This thesis seeks to contribute to the knowledge base about social policy in the United States, using long-term care (LTC) financing policy reform as an illustrative example. Specifically, this thesis explores LTC financing reform efforts during three U.S. Presidential administrations: Bill Clinton (1993-2001), George W. Bush (2001-2009), and Barack Obama (2009-2010). Within this historical framework, the LTC provisions of the Health Security Act of 1993, the development of the Community Living Assistant Services and Supports or 'CLASS' Act during the Bush Administration, and the legislative success of the CLASS Act as a part of the Patient Protection and Affordable Care Act of 2010 provide comparable cases to compare the drivers of social policy. Drawing on the explanatory frameworks of the welfare state such as ideology, historical institutionalism, and an actor-centered approach to policy analysis, this thesis argues that successful path-departing legislation is difficult to achieve due, in part, to the presumed high costs of social programs and the complex institutional framework of the American political system. Policy outcomes result from the interaction between the complex processes and dynamics of the political system through which policy change (or the failure to change) actually occurs. The fact that the CLASS Act was politically successful, yet administratively inoperable as designed, reinforces the argument that social policy outcomes in the United States are reflective of a complex, enduring struggle of competing ideologies. This continual struggle, coupled with a heightened concern over cost control and fiscal austerity, helps to ensure that policies which are legislatively successful within the institutional architecture of the American political system are unlikely to produce major expansions of the welfare state. Social change is therefore highly difficult to achieve, even in the face of significant unmet social needs. Comprehensive reform of U.S. LTC financing arrangements will remain an elusive goal for the foreseeable future. Instead, incremental, highly pro-market solutions are likely to be the types of policies promoted in the years of ahead.

Since diffusion models of social network are widely used in studying epidemiology, in this thesis, we apply diffusion models to study the contact immunity generated by attenuated vaccines.Oral polio vaccine (OPV) is a typical attenuated vaccine for polio that can produce contact immunity and therefore help protect more individuals than vaccinees. / To better capture the utilization of OPV’s contact immunity, we model the community as a social network, and formulate the task of maximizing the contact immunity effect as an optimization problem on graphs, which is to find a sequence of vertices to be “vaccinated” to maximize the total number of vertices “infected” by the attenuated virus. Furthermore, as immune defiicient patients may suffer from the live attenuated virus in the vaccine, we develop models in consideration of this restriction, and study related problems. / We present polynomial-time algorithms for these problems on trees, and show the intractability of problems on general graphs. / 社交網絡的擴散模型被廣泛運用于對流行病學的研究，在本文中，我們使用擴散模型對減毒活疫苗產生的接觸性免疫進行研究。口服脊髓灰質炎疫苗（OPV）是一種典型的減毒活疫苗，它可以在人群中產生接觸性免疫，使得更多未接種疫苗的人獲得免疫力。 / 爲了更好的刻畫OPV 產生的接觸性免疫，我們將社區模型化為社交網絡，從而將接觸性免疫效應最大化的任務轉化爲圖優化問題，即通過發現頂點的一個「接種」序列來最大化被減活病毒「感染」的頂點數量。此外，因爲減毒疫苗中的活病毒會使患有免疫缺陷的病人患病，我們考慮在此因素限制下的模型，并研究相關的問題。 / 我們給出這些問題在樹上的多項式時間算法，并證明其在一般圖上的複雜性。 / Ma, Chenglong. / Thesis M.Phil. Chinese University of Hong Kong 2015. / Includes bibliographical references (leaves 40-47). / Abstracts also in Chinese. / Title from PDF title page (viewed on 12, September, 2016). / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only.

