This thesis critically examines a national programme in mental health which has been driven by the implementation of National Institute of Health and Clinical Excellence (NICE) guidance. Assumptions which underpin research method, drawn from the natural sciences, are critiqued in terms of their adequacy in accounting for human relating and expert therapeutic practice. The work of Dreyfus and Dreyfus (1986) is problematized in how they account for proficiency and expertise as intuition and the leap that they make from calculative to deliberative rationality. An alternative source of understanding, based on non-linear causality and complex responsive processes, is developed, building on the work of Stacey (2001, 2005, 2007). The ineffability of expert practice (or clinical judgement) is contrasted with competence based, rule governed practice, which necessarily underpins the early stages of learning. It is argued that because research practices undertaken in randomised controlled trials (RCTs) must be describable, measurable and focussed on predictable outcomes, then these cannot account for expert practice, therefore the assertion that the Improving Access to Psychological Therapies programme (IAPT) is wholly based on research based, evidence based therapies, cannot be substantiated. The work explores professionalism and specifically considers the role of psychiatrists, psychologists and psychological therapists in mental health and in increasing access to psychological therapies. The role of managers and managerialism are explored, specifically how the NHS has sought to manage 3 professional staff and multi-disciplinary teams in adopting corporate and new ways of working (NWW). This includes the importance of and difficulty in countering professional identity using competence based approaches. The performance management processes in the NHS are recognised as an equally relevant source of evidence (to that of NICE), despite there being a poor (traditional) evidence base for it (Stacey, 2010; Seddon, 2008). Power relating in human relationships is identified as immanent, using the context of a management group, and it is argued that Foucault’s concept of disciplinary power (1994) can account for what is considered to be knowledge and truth, drawing on specialist expertise based on science and research, with a forceful potential for rendering others silent as well as pervasively self-silencing, in processes of inclusion and exclusion (Elias, 1978). It is argued that these on-going processes of relating influence policy decisions at national and local levels and how these policies are implemented in practice. The inevitability of unpredictable outcomes is highlighted, despite strong centralised programme management along with the provision of an explicit blueprint for implementation.

RB redactó el primer borrador del artículo y realizó la revisión final. EM redactó la versión presentada al comité editorial, elaboró las figuras del artículo, levantó las observaciones del comité editorial y redactó la versión final del artículo. AG realizó contribuciones al texto inicial, desarrolló la primera versión del resumen y revisó la versión final. GM realizó contribuciones al texto inicial, levantó las observaciones del comité editorial, realizó contribuciones al texto final y revisó la versión final. / Los estudios de síntesis (EDS): revisiones sistemáticas y metanálisis, son base para llevar a cabo las evaluaciones económicas en salud (EES). Los EDS, al permitir obtener parámetros para las probabilidades de estimación y de efectividad a partir de la combinación de resultados de estudios primarios y, al incluir en su metodología procesos de selección, evaluación, sistematización y síntesis, son considerados como el primer nivel de jerarquía en la evidencia científica. No obstante, pueden estar sometidos a sesgos y fallas metodológicas que afectan su validez. El presente artículo expone, inicialmente, la importancia de la aleatorización en la jerarquización de los diseños de investigación; luego se revisa los principales factores que afectan la validez de los EDS, incidiendo en el sesgo de publicación, la heterogeneidad y la inclusión de estudios primarios con objetivos principales distintos al del EDS; asimismo, se presenta a los estudios individuales como una alternativa válida para el desarrollo de una EES. Se concluye que uno de los aspectos claves en una EES es la selección adecuada de los tipos de estudio, sean estos primarios o secundarios. / Synthesis studies (SS): systematic review and meta-analysis are the basis for developing Health Economic Evaluations (HEE). SS allow us to obtain parameters for estimating probabilities and effectiveness from the combination of the results of primary studies, and, as they include in their methodology the selection, evaluation, systematization and synthesis processes, they are considered the first level of hierarchy in scientific evidence. Nevertheless, they can be prone to bias and methodological failures that can affect the validity of their results. This article initially presents the relevance of the randomization in the hierarchic classification of research designs, then it reviews the main factors affecting the validity of the SS, emphasising the publication bias, the heterogeneity and the inclusion of primary studies with main objective differing from the one of the SS. Moreover, it presents individual studies like a valid alternative for the development of a SS. The conclusion is that one of the key aspects in a SS is the correct evaluation of the study types and the objective evaluation of their quality, being these primary or secondary.

