Recent media articles have illustrated different human resource management problems within Zara Sweden and the retail industry in Sweden. In these articles numerous employees speak about mistreatment and abuse at Zara Sweden. A union official states that Zara is not a unique case, but more so a representative case of the retail industry. Adding to this Zara Sweden has not performed well financially and they state that they are still trying to adapt to the Swedish market.   There is plenty of research explaining the relationship between human resource management and performance. Furthermore, a lot of research urges international companies to be locally responsive especially in their people management. To understand the level of local responsiveness it is important to first examine the cultural disparity between the organization and the employees, for this Hofstede’s cultural dimension was used. With this background the study explores Zara Sweden’s level of local responsiveness as well as their general human resource management practices from three perspectives. Semi-structured interviews have been used to understand the employee perspective. The two other perspectives come from the Annual reports produced by both Inditex and Zara and media articles.   Our findings demonstrate that media perspective and employee perspectives comply well with each other. However, there is a great disparity between the annual report perspective and the other two perspectives. The results show three major HRM liabilities, the sole use of internal promotion, general employee dissatisfaction and the lack of local responsiveness. Our aim is that this study will benefit the Swedish retail industry, to perhaps understand performance issues through study. Also, benefit Zara and Inditex if they have similar problems in other countries and the study might explain their lack of financial performance in the Swedish market. In general, this research could assist companies that are expanding into the Swedish market, seeing it emphasis the importance of regional adaption.

Thesis (Ph. D.)--University of Texas at Austin, 2001. / Vita. Includes bibliographical references. Available also from UMI/Dissertation Abstracts International.

The objective of this study was to determine the influence of child and caregiver characteristics on asthma outcomes in Hispanic children. Specific research objectives of the study were to: (1) to asses the relative influence of family characteristics, caregiver level of education, asthma severity, insurance status and acculturation, on asthma outcomes in Hispanic children; (2) to asses the direct and indirect influence of acculturation on asthma outcomes in Hispanic children, while controlling for other variables; (3) to determine the relative influence of familial characteristics, parental level of education, asthma severity, insurance status and acculturation, as they predict utilization of asthma services. The Children's Health Survey for asthma, the abbreviated Multidimensional Acculturation Scale and components of the Children's Medicaid Managed Care Questionnaire were administered during a one time visit with Hispanic caregiver's of children with asthma in a primary care setting. The primary care setting was either a local pediatrician office in Hillsborough County or the local Hillsborough County Health Department. These facilities provide primary care for local residents of the county. The interviews were conducted to identify the relative influence of barriers to asthma outcomes in this at risk population. A sample of one hundred seventy eight caregivers of Hispanic children with asthma identified significant findings that have a profound effect on pediatric asthma outcomes. Findings suggest that factors such as caregiver age and asthma severity have a negative effect on asthma outcomes in Hispanic children. This study found that advanced caregiver age was associated with poorer healthcare outcomes. Acculturation was not found to be significantly associated with asthma outcomes, directly or indirectly even with use of service utilization as a mediator. In this subject sample the level of acculturation of the caregiver does not impact health care outcomes of the child. This study showed that asthma severity and acculturation significantly impacted service utilization. Children with higher asthma severity scores were found to utilize more services. Finally, acculturation was found to have a significant impact on service utilization. The more acculturated caregivers utilized more services than less acculturated caregivers.

This dissertation examines the extent to which individual-level and social network-level factors explain disparities in living donor kidney transplantation (LDKT) and considers the moral implications. Paper One examines whether patient characteristics explain racial disparities in the rate of donor presentation and LDKT in a sample of 752 potential kidney recipients and 654 potential kidney donors. Propensity score matching and subclassification were used to balance the patient characteristics. Survival models revealed that only 24% of blacks compared to 39% of whites would have at least one potential donor evaluated within the first year, even after accounting for differences in the distribution of patient characteristics. Thus, lower rates of donor presentation among black recipients cannot be explained by differences in individual-level characteristics. Paper Two examines whether differences in social networks contribute to disparities in LDKT. Using interview and medical record data from a representative sample of 389 dialysis patients in Greater Boston and a subsample of 302 alters, we found that social network characteristics, especially network size, were strongly predictive of pursuing LDKT. Significant racial disparities in health and medical distrust among social networks of black patients present compelling evidence for network effects. Fewer network members of black patients may be eligible for donation owing to compositional health differences, and those eligible may be less willing to donate due to greater distrust or poor socioeconomic position. Paper Three argues that society ought to be concerned with previously neglected disparities in LDKT, specifically the fraction stemming from disparities in social networks because networks provide one pathway by which inequalities can be perpetuated throughout society and over time. Insofar as social networks are influenced by an unjust distribution of social forces, and social networks influence life chances by restricting (or enhancing) one’s ability to obtain a LDKT, then life chances of dialysis patients are unjustly determined by social networks. Potential policies aimed at providing compensatory damages to patients whose networks have been adversely affected by the unjust influence of social determinants are examined.

