Current New Zealand health policy encourages collaborative health promotion in all sectors of health service delivery. The integrated approach to the acute management of coronary heart disease in a coronary care unit, combining medical therapy and lifestyle change, supports clinical health promotion. The aim of this study was to use the grounded theory approach to discover the main concerns of nurses' promoting health in an acute coronary care setting and to explain the processes that nurses used to integrate health promotional activities into their practice. Seventeen registered nurses from three coronary care units within a large metropolitan city in New Zealand were interviewed. Data were constantly compared and analysed using Glaser's emergent approach to grounded theory.The main concern for nurses promoting health within coronary care was ritualistic practice. In this study, ritualistic practice concerns the medically-based protocols, routines, language and technology that drives nursing practice in coronary care. This concern was resolved via the socio-cultural process of attitudinal shifting that occurs over time involving three stages. The three conceptual categories, environmental pressures, practice reality and responsive action are the main components of the theory of attitudinal shifting. In environmental pressures nurses experience a tension between specialist medically-dominated nursing practice and the generalist nursing role of promoting health. In practice reality, nurses become aware that the individual needs of patients are not being met. This causes role conflict until the nurse observes colleagues who role model possibilities for practice, working with patients to promote health. Responsive action sees the nurse engaging in self-development, also focusing on the nurse-patient relationship, thereby enabling active patient involvement in individual health-promoting decisions.The findings from this research have implications for nursing practice and education. With the increasing specialisation in nursing practice, these findings may be of interest to nurses working in delegated medical roles where the reality of everyday practice precludes nurses from undertaking their essential nursing role. Health care facilities also need to ensure that there are opportunities for the personal and professional development of nursing staff. The place of health promotion within nursing undergraduate curricula needs to be examined, as many nurses found that they were ill prepared for undertaking health promotional activities.

Three groups of health care professionals were canvassed for their views on euthanasia - student nurses, practising nurses and doctors. The aim of the research was to make a possible contribution to a formalised health policy on this issue for the ACT. The following forms of euthanasia were covered by the research: (i) voluntary active euthanasia: (ii) voluntary passive euthanasia: (iii) involuntary active euthanasia: (iv) involuntary passive euthanasia. Passive forms of euthanasia were found to be the most acceptable. Voluntary forms of euthanasia were not found, in general, to be more approved of than involuntary forms of euthanasia. However, active forms of euthanasia were much less acceptable than passive forms. In order to adapt the research findings to a methodology for policy use. Allison's models (1971) of public policy development were modified into a single model. This provided an application of the research results in such a way as to allow for the development of a possible formalised policy on euthanasia, and practical applications. The conclusions drawn from the research findings and the subsequent recommendations are supportive of law reform and the implementation of a new policy on the issue of euthanasia.

"January 2004" / Includes bibliographical references (leaves 297-313) / x, 313 leaves ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, School of Social Sciences, Discipline of Gender and Labour Studies, 2004

This dissertation aims at developing and testing a new method that can better capture preferences for multistate health profiles. The motivation arose from the failure of the QALY (Quality-Adjusted Life Year) model in adequately capturing preferences in multistate health profiles. The current QALY-based technique captures preferences for multistate health profiles by evaluating each health state in the profile independently of other states. As the past literature showed, this additive independence condition does not hold in practice and hence such approach is inadequate. To address this issue, this study proposes a novel approach to measure preferences for multistate health profiles by looking at two consecutive health states at a time. It hypothesizes that an evaluation of the future health state is dependent or "conditioned" on the level of the preceding, or current, health state. Characteristics of the current health state that are suspected to impact the resulting conditional preference scores for future health state are systematically explored in a carefully designed empirical study. The interested factors include duration of the current health state, direction of change and amplitude of change between the current and future health states. A 2

Physicians are familiar with organophosphates (OPs) as a classic, though obscure, cause of cholinergic poisoning. Many opportunities for human exposure existsixty million pounds of OPs are applied as insecticides to sixty million acres of U.S. land each year, and, until recently, over one-fifth of Americans used these chemicals in their homes. Most physicians, however, still know little about the dangers that these pesticides pose to the developing nervous system. By the late 1980s, toxicologists increasingly recognized that toxicants such as lead and mercury, even at doses well-below the level required to cause symptomatic poisoning, could induce subtle, yet permanent, neurological deficits if the exposure occurred during critical periods of brain development. In the early 1990s, scientists and regulators began to realize that developmental neurotoxicity (DNT), as this phenomenon was called, could also result from OPs. In 1996 Congress passed the Food Quality Protection Act (FQPA), marking a major turning point in the regulation of hazardous chemicals. Prior to the FQPA, the Environmental Protection Agency (EPA) based its calculations of pesticide risk on adults and largely neglected the increased susceptibility of infants and children. The new law took a precautionary stance, protecting the vulnerable neural and physical development of the fetus and child with the inclusion of a 10-X safety factor, and shifting the burden of proof from health advocates to the pesticide manufacturers. The ensuing ten-year battle between health groups, pesticide manufacturers, and the EPA over the laws enforcement now provides an instructive lesson into the complex scientific, political, and economic world of environmental health, and serves as a relatively successful example of effective policy improving public health.

Thesis (M.A.)--York University, 2001. Graduate Programme in Geography. / Typescript. Includes bibliographical references (leaves 109-129). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://wwwlib.umi.com/cr/yorku/fullcit?pMQ66394.