INTRODUÇÃO: O Brasil adentrou o século 21, caracterizado como o século da Ciência e Tecnologia - C&T, buscando discutir, identificar e implantar mecanismos de construção de uma sociedade onde o conhecimento seja o propulsor de conquistas sociais, econômicas e culturais. Tinha pela frente a tarefa de confrontar desafios que se apresentavam no cenário do sistema nacional de C&T, como a fragmentação das atividades de C&T, a ausência de coordenação interinstitucional e a concentração das atividades de C&T em determinadas regiões do país. OBJETIVO: Este estudo se propôs analisar uma das principais estratégias do recém-criado Departamento de Ciência e Tecnologia do Ministério da Saúde para o enfrentamento a estes desafios, desenvolvido, entre os anos 2002 e 2008 por meio do Programa Pesquisa para o SUS: gestão compartilhada em saúde PPSUS. MÉTODO: Trata-se de um estudo exploratório e descritivo, desenvolvido por meio de recursos dos métodos quantitativo de pesquisa e com suporte de instrumentos multivariados de coleta de dados: pesquisa bibliográfica e pesquisa documental. No tocante aos dados, foram coletados dados sobre o conjunto de projetos de pesquisa em ciência e tecnologia em saúde, fomentados no país no período de 2002 a 2008 e financiados pelo Ministério da Saúde, em ação compartilhada com Fundações de Amparo à Pesquisa (FAPs) de Unidades Federativas do país e com Secretarias Estaduais de Saúde (SES). As fontes de coleta dos dados foram a base de dados gerenciais PesquisaSaúde do Ministério da Saúde e a base de dados do Curriculum Lattes do CNPq. A coleta de dados abrangeu o universo de 1.271 projetos de pesquisa, fomentados no país desde o início do programa de fomento à pesquisa em ciência e tecnologia em saúde (2002), até 2008, quando teve início a pesquisa. RESULTADOS: Nas três edições do PPSUS estudadas, houve a participação de todos os 27 estados da federação, 213 instituições de pesquisa e 1.151 pesquisadores. Do total de recursos 41 por cento foram alocados pelas FAPs e SES, mostrando uma crescente responsabilização destes como parceiros efetivos na consolidação do programa. CONCLUSÃO: Os resultados observados reforçaram a hipótese positiva de que o programa de gestão descentralizada produziu efetivamente uma reestruturação em termos de gestão de C&T, interferindo no aprimoramento das políticas de C&T nos estados, institucionalizando ações de gestão de forma a se constituírem numa rotina administrativa. Quanto à redução das desigualdades na distribuição de recursos de C&T entre as grandes regiões do país, os resultados demonstraram que, nos estados onde as FAPs e SES estavam mais estruturadas foram, justamente, aqueles que mais contribuíam para as ações de C&T. Este movimento repete o status quo, proporcionando a continuidade das disparidades regionais. Porém, teve o êxito de produzir uma adesão positiva para ações efetivas em C&T em Estados onde não havia um histórico nesta área, traduzindo-se num forte aliado para a redistribuição de forças no cenário de C&T. / INTRODUCTION: Brazil began the 21st century characterized as the century of Science and Technology - S&T, seeking to discuss, identify, and implement mechanisms for building a society where knowledge is the engine of social achievements, economic and cultural. Its objective was to confront challenges that were presented in the national scenario of S&T, as the fragmentation of S&T, the lack of interagency coordination and, concentration of S & T in certain regions of the country. OBJECTIVE: This study aimed to analyze one of the main strategies of the newly created Department of Science and Technology of the Ministry of Health to face these challenges, developed between 2002 and 2008 by the \"Research Program to the SUS: management shared health - PPSUS\". METHOD: This was an exploratory and descriptive, developed through features of quantitative methods of research