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This dissertation advances a cohort perspective to analyze trends in racial and educational disparities in U.S. adult mortality. The project is organized around three themes. First, I emphasize that recent temporal changes in U.S. adult mortality risk are rooted in cohort forces. Unfortunately, much of the mortality literature has failed to account for the fact that the sociohistorical conditions of U.S. cohorts have changed dramatically, and these changes have tremendous implications for population health and mortality trends. My work clearly shows the pitfalls of omitting these cohort effects from analyses of U.S. adult mortality risk. Second, I illustrate that because exposure to social and health conditions have changed over time, resources in adulthood are growing increasingly important in shaping U.S. adult mortality risk. In this regard, my findings also highlight growing disparities in U.S. mortality across race/ethnic gender groups. Third, I advance a cohort theory of U.S. mortality, drawing from both “fundamental cause” theory and a life course perspective of mortality but couching them in a cohort framework to highlight the importance of historical changes in U.S. social and health contexts in both childhood and adulthood. This cohort perspective is then used to analyze three central topics in the U.S. mortality literature: the black-white crossover in older-adult mortality, the growing educational gap in U.S. adult mortality, and the origins and persistence of black-white inequalities in U.S. adult mortality. I estimate hierarchical age-period-cohort cross-classified random effects models using National Health Interview Survey-Linked Mortality Files between 1986 and 2006 to simultaneously analyze age, period, and cohort patterns of U.S. adult mortality rates. I find (1) the black-white crossover is a cohort-specific phenomenon, (2) educational disparities in U.S. adult mortality rates are growing across birth cohorts, not time periods, and (3) racial disparities in U.S. adult mortality rates stem from cumulative racial stratification across both cohorts and the life course. Such findings have direct consequences for both mortality theories and policy recommendations. Only by considering the disparate sociohistorical conditions that U.S. cohorts have endured across their life courses can we fully understand and address current and future health disparities in the United States. / text

Utilizing data from the Oklahoma Department of Health Pregnancy Risk Assessment Monitoring System (PRAMS) for the years 2004 through 2011, this study examines racial and ethnic differences in unhealthy maternal behaviors and the consequences of those actions on the health of both mother and child. The maternal behavior variables include smoking cigarettes, drinking alcohol, multivitamin use, and prenatal care utilization. The maternal health variables include gestational diabetes and hypertension. The labor and delivery outcome variables include placental issues, premature rupture of membranes (PROM), low birth weight, and child placement in an intensive care unit. This researcher hypothesized that minorities would engage in risky and unhealthy behaviors while pregnant more often than whites due to social disadvantages in the economic and educational realms. Furthermore, minorities would be more likely than whites to have unfavorable outcomes regarding labor, delivery, and health of the child due to lower socioeconomic status, poor maternal health, and underutilization of preventative care. The researcher finds that minority women seem to adhere to proper maternal health recommendations associated with personal choice, including smoking and drinking, though disparities are evident when compared to whites regarding behaviors associated with socioeconomic status, including prenatal care utilization and multivitamin use. African American women are more likely than whites to experience premature rupture of the membranes, have an underweight baby, and to place their baby in ICU, though less likely to experience placental issues. Native American women are less likely than whites to experience premature rupture of the membranes, have an underweight baby, and to place their baby in ICU, but more likely to experience placental issues. As expected, substantial changes have occurred in the maternal health and well-being of Oklahoma mothers over the course of the two PRAMS data collection phases.

