Yes / Introduction: The international recruitment of healthcare workers remains a UK strategy to manage workforce gaps and maintain service delivery. Although not a new phenomenon, this has been exacerbated by chronic shortages. There is a need to profile the current international recruits and identify individual motivators to understand the opportunities for future recruitment and retention initiatives. Method: A UK-wide electronic survey was conducted using the Jisc platform. The survey was promoted using social media and researcher networks. Eligibility criteria were diagnostic radiographers, internationally educated, and currently working in the UK. Results: 226 responses were received. Most were working in England (90.7%) and 58.0% were under 35 years of age. The majority had migrated having moved to the UK since 2020 (63.7%) and the main drivers were career and/or training opportunities. Initial education was in 30 different countries, the highest number originating from Africa and Asia, with a median of 6 years post-qualification experience (IQR 4–11yrs). Despite experience, most were employed in band 5 (n = 72) or band 6 posts (n = 95). 56% had postgraduate qualifications on entry and a third had undertaken postgraduate study in the UK. Conclusion: Based on the survey responses, the profile of internationally recruited diagnostic radiographers is relatively young but with pre-migration experience originating all over the globe. They are motivated to work in the UK particular for career progression opportunities. Implications for practice: This study provides an insight into the motivations, demographics and employment patterns of internationally recruited radiographers working in the UK.

Thesis (M.S.H.P.) / BACKGROUND: Dual eligible (DE) patients qualify for Medicare and Medicaid. There are approximately nine million DE patients in the United States, and healthcare costs for this population totaled 319.5 billion dollars in 2011. Behavioral health illness (BHI) is a risk factor for increased healthcare service utilization. The healthcare utilization of adult DE patients <65 years of age with BHI has been studied sparsely. This study sought to describe the adult DE patient population <65 years of age at an urban academic safety net health center and compare hospital and emergency department (ED) utilization of those with and without BHI. METHODS: The study was a secondary analysis of hospital administrative data. Inclusion criteria were patients with Medicare and Medicaid between ages 18 and 65 years, who utilized Boston Medical Center between 1/1/2011 and 1/1/2012. The independent variable was diagnosis of BHI, and the dependent variables were hospital admission and ED utilization. Chi-square and Wilcoxon rank-sum tests were used for descriptive statistics on categorical and continuous variables, respectively. Greedy propensity-score matching without replacement with a caliper distance of half of a standard deviation was used to control for confounding factors. Rate ratios (RR) and confidence intervals (CI) were determined after matching and after adjusting for those variables that remained significantly different after matching. RESULTS: Pre-propensity-score matched data showed significant differences in age, sex, race/ethnicity, marital status, education, employment, physical comorbidities, and Charlson Comorbidity Index score. Post-propensity-score matched analysis found significant differences in sex, Hispanic race, and other education and employment status. As compared to those patients without BHI, patients with BHI had RR 2.07 (CI: 1.81- 2.38) (p<.0001) of hospital admission and a RR 1.61 (CI:1.46-1.77) (p<.0001) of ED utilization. After adjustment, RR for hospital admission and ED utilization remained significantly different and even increased slightly, RR 2.14 (CI: 1.87-2.46) (p<.0001) and RR 1.64 (CI:1.49-1.81) (p<.0001), respectively. CONCLUSION: As compared to DE patients without BHI, those with BHI had significantly more hospital admission and ED utilization, even after controlling for confounding factors. Results suggest interventions for decreasing healthcare services utilization in this population should focus on those DE patients with mental health illness. / 2999-01-01