and support tools for multivariate data collection: bibliographic research, desk research. As regards the data were collected on the number of research projects in science and technology in health, fostered in the country in the period 2002-2008 and funded by the Ministry of Health, in action shared with the Research Support Foundations (FAPs) of Federal Units of the country and the State Departments of Health (SES). The sources of data collection were the data base management \"PesquisaSaúde\" the Ministry of Health and, the database of the CNPq Lattes Curriculum. The data collection covered the universe of 1,271 research projects, promoted in the country since the beginning of the program to encourage research in science and technology in health (2002) until 2008, when the survey began. RESULTS: In the three editions of PPSUS studied, there was participation from all 27 states of the federation, 213 research institutions and researchers 1151. 41 per cent of the total funds were allocated by FAPs and SES, showing an increasing accountability of consolidation as effective partners in the program. CONCLUSION: The results reinforced the positive assumption that the program of decentralized produced effectively restructured in terms of management of C&T, interfering in improving policies for S & T in the states, institutionalizing management actions in order to constitute an administrative routine. As for the reduction of inequalities in the distribution of resources in S & T among the major regions of the country, the results showed that, in states where the FAPs were more structured and SES were precisely those who most contributed to the actions of S&T. This movement repeats the status quo, providing continuity of regional disparities. But the success had to produce a positive adherence to effective actions in S&T in states where there was a historic in this area, resulting in a strong ally for the redistribution of forces in the scenario of S&T.

Introdução: A Saúde Coletiva articula múltiplas disciplinas, incluindo as Ciências Sociais, no intuito de proporcionar maior poder explicativo ao processo saúde-doença. Apesar da institucionalização da Enfermagem evidenciar profícua experiência na formação de doutores e de sua importante participação na produção do conhecimento, além da atuação no processo de produção dos serviços de saúde, ainda persistem lacunas no percurso reflexivo referente à apropriação da complexidade epistemológica do campo da Saúde Coletiva. Objetivos: Analisar a contribuição da produção acadêmica no âmbito do Doutorado em Enfermagem dos Programas de Pós-Graduação Senso Estrito em Enfermagem para a constituição do campo da Saúde Coletiva. Material e métodos: Trata-se de pesquisa documental, com base na hermenêutica dialética. A amostra foi composta por 87 teses de Doutorado de 15 programas de pós-graduação, no período 2011-2012. Após leitura compreensiva, o material empírico foi decomposto em temas que constituem o corpus dos objetos de estudo. A análise hermenêutica também compreendeu a identificação do marco teórico-referencial, sujeitos que constituíram as populações de estudo e locais de ocorrência. Resultados: Os oito temas encontrados foram: Práticas em saúde (26,4%), Avaliação das políticas e serviços de saúde (16,1%), Tecnologias em saúde (13,8%), Sentidos e representações vividos pelos usuários (12,6%), Informação em saúde (10,3%), Violência em saúde (8,1%), Saúde, ambiente e trabalho (8,1%), e Formação em saúde (4,6%). Os três primeiros temas concentraram 56,3% dos estudos. As práticas em saúde tiveram como foco o cotidiano do enfermeiro associado ou não à prática de outros profissionais de saúde. O tema Avaliação das políticas e serviços de saúde refere-se à produção de estudos sobre acesso das pessoas aos serviços de saúde em associação à operacionalização das redes de atenção e políticas de controle