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The aim of this thesis is to contribute to existing knowledge. If the knowledge is not useful in building society it has limited value. In order to be a tool for decision-makers, Preventive Home Visits (PHVs) are described and discussed according to a realist synthesis approach. The premise of this approach is that a single trial cannot tell the whole story and that understanding theoutcome pattern is much more important than seeking regularities in results across different trials. In order to understand the o utcome pattern, the PHV strategy in Nordmaling is examined against other trials and scientific work, and also in grey literature such as reports and workingpapers. An increasing population of seniors means that resources for health and elderly care are being scrutinised in order to achieve the best possible health for the money invested. PHVs represent one strategy that attempts to promote health among independent seniors. This thesis is a multidisciplinary study aiming to gain knowledge about the effects of PHVs and to understand the mechanisms of importance when implementing this particular strategy. The point of departure is a study conducted in Nordmaling in the north of Sweden among healthy seniors aged 75 years and over. The study, conducted as a controlled trial during 2000 and 2001, showed a decrease in mortality as well as the utilisation of care, and an improvement in indicators of perceived health. Cost analyses showed significant savings for the municipality following a reduction in the use of home help. These and other savings combined with costs of the intervention were related to saved life years and used to conduct health economic analyses. Medical and social records from the primary health centre and the municipality, along with official registers provided information for modelling health economic analyses from a lifetime perspective. Results showed that the costs of PHVs were less than 10 000 Euros per gained life year, against an acceptable level of cost effectiveness of 50 000 Euros. Using a shorter time perspective, the result was even more favourable for PHVs. It was evident that the time window used in the analyses, the normative choice of including future healthcare costs or not, and how to handle the value of the seniors’ production were important factors in determining the results. Two years after the trial, in-depth interviews were conducted with 5 seniors who had experienced PHVs, in order to gain understanding of the outcome of the PHV trial in Nordmaling. Participants were selected with respect to their health and how they responded to advice given during the PHV trial. Grounded Theory was used to analyse the interviews. Seniors who used autonomous coping strategies in everyday life gained less from PHVs than other seniors. All participants could benefit from PHVs, but in order for these to be successful it was important for the home visitor to be professional and to understand how the different coping strategies of seniors worked. Taken together, the different aspects of this study raised normative questions that are discussed in this thesis. One, whether the production of seniors has any monetary value in health economic analyses conducted from a societal perspective, was addressed in a smaller diary study where 23 seniors were asked to keep a diary in order to identify everything they did over a oneweek period. It was evident that most of the respondents “produced” a lot, however the production of seniors is rarely taken into account in health economic analyses. The concept of “senior production” includes both the market value of what seniors do, as well as the value of what society can avoid doing if the seniors are independent and healthy.

In order to find politically feasible ways to reduce greenhouse gas emission emissions, governments must examine how policies affect a variety of stakeholders. The costs and benefits of low carbon technology options are unique and affect different market participants in different ways. In this thesis, we examine the cost effectiveness of carbon mitigation technologies and policies from the social perspective and from the perspective of consumers. In Chapter 2, we perform an engineering-economic analysis of hybridizing concentrating solar thermal power with fossil fuel. We examine the cost effectiveness of substituting the solar power for new coal or gas and find the cost of mitigation to be approximately ~$130/tCO2 to ~$300/tCO2. In Chapter 3, we quantify some externalized social costs and benefits of wind energy. We estimate the costs due to variability and transmission unique to wind to have an expected value of ~$20/MWh. In Chapter 4, we quantify the cost effectiveness of a renewable portfolio standard and a carbon price from the perspective of consumers in restructured markets. We find that both that the RPS can be more cost effective than a carbon price for consumers under certain circumstances: continued excess supply of capacity, retention of nuclear generators, and high natural gas prices. In Chapter 5, we examine the implications of lowering electricity sector CO2 emissions in PJM through a Low Carbon Capacity Standard (LCCS). We estimate that an LCCS would supply the same amount of energy (105,000 GWh) as the RPS’s in PJM and an additional ~10 GW of capacity. We find that the LCCS could be more cost effective for consumers than an RPS if it lowered capacity prices.

This study was designed to identify correlates of success in Supported Employment (SE) programs for persons with psychiatric disabilities. Indiana policy-makers are seriously considering a managed care, or "capitated," system of payment to make SE provider programs more efficient economically. However, many agencies are concerned about providing services to more severely impaired individuals because of the potentially higher costs of serving these individuals. Two studies are included in this project. The goals of the first study were to identify SE consumer (clinical) characteristics that predict (1) successful outcomes, defined as whether the consumer achieves gainful work, and (2) program costs, defined as the amounts of SE service hours utilized by consumers who obtain work. In two large samples of SE consumers with serious mental illness, no clinical characteristics (e.g., diagnosis, rated functioning, hospitalization history) were associated with vocational outcome or service costs. The goal of the second study was to describe the types and amounts of services utilized by SE consumers who obtain work. Specific service categories associated with obtaining work were travel, training, and advocacy that was unrelated to the consumer's job. The implications of these findings are discussed in the framework of the debate over clinical versus empirical prediction. The need for a theoretical model of SE services that allows the use of predictive clinical and consumer driven services is also discussed. / Department of Psychological Science