Thesis (M.S.H.P.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / IMPORTANCE: With greater access to health care through health care reform it is important to know if quality of care for similar complaints differs across clinical settings. OBJECTIVE: Develop and pilot a chart review instrument to measure quality of care for patients presenting with urethritis and vaginitis. METHODS: List of sexually transmitted infection (STI) quality of care measures was reviewed by a panel of five STI experts representing Emergency Department (ED), Obstetrics/Gynecology (Ob/Gyn), Family Medicine (FM), Primary Care (PC) and Infectious Disease. Panel members grouped each measure into “standard” or “exceeds standard of care” in evaluation and management of male patients with penile discharge/dysuria or female patients with vaginal discharge. The chart review instrument was piloted on 50 charts per gender from the STI Clinic and matched charts, by patient presenting complaint, age, gender, and visit date, from PC, FM, ED, and Ob/Gyn (for vaginal discharge) in the same large safety-net hospital in Massachusetts. RESULTS: Twenty-four and 34 final measures in male and female patients, respectively, were selected on plurality of expert panel member’s categorization into “standard of care”. Measures were grouped into 7 clinical domains: history, examination, laboratory testing, additional screening, assessment, treatment, and counseling. Performance on the 7 domains ranged from 3.16-4.36 on male patients and 3.17-4.40 on female patients, with the highest scores in the STI Clinic. However, each clinical setting had particular documentation strengths and weaknesses: STI Clinic scored higher on laboratory testing, additional screening, and counseling, but scored lower on examination and assessment; ED scored higher on examination and treatment; PC and FM scored higher on laboratory testing for male patients and on examination and treatment for female patients; Ob/Gyn scored higher on treatment. All sites other than the STI Clinic scored poorly on additional screening and counseling. CONCLUSIONS: An instrument to discern standard of care and identify strengths and weaknesses in specific domains of clinical documentation for patients presenting with STI complaints can be rapidly developed and implemented to evaluate quality of care across care settings. Further research is needed on whether these findings can be integrated into site-specific quality improvement processes and linked to cost analyses. / 2999-01-01

In the ever-evolving landscape of health systems, citizen advocacy stands as a tool for influencing policy aiming to strengthen health systems. This dissertation delves into the multifaceted nature of health policy advocacy and how citizen advocates can leverage research evidence in addition to the commonly used emotional messaging to influence policy. The first study is a critical interpretive synthesis (CIS), creating a theoretical framework that helps us understand the roles of citizen health policy advocates and their relation to research evidence. The second study is a multiple-case study that examines the approaches taken by citizen-serving NGOs in their advocacy training and whether and how research evidence is incorporated into the training. The third study is a qualitative descriptive study that explores citizens' experiences participating in these training modules and their perceptions of factors affecting the incorporation of research evidence in the training. In Chapter 2, we included 32 publications in the CIS, and four thematic groups were identified, including the roles of citizen health policy advocates, how research evidence could support them and the facilitators and barriers to their use of research evidence. In Chapter 3, we conducted a documentary review of 27 documents and interviewed 16 staff and board members of three organizations that provide advocacy training to citizen advocates. In Chapter 3, we interviewed 14 citizens who participated in the training of the three organizations. v The first study outlined how citizens could use research evidence and its importance to their advocacy roles, while the last two studies provide an understanding of how citizen-serving organizations offer training to citizen advocates and whether, how, and under what conditions they include research evidence in training. / Thesis / Doctor of Philosophy (PhD) / Advocacy is an effective way to influence policies in democratic societies. One of those areas that are influenced by policy advocacy is health systems. Citizens who advocate for improving their health systems often rely on personal emotional messages rather than peer-reviewed research evidence. This dissertation tries to understand why this is the case and how research evidence can support those citizens. We also explore the factors that encourage or hinder citizens from using research evidence in health policy advocacy. We then examine three citizen-serving organizations that support citizens with advocacy training and explore how they support the trainees to use research evidence in advocacy. We also examine the experiences of citizens who participated in those training sessions and how they perceive the utility of research evidence in their advocacy to strengthen their health systems.