da tuberculose, DST/Aids, entre outras. O tema Tecnologias em saúde refere-se, substantivamente, ao desenvolvimento de manuais ou instrumentos para intervenção individual ou coletiva em espaços institucionais específicos, orientados a aprimorar principalmente as práticas à saúde da mulher e DST/Aids. Conclusões: Os temas encontrados contribuem majoritariamente na explicitação e na compreensão das ações de cuidado desenvolvidas no micro espaço das relações interpessoais do enfermeiro com os usuários e outros profissionais da saúde em prol do direito universal à saúde e em consonância ao projeto político do SUS. A predominância da Estratégia Saúde da Família como local de pesquisa confirma a iniciativa do governo federal em promover a reorganização das práticas na atenção primária em saúde. Ademais, a potência analítica dos estudos pode auxiliar a subárea acadêmica Enfermagem em Saúde Coletiva na elaboração de pesquisas com novos objetos e inovações teórico-metodológicas em correspondência às necessidades e problemas de saúde da população brasileira. / Introduction: Collective Health articulates multiple subjects, including social Sciences to provide a more comprehensive understanding on the health-disease process. Although Nursing institutionalization presents a profitable experience in doctoral formation and an important participation in production of knowledge, beyond his performance in the process of health services production, gaps still persist in the reflexive course to the epistemological complexity appropriation in the field of Collective Health. Objectives: To analyze the contribution of the academic production from Doctorate in Nursing to the Collective Health field. Material and methods: It is a documental research, based on dialectical hermeneutics. The sample was composed of 87 Doctoral thesis of 15 graduate programs, from 2011 to 2012. After a comprehensive reading, the empirical data was decomposed in themes that constitute the corpus of the study objects. The hermeneutics analysis also comprised the identification of theoretical-reference, subjects that constituted the population of study and places where studies were developed. Results: We found eight themes: Health practices (26.4%), Evaluation of politics and services in health (16.1%), Technologies in health (13.8%), Senses and representations experienced by the users (12.6%), Information in health (10.3%), Violence in health (8.1%), Health, environment and work (8.1%), and Training in health (10.3%). The first three themes focused 56.3% of the studies. The health practices had as focus the nursings everyday associated or not to the practice of other health professionals. The Evaluation of politics and services in health theme refers to studies about the people access to health services in association to the network attention in health and tuberculosis, STD/Aids control policies, among others. The Technologies in health theme refers, substantively, to the development of manuals or tools to individual or collective intervention in specific institutional spaces, mainly oriented to improve the practices in womans health and STD/Aids. Conclusions: The themes mostly contribute to elucidate and to understand care actions in the micro space of interpersonal nursing relationships with patients and other health professionals, in order to benefit the universal right to health and in accordance to the SUS Unified Health System in Brazil. The predominance in Familys Health Strategies as a research place confirm the federal government initiative to promote the reorganization of practices in primary health care. Moreover, the analytic strength of the studies can help the academic subarea of Nursing in Collective Health on the formulation of researches with new objects and theorical-methodological innovations in correspondence to the health needs and of the Brazilian population.