We are at a point in the history of higher education in South Africa when radical changes are occurring in instructional delivery system models. Of increasing significance is a mixed mode of traditional and distance delivery (i.e. Telematic Learning Systems at the PU for CHE). In this changing environment, language lecturers, the persons responsible for developing language modules within various Telematic programmes, remain a key element in the teaching and learning process. However, these lecturers are suddenly expected to make appropriate decisions in terms of distance education technology classification, evaluation, and consequent selection without the necessary knowledge and/or capacity to make effective technological decisions. The purpose of this article is to assist "Lone Ranger" language lecturers, in making pedagogically sound decisions when classifying, evaluating and selecting distance education technologies by: (a) considering technology selection as part of the instructional design process, (b) referring to some reasons for using technology for language learning, (c) focusing on criteria for classifying and evaluating distance education technologies, and by (d) reviewing selected studies in order to indicate the application possibilities of technologies for language teaching and learning. / Thesis (M.A. (English))--Potchefstroom University for Christian Higher Education, 2002

In recent years, there has been much debate regarding the rationality of consumption and cost effectiveness of antidepressants. The economic aspects of treating depression are becoming more frequently evaluated as newer antidepressants become available and as healthcare entities attempt to address increasing costs. The aim of the research. To investigate and assess the possibilities of a more rational use of the public and private funds of the Lithuanian population in the cases of medicament depression treatment. The tasks of the research: 1. To perform a comparative analysis of the antidepressant consumption in the years 2004 to 2009 in Lithuania. 2. To evaluate depression diagnosis and treatment effectiveness and depression diagnosis dynamics in Lithuania from 2004 to 2009. 3. To perform antidepressant cost analysis from 2004 to 2009 in Lithuania. 4. To perform the cost-effectiveness analysis of depression treatment and propose the possible ways for costs rationalization. Scientific novelty of the research. For the first time, depression relapse rate was used as a medicament depression treatment effectiveness evaluation indicator in assessing the rationality of the costs of treatment with antidepressants. The survey data can be used in practice when dealing with antidepressants consumption and the improvement of the effectiveness of evaluation and reimbursement systems in Lithuania. / Pastaraisiais metais kyla daug diskusijų dėl antidepresantų panaudojimo racionalumo bei sąnaudų efektyvumo. Rinkoje atsirandant naujiems antidepresantams vis dažniau analizuojami ekonominiai depresijos gydymo aspektai, o sveikatos priežiūros sektoriaus valdymo institucijos bando spręsti išlaidų didėjimo problemą. Darbo tikslas. Ištirti ir įvertinti galimybes racionaliau naudoti viešąsias ir privačias Lietuvos gyventojų lėšas vaistams, skiriamiems medikamentiniam depresijos atvejų gydymui. Darbo uždaviniai. 1. Atlikti lyginamąją antidepresantų sunaudojimo 2004–2009 m. Lietuvoje analizę. 2. Įvertinti depresijos diagnozavimo ir gydymo efektyvumą bei depresijos diagnozavimo dinamiką Lietuvoje 2004–2009 m. 3. Atlikti išlaidų antidepresantams per 2004–2009 m. Lietuvoje analizę. 4. Atlikti depresijos gydymo sąnaudų efektyvumo analizę ir pateikti galimus išlaidų racionalizavimo būdus. Darbo mokslinis naujumas ir praktinė reikšmė. Vertinant gydymo antidepresantais išlaidų racionalumą, pirmą kartą kaip medikamentinio depresijos atvejų efektyvaus gydymo vertinimo indikatorius buvo panaudotas depresijos pasikartojimo rodiklis. Tyrimo rezultatai gali būti naudojami praktikoje, nagrinėjant antidepresantų panaudojimą, sąnaudų efektyvumo vertinimą ir kompensavimo sistemos tobulinimą Lietuvoje.

An economic evaluation of the three interventions to conceive without the sexual transmission of HIV between heterosexual, HIV-discordant couples with positive male partners can inform policy decisions to subsidize pregnancy planning in this setting, as there is currently no coverage as such in Ontario. A decision tree and Markov model were designed to determine the short and long-term outcomes of unprotected intercourse restricted to timed ovulation (UIRTO), sperm washing with intrauterine insemination (SWIUI), and unprotected intercourse restricted to timed ovulation with pre-exposure prophylaxis (UIRTO-PrEP). In the short-term, UIRTO was the most cost-effective strategy. In the long-term, cases of negligible HIV transmission risk determined UIRTO-PrEP as the preferred option, while SWIUI was the choice method when this risk was high. There remains a viable risk of HIV transmission between discordant couples during attempts to conceive that require the concurrent and subsidized use of UIRTO-PrEP or SWIUI to protect against HIV infection.