Yes / The coronavirus (COVID-19) pandemic coincides with the tenth anniversary of the recognition of the rights to water and sanitation within the United Nations system. Although water, sanitation and hygiene (WASH) remain critical for COVID-19 infection prevention and control, billions of people around the world lack access to basic WASH services in different spheres of life. Mostly affected are people living in vulnerable situations. While the pandemic has significantly impacted regulatory practices and access, key actors in the WASH sector continue to adopt diverse approaches to ensure safety, continuity, and reliability of supply. This chapter explores how COVID-19 influences WASH services and how the rights to water and sanitation can ultimately strengthen resilience to health pandemics? It makes recommendations from the perspective of inclusive development theory, for strengthening WASH sector governance towards ensuring the progressive realization of the rights to water and sanitation during and post the COVID-19 pandemic. Experiences with the coronavirus pandemic illustrate the crucial importance of access to water and sanitation as basic human rights and as necessities for the realization of health, education, food, gender equality, and other human rights (United Nations 2020). Emergent issues, particularly include the high public health risks associated with lack of water and sanitation and the disproportionate burden borne by women and girls, transgendered people, people living in informal settlements, people living with disabilities, the urban poor, migrant workers, workers in the informal sector, people who are sick or living with underlying health conditions, the elderly, school-aged children, and other groups living in vulnerable situations (Banerji 2020; Tan 2020; UNESCO n.d.). These highlight intersecting layers of inequalities in different situations of vulnerability and the interconnectedness of human rights. The pandemic has also demonstrated the imperative of leaving no one behind and ensuring universal access to water and sanitation to achieve sustainable development. From Africa to the Pan-European region, it is a similar picture: there are remarkable inequities in access to water and sanitation based on whether people live in urban or rural areas, whether people are rich or poor, and whether they have any special circumstances which render them vulnerable (Local Burden of Disease WaSH Collaborators 2020; Wang et al. 2019; World Health Organization & UN-Water 2019; United Nations 2020). Furthermore, because of the pandemic, several assumptions and modes of service delivery need to be reexamined to ensure continued suitability for promoting universal access to water and sanitation. It is in light of these realizations that this chapter examines the question: How has COVID-19 influenced water, sanitation and hygiene services and how can the rights to water and sanitation strengthen resilience in health pandemics? This question is addressed from the perspective of inclusive development theory which emphasizes the need to address the social, relational, and ecological aspects of human development (Gupta, Pouw, & Ros-Tonen 2015).

No

Yes / New wave public health places an emphasis on exhorting individuals to engage in healthy behaviour with good health being a signifier of virtuous moral standing, whereas poor health is often associated with personal moral failings. In effect, the medical is increasingly being collapsed into the moral. This approach is consistent with other aspects of contemporary neoliberal governance, but it fuels moral panics and creates folk devils. We explore the implications and dysfunctional consequences of this new wave of public health policy in the context of the latest moral panic around obesity.

This dissertation begins from a desire to explain situations in which left-wing parties appear to adopt policies that are more typically associated with right-wing thinking. A standard explanation for such behaviour is that relatively weak left-wing parties are drawn to adopt those policies as a way of getting elected — commonly expressed as convergence on the median voter. The puzzle, however, is that this explanation often seems to fall foul of the empirical reality that left-wing parties adopt these policies when they are relatively strong, not weak. The explanation for this advanced here is that parties, seeking to improve outcomes for their constituencies both now and in the future, often operate in political environments which lead them to assign a high probability that today’s policy choices will not survive the predations of government by opposing parties tomorrow. Where this is the case, there is incentive to pursue policies that are less efficient, but which have inbuilt political defence mechanisms: with the main such mechanism focused upon here being the power of organised public sector labour. The effect of partisanship is, therefore, conditioned by expectations about the future political power of parties. Where left-wing parties expect to be weak, they will tend to adopt the highly statist, bureaucratised, nationalised policies that are traditionally associated with the Left as these will tend to embody large amounts of organised labour that will be a counter to future right-wing governments. Where left-wing parties expect to be strong, the costs associated with such policies come to outweigh the benefits, with the result that they do not need to pursue such ‘left-wing’ policies. These ideas are developed heoretically within an institutionalist framework, yielding a synthesis between the historical and rational choice institutionalisms. Empirically, the theoretical framework is applied to the development of welfare states and to the issue of privatisation of state-owned enterprises.