Orientador: Anderson L.H. Christofoletti / Banca: Sandra Elisa Contri Pitton / Banca: Thiago Salomão de Azevedo / Resumo: Cordeirópolis é uma cidade com aproximadamente 20.000, localizada em meio a Depressão Periférica Paulista, uma das regiões com umidade relativa do ar mais baixas do estado de São Paulo durante a estação de inverno. Por outro lado, a cidade também conta com uma série de problemas socioambientais, como a exploração indiscriminada dos recursos naturais e os baixos níveis educacionais apresentados pela população local, colocando em risco a qualidade de vida dos habitantes. Diante dos fatos, buscou-se estabelecer relações entre os diferentes tipos de tempo atmosférico e as doenças cardiorrespiratórias, considerando que as variações do tempo atmosférico tendem a desencadear uma série de reações no organismo humano, causando ou agravando um emaranhado de sintomas, enfermidades e mudanças no quadro clínico de saúde da população. Também foi possível identificar os grupos de risco e mapear as áreas mais vulneráveis e o local de residência dos pacientes portadores de enfermidades ligadas ao sistema circulatório e respiratório atendidos pelo Programa Saúde da Família, servindo de contribuição para que o poder público possa pensar novas diretrizes que sejam ecologicamente, social e economicamente mais viáveis e justas / Abstract: Cordeirópolis is a small town with approximately 20,000 inhabitants and is located in the midst of the Depressão Periférica Paulista, one of the driest regions of the state of São Paulo during the winter season. On the other hand, the city is among the largest and most important deposits of clay, which explains its economic vocation, aimed mainly to the production of ceramic artifacts and agriculture of sugar cane. Despite being part of the largest ceramic center in Latin America,and although the ceramic industries as well as the sugar industry are the main sources of income of the municipality, the city has a number of socio-environmental problems, such as the indiscriminate exploitation of natural resources and low levels of education provided by the local population, threatening the quality of life for residents. Given the above facts, we sought to establish relationships between different types of weather and cardiopulmonary diseases, considering that variations in the weather tend to trigger a series of reactions in the human body, causing or exacerbating a tangle of symptoms, diseases changes in clinical and population health. By the way, were collected, processed and organized weather data on precipitation, temperature, relative humidity and air quality standard, and was then correlated with the information collected by the Hospital Health System (SIH-SUS), referring to the monthly number of patients hospitalized for some kind of cardiopulmonary disease. Through the questionnaires it was possible to identify risk groups and map the area's most vulnerable and place of residence of patients with diseases related to circulatory and respiratory system served by the Family Health Program, serving as a contribution to the local government can think of new guidelines that are environmentally, socially and economically more viable and fair / Mestre

Submitted by Erika Demachki (erikademachki@gmail.com) on 2014-10-17T18:22:52Z No. of bitstreams: 2 Dissertação - Bárbara Morais Arantes - 2014.pdf: 768117 bytes, checksum: a473c32fd85f4cc22b2e97a9297b24fb (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Jaqueline Silva (jtas29@gmail.com) on 2014-10-17T20:32:25Z (GMT) No. of bitstreams: 2 Dissertação - Bárbara Morais Arantes - 2014.pdf: 768117 bytes, checksum: a473c32fd85f4cc22b2e97a9297b24fb (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2014-10-17T20:32:25Z (GMT). No. of bitstreams: 2 Dissertação - Bárbara Morais Arantes - 2014.pdf: 768117 bytes, checksum: a473c32fd85f4cc22b2e97a9297b24fb (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2014-02-05 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Much knowledge has been produced in the area of Health Promotion (HP), but this information is not always translated so that it can be incorporated into everyday practice of health managers and professionals at the local level. The knowledge translation (KT) can contribute to more effective processes in health. The aim of this study was to analyze the effectiveness of KT in the context of health promotion for managers and professionals in public health. The strategies used were literature survey, semi-structured narrative interviews with managers and professionals of a large municipality and documentary analysis of Health Promotion. Content analysis was applied to establish the analytical categories. About the concepts of HP, it was noted that there is still a great confusion with other concepts; the HP actions reported arouse from programs and official publications and the respondents considered any action which was not clinical as being HP; knowledge sources of HP were associated with official documents more than with scientific papers, which were referred only when postgraduate courses were taken; little is known about knowledge translation; the main challenges were related to access and to scientific language, the access to publications of scientific papers has become more available online; among the challenges it is highlighted the great demand for permanent education for managers and professionals. We conclude that the knowledge translation in the context of health promotion takes place most effectively by the primary care team, which