers in order to facilitate the task of allocating resources and to come to terms with the uncertainty inherent in the decision-making environment. The research also revealed a number of tension points arising from the management structure, many of which served to reinforce the obstacles to change through development fund allocations.

No description available.

The aims of this thesis were to describe views of the dependent elderly and their carers about long-term care services, and to explore ways in which a more consumer-oriented approach to the delivery of services might influence the outcomes of care. Taking the results of the studies together, the following conclusions were reached:- (1) Consumers lack information about long-term care services (2) Perceived unmet needs for services are modest, but specific (3) Evaluation of long term care services from a consumer perspective is possible using a variety of approaches (4) There is considerable scope to change practice towards improving quality of life of the dependent elderly and their carers (5) There is no evidence that a consumer-oriented approach leads to unmanageable demand for resources, at least in the short term. Incidental findings included:- (1) A primary care team's support to the carers of the demented elderly was inadequate not because of failure to identify cases, but by failure to support known cases. (2) The level of community support to its perceived adequacy by carers did not affect the likelihood of institutionalization of elderly patients following admission to acute hospital care. However, carers were accurate in their predictions of that outcome, and carers quality of life improved most for those who had greatest proximity to dependents. (3) There was a large overlap of dependency between geriatric and psychogeriatric patients in long term hospital care suggesting an illogical adminstrative structure. (4) There was lower patient dependency, cost of care (to the taxpayer) and higher nurse morale in nursing homes than in long-term hospital wards, but quality of life appeared to depend on factors operating at the level of the individual homes or wards, rather than which sector provided care.

Some groups of patients obviously use the services provided by the general practitioner in the National Health Service more frequently than others. Frequent attenaers can be divided into two main categories. There are those who have frequent consultations but do not necessarily have frequent episodes of illness, and on the other hand those who have frequent episodes of illness, the individual episodes not necessarily requiring frequent consultations. The use of the general practitioner services by patients is probably dependent on two main factors, these factors being the nature of the illness and the patient's reactions to that Illness. The reactions to the illness may be influenced by the patient's personal characteristics and by his environmental conditions. This study attempts to evaluate the morbidity in adults in both groups of frequent attenaers. The illnesses in these groups are compared with the pattern of morbidity in the practice as a whole, the findings regarding morbidity in this practice having first been compared with published findings from other practices in an attempt to ensure that the practice is fairly typical. Further studies have been conducted to try to assess the personal and social characteristics of the group of patients who have frequent episodes of illness. For this part of the study a control group paired by age and sex has been used. For the reason that with children the doctor-patient contact is usually initiated by the parent rather than the child, morbidity in patients under fifteen years of age has been omitted from this latter part of the study.