Made available in DSpace on 2016-12-23T14:36:50Z (GMT). No. of bitstreams: 1 Rossana Reis.pdf: 2453531 bytes, checksum: 073553410e861c8a38e91c175293f71b (MD5) Previous issue date: 2009-06-29 / O objetivo deste estudo é identificar como o projeto democrático participativo e o projeto neoliberal atravessam a dinâmica de funcionamento do Fórum de Saúde Mental do Espírito Santo (FSMES) desde seu surgimento em 1999 até 2008/1. O problema de pesquisa é a identificação da tensão entre os dois projetos políticos antagônicos presentes na política de saúde mental brasileira (projeto da reforma psiquiátrica versus projeto privatista, de exclusão dos sujeitos com transtorno mental) tendo como lócus o espaço do FSMES. Foi feita pesquisa documental em sete relatórios de gestão (do período de 2000 a 2007) e em três planos de ação (de 2000-2003; 2004-2007; 2008-2011) da coordenação estadual de saúde mental da Secretaria de Estado da Saúde (SESA), em dez listas de presença dos encontros do FSMES do período de 2005 a 2008, e em um documento do ano de 1995 que versa sobre a proposta de reorientação do modelo de atenção no Estado, naquele ano. Foram realizadas cinco entrevistas semi-estruturadas com atores participantes do FSMES ou informantes-chave sobre esse espaço. E também foi realizada observação sistemática nos encontros do FSMES (no período de 2007 a 2008). O discurso dos entrevistados e o discurso impresso nos documentos indicam uma orientação política-ideológica do FSMES voltada ao processo de reforma psiquiátrica. O FSMES é considerado por seus atores um espaço privilegiado para a saúde mental. O projeto político defendido é o da reforma psiquiátrica. Profissionais e/ou gestores das esferas estadual e municipal são segmentos que continuamente fazem parte desse espaço, enquanto a participação de usuários e da sociedade civil organizada se dá de forma pontual e tímida. No período em análise, os atores atuantes nesse espaço expressaram uma direção de contribuição do espaço do FSMES para o processo de reforma psiquiátrica no Estado. Os entrevistados da pesquisa apontaram avanços na trajetória de existência desse espaço, como: quantidade de pessoas que consegue reunir e temáticas para discussão, relacionando a saúde mental e a saúde de modo geral. Verificam-se também entraves, como: tendência de declínio de realização dos encontros (o que demonstra uma periodicidade instável) e dificuldade em assegurar a participação contínua de usuários. A análise mostra que o FSMES foi construído em uma direção contrahegemônica, defendendo o projeto da reforma psiquiátrica, e está impulsionado a contribuir para o processo de implementação do novo modelo de atenção em saúde mental. Como esse processo não é linear, enfrenta dificuldades que devem ser contextualizadas na conjuntura sócio-política de hegemonia das políticas neoliberais que incentivam a despolitização da sociedade e expressivos investimentos no setor privado. / This study aims at identifying how the democratic-participative and the neoliberal projects have gone through the operating dynamics of the Mental Health Forum of Espírito Santo (FSMES) from its beginning in 1999 to 2008/1. The research problem is to identify the tension between these two main antagonistic political projects present in the Brazilian mental health policies (the psychiatric reform project versus the privatist project excluding subjects with mental disorders) taking place at the FSMES. Documental research was carried out based on seven management reports (from 2000 to 2007); on three action plans (from 2000 to 2003; 2004 to 2007; 2008 to 2011) of the state mental health coordination of SESA State Department of Health; on ten attendance lists of the FSMES meetings between 2005 and 2008; and on a 1995 document about the proposal of reorienting the care model in the state that year. Five semi-structured interviews were carried out with participant actors of the FSMES or key-respondents of this space. Systematic observation of the FSMES meetings (between 2007 and 2008) was also performed. The respondents discourse and the discourse printed on the documents indicate a political and ideological bias of the FSMES towards the psychiatric reform process. FSMES is considered a privileged mental health space by its actors. The political project defended is psychiatric reform. The professionals and/or managers of the state and municipal spheres are segments that continually take part in this space, whereas users and organized civil society s participation is limited and shy. In this period under analysis, the actors in this space made contributions in the FSMES space towards the psychiatric reform process in the state. The respondents in this study reported advances in the history of this space such as: number of people it can gather and discussion topics relating mental health to health care in general. Some obstacles were also identified, such as: tendency to decrease the number of meetings (which shows an instable periodicity) and difficulty to ensure the continuous participation of users. The analysis shows that the FSMES has been built in a counter-hegemonic direction, defending the psychiatric reform project. Also, it is being led to contribute to the process of implementing a new mental health care model. Since this process is not linear, it faces difficulties that should be contextualized in the social-political setting of hegemonic neoliberal policies that encourage both the depoliticization of society and significant investments in the private sector.