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The objective of this dissertation is to evaluate whether two different types of policy interventions in the United States are associated with health service utilization and economic outcomes. Paper 1: The number of government lawsuits accusing pharmaceutical companies of off-label marketing has risen in recent years. We use Medicare and Medicaid claims data to evaluate how an off-label marketing lawsuit and its accompanying media coverage affected utilization and spending on gabapentin as well as other anticonvulsant medications. In this interrupted time series analysis of dual eligible patients with bipolar disorder, we found that the lawsuit and accompanying media coverage corresponded with a decrease in market share of gabapentin, a substitution of newer and expensive anticonvulsants, and a substantial increase in overall spending on anticonvulsants. Paper 2: Medicare Part D was a major expansion of Medicare benefits to cover pharmaceuticals. There were initial concerns about how the dually eligible population who previously had drug coverage through Medicaid would fare after transitioning to Part D plans. Using a nationally representative longitudinal panel survey of Medicare Beneficiaries that are dually eligible for Medicaid, we investigated whether differences in generosity of Medicaid drug benefits were associated with differential changes in drug utilization and out-of-pocket spending for duals after they transitioned to Part D. Our finding suggest that those who previously encountered a monthly drug cap prior to Part D implementation experienced a differentially higher increase in annual prescription drug fills compared with those who did not face a cap.

Dental caries, popularly known as tooth decay or cavities, is among the world's most common health problems. When caught early, it is also one of the most easily resolvable. Yet, advanced decay is a trenchant marker of social inequality and a major contributor to the maldistribution of physical pain and psychosocial suffering. Why? Access to dental care within the U.S. model of fee-for-service dental private practice follows existing lines of social stratification. Dental disparities, a term that calls attention to the relationships between maldistributed disease and maldistributed care, reflect deep ontological, moral, and political differences about responsibility for the prevention and treatment of dental disease, the quality and distribution of dental care, and even what constitutes health and well-being. What kinds of sociopolitical and moral negotiations constitute and transpire around dental disparities? How do these negotiations shape the experiences of patients and providers, and how do their experiences shape these negotiations? What can an ethnography of the dental safety net–a complex, fragile, and unpredictable network of treatment opportunities for low-income families–tell us about health governance more broadly? These are some of the questions that drive my research. In this dissertation, I explore how the sociopolitical relations of dental disparities are enacted through the dental safety net. Drawing on fifteen months of ethnographic research in clinical and community settings in central Appalachia, a region that has come to symbolize the dental crisis in the popular imagination, I show how the dental safety net exemplifies health governance in a neoliberal milieu. A fragmented system characterized by a discontinuity that starkly contrasts the model of health care generally advocated in both private and public medical systems, I argue that the dental safety net in far southwest Virginia does not merely fail to relieve the suffering of marginalized people but also can produce it. For example, the constitution of publicly-funded and charitable dental care can serve to routinize and even incentivize excess extractions among low-income adults while exempting preventive or restorative care. In addition to its effects on underserved patients, the dental safety net is a site through the fraught and contradictory relationships of dental providers and the sociopolitical stakes of the pursuit of oral health equity can be understood. For example, the flexible teamwork arrangements prized in private practice, when posited for the dental safety net, are often interpreted by dentists as risks of pluralization and threats to professional hierarchy that must be contained through legislative means. Borrowing from the crude classificatory scheme used to screen teeth quickly, I show how the dental safety net is decayed, as it bears the wear of overuse beyond maintenance; missing, or better described as an absence than a presence; and filled, like a cavitated tooth or a canaled dental root, with manufactured solutions of variable standards and longevity.

Purpose: Identify specific legislative barriers to full practice authority (FPA) legislation and describe how they were overcome during the 2013 legislative session in Nevada. Background: Legislative restrictions in 31 states prevent nurse practitioners from practicing to the full extent of their education and training. FPA legislation is introduced, but not often signed into law. A comprehensive literature review revealed multiple barriers to autonomous practice: conflict between medical and nursing roles, lack of nurse practitioner role recognition, financial challenges, and a lack of business knowledge. Barriers caused by policy limitations were most frequently mentioned: limited scope of practice, limited prescriptive authority, limited clinical privileges, credentialing limitations and reduced reimbursement rates. Methods: This study employed a qualitative, multiple case study design. Semi-structured interviews were conducted with four actively-involved contributors to the 2013 FPA initiative in Nevada. Homogeneous questions were used, guided by the use of a predetermined set of questions based on Kotter’s (1995) Change Management Model. Each interview began with the question, "What prompted this movement and why was it introduced at this time?" Participants were asked to identify perceived barriers to FPA legislation, and how they were overcome. Recorded interviews were transcribed into text, which led to thematic analysis. Results: Repetition of shared perceptions revealed eleven barriers separated into six main themes. 1) Vision includes the barrier of lacking a clear and shared vision. 2) Physician Support includes the barrier of lacking the support of physicians and Organized Medicine. 3) Addressing Stakeholders includes the barriers of the inability to address stakeholders, lack of role recognition and community support, and social media. 4) Community Organization Support includes the barriers of having a Board of Nursing with a poor reputation, and a lack of support from the Board of Pharmacy. 5) Leading Coalition includes the barriers of lacking a strong, leading coalition lacking history of leadership and legislative experiences, and choosing a legislator without experience, authority, and respect in the legislature and the community. 6) Resources include the barrier of lacking necessary resources including time and preparation. Implications: The findings of this study may be useful for those living in one of the 31 states without FPA legislation. This is one of the first published studies to identify the importance of literature identifying legislative barriers to FPA, and starts to fill the current gap in the literature surrounding this topic. This information may be invaluable in the preparation and introduction of FPA legislation in other states. The findings may also act as a stepping-stone to addressing the provider shortage in the U.S., and may be instrumental in improving access to care. Further research is needed to identify whether similar barriers found in this study are prevalent in other states with FPA legislation for nurse practitioners.