by managers; there is still confusion of content and concepts of health promotion with strong linkages to prevention and education health; promotion practices are associated to those induced by public policies and programs predominantly from official documents and manuals from the Ministry of Health, principal source used by managers and professionals, access to new knowledge was associated with the academic world by internet, official sources by the documents and manuals, on the processes of knowledge translation most important were collective activities such as workshops and reading group, among these challenges include the difficulty of access to restricted sites and / or paid on the Internet, setting up spaces for discussion and exchange of experiences. / Muito conhecimento tem sido produzido na área de Promoção da Saúde (PS), porém essas informações nem sempre são traduzidas de forma que possam ser incorporadas na prática cotidiana de gestores e profissionais de saúde no nível local. A tradução do conhecimento pode contribuir para processos mais efetivos em saúde. O objetivo deste estudo foi analisar a efetividade da tradução do conhecimento (TC) no contexto da promoção da saúde por gestores e profissionais em saúde pública. As estratégias utilizadas foram levantamento bibliográfico, entrevistas narrativas semi-estruturadas com gestores e profissionais de um município de grande porte e análise documental com resgate de documentos sobre Promoção de Saúde. A análise de conteúdo foi aplicada para o estabelecimento das categorias analíticas. Sobre os conceitos de PS notou-se que há grande confusão com outros conceitos; as ações de PS relatadas originam-se de programas e publicações oficiais e os entrevistados demonstraram considerar quaisquer ações não clínicas como sendo de PS; as fontes de conhecimento sobre PS foram mais associadas a documentos oficiais que a artigos científicos, sendo estes referidos quando da realização de cursos de pós-graduação; pouco se conhece a respeito de tradução do conhecimento; os principais desafios foram relativos a acesso e linguagem científica, sendo que o acesso a publicações de caráter científico tem se tornado maior pela disponibilização on-line; entre as sugestões destaca-se a demanda de educação permanente por gestores e profissionais. Conclui-se que a tradução do conhecimento no contexto da Promoção da Saúde se dá de forma mais efetiva pelos profissionais da atenção básica, que pelos gestores; ainda há confusão de conteúdos e conceitos de Promoção da Saúde com forte vinculação à prevenção e à educação em saúde; as práticas de Promoção são associadas àquelas induzidas pelas políticas públicas e pelos programas oficiais predominantemente originários de documentos e manuais do Ministério da Saúde, principal fonte utilizada por gestores e profissionais; o acesso aos novos conhecimentos foi associado ao mundo acadêmico por meio de internet, bem como às fontes oficiais por meio dos documentos e manuais, sobre os processos de tradução do conhecimento destacaram-se as atividades coletivas como oficinas e leitura em grupo; entre os desafios citados destacam-se a dificuldade de acesso a sítios restritos e/ou pagos na internet, constituição de espaços de discussões e trocas de experiências.

A autora avaliou a qualidade dos artigos publicados na literatura brasileira, na área de Ortopedia e Traumatologia. Foi feita a revisão de todos os artigos constantes dos sumários da Acta Ortopédica Brasileira e da Revista Brasileira de Ortopedia, em seus fascículos publicados nos anos de 2004 e 2005. Considerou que o conteúdo dessas duas Revistas retrata a produção científica nacional na área e que sua análise pode responder ao objetivo do trabalho. Após o levantamento da literatura, foi escolhida a classificação de Cook adaptada por Atallah para a classificação dos artigos por Nível de Evidência. Foi utilizada a lista de Atallah para a avaliação metodológica para trabalhos sobre terapêutica, etiologia e diagnóstico. Os artigos de ciência básica foram avaliados por suas características metodológicas e classificados por parâmetros representativos de seu nível e utilizados formulários preenchidos por dois avaliadores. Foram aplicados cálculos de estatística descritiva. A autora conclui que a qualidade metodológica dos artigos publicados nas revistas analisadas é inadequada e tem baixo Nível de Evidência. / The author evaluated the quality of articles published within the field of Orthopedics and Traumatology in Brazil. A review was conducted on all the articles appearing in the summaries of Acta Ortopédica Brasileira and Revista Brasileira de Ortopedia, in their issues published in the years 2004 and 2005. The author took the content of these two journals to portray the national scientific production in this field and made the assumption that analysis of these journals would provide answers for the study objective. After surveying the literature, the classification of Cook as adapted by Atallah for classifying articles by evidence level, was chosen. Atallahs list for evaluating the methodology of studies on therapies, etiologies and diagnoses was utilized. Articles on basic science were evaluated according to the methodological characteristics and were classified using parameters that represented their level. Forms filled out by two evaluators were utilized. Descriptive statistical calculations were applied. The author concluded that the methodological quality of the articles published in the journals analyzed is inadequate and provides a low level of evidence.