Made available in DSpace on 2016-12-23T14:36:51Z (GMT). No. of bitstreams: 1 Dissertacao de Rossana dos Reis.pdf: 2453531 bytes, checksum: ab50e2aa8bccf9fe720f81d5a0094ce5 (MD5) Previous issue date: 2009-06-29 / O objetivo deste estudo é identificar como o projeto democrático participativo e o projeto neoliberal atravessam a dinâmica de funcionamento do Fórum de Saúde Mental do Espírito Santo (FSMES) desde seu surgimento em 1999 até 2008/1. O problema de pesquisa é a identificação da tensão entre os dois projetos políticos antagônicos presentes na política de saúde mental brasileira (projeto da reforma psiquiátrica versus projeto privatista, de exclusão dos sujeitos com transtorno mental) tendo como lócus o espaço do FSMES. Foi feita pesquisa documental em sete relatórios de gestão (do período de 2000 a 2007) e em três planos de ação (de 2000-2003; 2004-2007; 2008-2011) da coordenação estadual de saúde mental da Secretaria de Estado da Saúde (SESA), em dez listas de presença dos encontros do FSMES do período de 2005 a 2008, e em um documento do ano de 1995 que versa sobre a proposta de reorientação do modelo de atenção no Estado, naquele ano. Foram realizadas cinco entrevistas semi-estruturadas com atores participantes do FSMES ou informantes-chave sobre esse espaço. E também foi realizada observação sistemática nos encontros do FSMES (no período de 2007 a 2008). O discurso dos entrevistados e o discurso impresso nos documentos indicam uma orientação política-ideológica do FSMES voltada ao processo de reforma psiquiátrica. O FSMES é considerado por seus atores um espaço privilegiado para a saúde mental. O projeto político defendido é o da reforma psiquiátrica. Profissionais e/ou gestores das esferas estadual e municipal são segmentos que continuamente fazem parte desse espaço, enquanto a participação de usuários e da sociedade civil organizada se dá de forma pontual e tímida. No período em análise, os atores atuantes nesse espaço expressaram uma direção de contribuição do espaço do FSMES para o processo de reforma psiquiátrica no Estado. Os entrevistados da pesquisa apontaram avanços na trajetória de existência desse espaço, como: quantidade de pessoas que consegue reunir e temáticas para discussão, relacionando a saúde mental e a saúde de modo geral. Verificam-se também entraves, como: tendência de declínio de realização dos encontros (o que demonstra uma periodicidade instável) e dificuldade em assegurar a participação contínua de usuários. A análise mostra que o FSMES foi construído em uma direção contrahegemônica, defendendo o projeto da reforma psiquiátrica, e está impulsionado a contribuir para o processo de implementação do novo modelo de atenção em saúde mental. Como esse processo não é linear, enfrenta dificuldades que devem ser contextualizadas na conjuntura sócio-política de hegemonia das políticas neoliberais que incentivam a despolitização da sociedade e expressivos investimentos no setor privado / This study aims at identifying how the democratic-participative and the neoliberal projects have gone through the operating dynamics of the Mental Health Forum of Espírito Santo (FSMES) from its beginning in 1999 to 2008/1. The research problem is to identify the tension between these two main antagonistic political projects present in the Brazilian mental health policies (the psychiatric reform project versus the privatist project excluding subjects with mental disorders) taking place at the FSMES. Documental research was carried out based on seven management reports (from 2000 to 2007); on three action plans (from 2000 to 2003; 2004 to 2007; 2008 to 2011) of the state mental health coordination of SESA State Department of Health; on ten attendance lists of the FSMES meetings between 2005 and 2008; and on a 1995 document about the proposal of reorienting the care model in the state that year. Five semi-structured interviews were carried out with participant actors of the FSMES or key-respondents of this space. Systematic observation of the FSMES meetings (between 2007 and 2008) was also performed. The respondents discourse and the discourse printed on the documents indicate a political and ideological bias of the FSMES towards the psychiatric reform process. FSMES is considered a privileged mental health space by its actors. The political project defended is psychiatric reform. The professionals and/or managers of the state and municipal spheres are segments that continually take part in this space, whereas users and organized civil society s participation is limited and shy. In this period under analysis, the actors in this space made contributions in the FSMES space towards the psychiatric reform process in the state. The respondents in this study reported advances in the history of this space such as: number of people it can gather and discussion topics relating mental health to health care in general. Some obstacles were also identified, such as: tendency to decrease the number of meetings (which shows an instable periodicity) and difficulty to ensure the continuous participation of users. The analysis shows that the FSMES has been built in a counter-hegemonic direction, defending the psychiatric reform project. Also, it is being led to contribute to the process of implementing a new mental health care model. Since this process is not linear, it faces difficulties that should be contextualized in the social-political setting of hegemonic neoliberal policies that encourage both the depoliticization of society and significant investments in the private sector