In the United States, concern about breast cancer has generated policies and programs aimed at increasing screening mammography and treatment access for the uninsured and underinsured. Oriented toward the importance of early detection and the state's responsibility to ensure health care access to its citizens, these policies and programs reflect and reinforce a moral economy of disease management that shapes the ethical behavior of patients, providers, and advocates. In contrast, the moral economy of market-based health care generates norms and assumptions about individual responsibility for health and limits expectations of the state in providing access to health care. Using breast cancer care for structurally vulnerable women as a focal point, this dissertation examines the social effects of intersecting moral economies of breast cancer management and market-based health care. It describes the relationships between public policies, social and economic marginalization, and gaps in health care access. Based on 18 months of ethnographic field work in Southern Arizona, I report findings from interviews with physicians, nurses, advocates, clinic office staff, and community health workers; from recurring discussions with women undergoing treatment for breast cancer; and from participant-observation in cancer-focused events and activities. This dissertation explores how policies that extend low-cost or free health care to broad populations also reproduce social exclusion and complicate what it means to be uninsured in America. I describe how everyday practices of health care, including determinations of eligibility for public insurance, reflect and reinforce social inequities based on citizenship status, gender, and occupational status. I conclude that the organization of cancer care for structurally vulnerable women effectively directs the focus away from the state's responsibility to provide health care access and instead privatizes that responsibility so that it resides with structurally vulnerable clinics and non-licensed health care staff. Furthermore, a charity approach to managing cancer care for unauthorized U.S. residents diverts public responsibility for their social exclusion to private entities. Finally, the findings of this dissertation contribute to debates about health reform efforts, such as the Affordable Care Act, by outlining the relationship between moral worth and government entitlements.

Background. In Pima County, twenty-four percent of the population is obese, and this figure has steadily increased over the past ten years. A major cause is lack of regular exercise, which is a factor for other chronic health illnesses as well. An important intervention for improvement has been identified as regular, moderate-intensity physical activity. Proper surveillance is necessary to identify health disparities and barriers. The purpose of this scholarly practice inquiry (PI) was to use the American College of Sports Medicine American Fitness Index (ACSM-AFI) instrument to identify personal and community health disparities in Pima County, using the Global Strategy on Diet, Physical Activity and Health (DPAS) as a framework. Additionally, the purpose was to identify pertinent stakeholders who would benefit from these findings. Methods. This was a descriptive cross-sectional study that used publicly available surveillance data. The analysis of the ACSM-AFI instrument results for Pima County, Arizona yielded personal health indicators, community/environment indicators, county advantages, and challenges in comparison to national averages, and identification of pertinent stakeholders. The sample population for this study was comprised of the residents of Pima County, Arizona as determined by publically available surveillance data. Results. Pima County, compared to the national average, has a higher percent of moderately physically active residents, a lower percent of obese residents, more park-related expenditures, more swimming pools, more recreational centers, and more golf courses. Pima County has a lower percent of residents with health insurance, a higher death rate from diabetes and cardiovascular disease, lower parkland in city land area, a lower level of state requirements for Physical Education classes, fewer primary care providers, fewer dog parks, baseball diamonds, acres of parkland, and more violent crime. Conclusions. The major deficits, which should be the focus for community leaders, were health care coverage, cardiovascular and diabetes mortality, and environmental safety. These findings are relatable to obesity, metabolic syndrome, and socioeconomic barriers, which were identified in the initial literature review conducted for this PI. Examples of four major areas of pertinent stakeholders were the Pima County Health Department, the Pima County Business Community, the Arizona Daily Star, and The University of Arizona.

Mammography is widely recognized as the best method to detect breast cancer. This study examined the screening rate differences among women who live in urban and rural counties in Georgia and North Carolina. Data on the mammography screening rates was obtained from the Behavior Risk Factor Surveillance System (BRFSS) for 2002 and 2004. To assess the availability of mammography facilities, data was obtained from the Mammography Facility Database provided by the FDA. Multivariate logistic regression showed that having a usual source of care in urban counties was a positive predictor of women 40-59 years of age getting screened in both states; having a personal doctor and health care coverage was significantly associated with women ages 60 and above getting screened. Getting screened was negatively predicted for women 60 years of age and older who had only a high school education. Data pertaining to mammography screening rates at the state level needs to be made publicly available to compare differences that exist among states. To better address an individual’s access to mammography facilities, a survey should be developed by the American Cancer Society which addresses the facility’s hours of operation, populations served from neighboring counties, translation services available and number of mobile versus permanent facilities in each county. INDEX WORDS: mammography, screening, breast cancer, urban, rural, barriers, access, state cancer plan, metropolitan, non metropolitan