Master of Philosophy / As Australia’s leading agency for funding health research (expending over $400 million in 2006), the National Health and Medical Research Council (NHMRC) has a major responsibility to improve the evidence base for health policy and practice. There is an urgent need for better evidence to guide policy and programs that improve the health of Indigenous peoples. In 2002, NHMRC endorsed a series of landmark policy changes to acknowledge its ongoing role and responsibilities in Indigenous health research—adopting a strategic Road Map for research, improving Indigenous representation across NHMRC Council and Principal Committees, and committing 5% of its annual budget to Indigenous health research. This thesis examines how these policies evolved, the extent to which they have been implemented, and their impact on agency expenditure in relation to People Support. Additionally, this thesis describes the impact of NHMRC policies in reshaping research practices among Indigenous populations.

As Africa faces the challenges of its renewal or renaissance, the HIV/AIDS epidemic poses the greatest potential barrier to the attainment of this vision (Makgoba, 2001 in Dorrington, Bourne, Bradshaw, Laubscher & Timaeus, 2001). The development of an HIV vaccine that is safe, effective and affordable, has been widely contemplated as a necessary supplement to already established interventions. In preparation for HIV vaccine trials in South Africa the current project aimed to assess students' understanding (knowledge and perceptions) and experiences of vaccination in general, and to explore if these were associated with demographics such as motherhood and gender. A parallel aim was to assess students' knowledge and expectations of HIV vaccination and trial participation. A sample of 33 students was recruited from university residences at the University of Natal, Pietermaritzburg. Participants were interviewed via a semi-structured interview schedule. The data collected was then coded and analysed using content analysis, while Chi - square analysis was used to evaluate if demographics such as gender and motherhood were systematically associated with various responses. The results revealed that the vast majority of participants (97%) knew the purpose of vaccination, stating that it was to promote health and prevent illness. Most participants (67%) knew that vaccination works by mobilising the immune system (vaccination mechanism). The vast majority of participants (91%) could name at least one vaccine preventable disease. Uptake of childhood immunisation was reportedly high (88%) while adult uptake of immunisation was low (33%). A significant minority (36%) reported that they had experienced side effects but understood these to be an integral part of vaccination. Thirty percent of participants stated they were willing to participate (WTP) in a hypothetical vaccine trial, 33 % of participants were not WTP and 15% were not sure. Motivations for trial participation were reportedly influenced most by personal incentives of altruism (39%) and barriers such as perceived significant physical risk (61%). In general, knowledge and experiences of vaccination were not associated with gender or with motherhood. The results suggest that more awareness of HIV vaccine trials is needed. In this regard education should emphasise that the prospective vaccine will be preventive, that only healthy people can volunteer and that the HIV vaccine will not guarantee immunity to HIV infection. Suggestions are made for future research into motivations, barriers and incentives to facilitate an ethical process of vaccine trial participation. / Thesis (M.Soc.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2004.

Master of Philosophy / As Australia’s leading agency for funding health research (expending over $400 million in 2006), the National Health and Medical Research Council (NHMRC) has a major responsibility to improve the evidence base for health policy and practice. There is an urgent need for better evidence to guide policy and programs that improve the health of Indigenous peoples. In 2002, NHMRC endorsed a series of landmark policy changes to acknowledge its ongoing role and responsibilities in Indigenous health research—adopting a strategic Road Map for research, improving Indigenous representation across NHMRC Council and Principal Committees, and committing 5% of its annual budget to Indigenous health research. This thesis examines how these policies evolved, the extent to which they have been implemented, and their impact on agency expenditure in relation to People Support. Additionally, this thesis describes the impact of NHMRC policies in reshaping research practices among Indigenous populations.