RESUMO OLIVEIRA, M. F. S. Avaliação da cobertura vacinal em Menores de cinco anos em Bom Jesus, Província do Bengo Angola, 2010. 111f. 2011. (Dissertação) Faculdade de Medicina de Ribeirão Preto-USP, Ribeirão Preto, 2011. Este estudo tem como objetivo avaliar a cobertura vacinal em crianças menores de cinco anos na comuna de Bom Jesus, Bengo, Angola e descrever as relações entre esse indicador com algumas características do contexto sócio econômico e demográfico local, do saneamento do meio, dos agregados familiares, das crianças e das mães ou responsáveis das mesmas. Material e Métodos: trata-se de uma pesquisa descritiva, transversal e censitária, com 1205 crianças menores de cinco anos residentes em Bom Jesus no 1° semestre de 2010, razão pela qual não estabelecemos relações de associação entre as variáveis em estudo. As fontes de dados foram: 1) O inquérito domiciliar por entrevistas as mães ou responsáveis das crianças e aos chefes de família. 2) Cartão de saúde infantil e de saúde materna para os dados referentes ao estado vacinal das crianças e a vacinação antitetânica das mães ou responsáveis, respectivamente. 3) Registros sobre vacinações dos serviços de saúde de Bom Jesus e da província do Bengo. Para o processamento, analise e tratamento dos dados foi utilizado o software Epi-Info, versão 3.5.2. Resultados: Das 1205 crianças, 67,5 não possuíam cartão de vacina; a cobertura vacinal de Bom Jesus foi de 36,6%, sendo mais elevadas nos bairros Coxe e Matabuleiro com 65,2% e 65%, respectivamente e sem diferença entre os sexos; para a VOP, DTP e Hep B, 72,4%, 69,9% e 67,1% das crianças fizeram as doses com intervalos corretos; a maior cobertura vacinal ocorreu nos menores de 30 dias, com 67,9%, sendo esses valores muito menores que a meta de 90%, do PAV/Angola.A cobertura vacinal específica para a BCG, DTP, VOP, contra Hep B, Sarampo, Febre Amarela e antitetânica foi de 90,8%, 47,2 %, 51%, 14,2 %, 43%, 41,5% e 59%%, respectivamente e podem ser consideradas muito baixas com exceção para a BCG; a taxa de abandono para a DTP, VOP e Hep B foi de 32,2%, 32,8% e 25,4% respectivamente, valores muito superiores a meta que OMS/África recomenda é de até 10%; se constatou que aparentemente a cobertura vacinal aumentava conforme houvesse um incremento da escolaridade do chefe de família da e da mãe ou responsável pela criança, quando o chefe de família fosse o pai, mãe doméstica, com a presença da avó, os pais fossem de etnia kimbundo, melhores condições habitacionais, usuários dos serviços públicos de abastecimento de água e de coleta de lixo; os dados sugerem o decréscimo desse indicador conforme aumenta a idade da mãe ou responsável, o tamanho da família, o número de filhos vivos, a ordem de nascimento e a idade da criança. Conclusões: Os resultados indicam a importância dos inquéritos domiciliares como ferramentas indispensáveis na avaliação da cobertura vacinal real e a probabilidade de alguns fatores contextuais, individuais e familiares influenciarem a variabilidade desse indicador, para além de puderem subsidiar a decisão sobre o aperfeiçoamento de programas locais de imunização. Palavras Chaves: Avaliação, Determinantes sociais de Saúde, Vacinação, Programas de Imunização, Cobertura Vacinal e Taxa de Abandono. / ABSTRACT OLIVEIRA, M. F. S. Evaluation of the vaccine covering in Minors of five years in Bom Jesus, Province of the Bengo Angola, 2010. 111f. 2011. (Dissertation) College of Medicine of Brook Black Color, Ribeirão Preto, 2011. This study it has as objective to evaluate the vaccine covering in minors of five years in Good Jesus ,Bengo, Angola and to describe the relations between this pointer with some characteristics of the context economic partner and demographic place, of the sanitation of the way, the family units, the children, the mothers or responsible of the same ones. Methodology: one is about an evaluative, descriptive research and tax, with 1205 lesser children five year residents in Good Jesus in the first semester of 2010. The sources of data had been: 1) the domiciliary inquiry for interviews the responsible or mothers of the children e to the family heads, through the application of a form elaborated for the effect. 2) Card of infantile health and maternal health for the referring data to the vaccine state of the children and the against the tetanus vaccination of the responsible mothers or, respectively. 3) Registers on existing vaccinations in the local services of health of Good Jesus and the province of the Bengo. For the processing, it analyzes and treatment of the data was used software Epi-Info, version 3.5.2. RESULTS: Of the 1205 children, 67,5 do not passim vaccine card; the vaccine covering of Good Jesus was of 36,6%, being more raised in the quarters Coxe and Matabuleiro with 65,2% and 65%, respectively; it was observed that the children with less than 30 days had presented the biggest vaccine covering with 67,9%, without difference between the sexes. These values are placed very on this side of the 90% goal, established for the PAV/Angola. The specific vaccine covering for the BCG, DTP, Antipóliomielite, against Hepatitis B, Measles, Yellow Fever and antitectanic was of 90,8%, 47.2%, 51%, 14.2%, 43%, 41.5% and 59%, respectively and can be considered very low with exception for the BCG; the tax of abandonment for the DTP, Antipóliomielite and Hepatite B was of 32,2%, 32.8% and 25.4% respectively, very superior values the goal that OMS/Africa recommends is of even 10%; if it evidenced that apparently the vaccine covering increased as had an increment of the schooling of head of family, the schooling of the responsible mother or for the child, when the family head was the father, mother domesticates, with the presence of the grandmother, the parents was speakers of the local language (Kimbundo), with better house conditions and using conditions of the public services of supplying of water and basic sanitation of the environment; the data suggest the decrease of this in agreement pointer it increases the age of the responsible mother or, the size of the family, the number of children livings creature, the increment in the birth order and the age of the child. CONCLUSIONS: The results indicate the importance of the inquiries domiciliary as indispensable tools in the evaluation of real the vaccine covering and the probability of some contextual, individual and familiar factors to influence the variability of this pointer, stops beyond will be able to subsidize the decision on the perfectioning of local programs of immunization. Key Words: Evaluation, Determinative social of Health, Vaccination, Programs of Immunization, Vaccine Covering and Tax of Abandonment.

Made available in DSpace on 2014-12-17T15:43:51Z (GMT). No. of bitstreams: 1 JanmilleVS_DISSERT.pdf: 924305 bytes, checksum: f63a120cee4f02a246910cfb885de7a3 (MD5) Previous issue date: 2012-12-07 / Despite the improvement of Brazilian s living conditions in recent decades, this improvement occurred in a polarized way between groups of better social position. Then, there is still a health inequity?s panorama in Brazil which encompasses the oral health state. This panorama instigated the attainment of this ecological study that aimed to evaluate the relationship of socioeconomic conditions, and public health policies with oral health status in Brazilian capitals. Thus, we performed factor analysis and linear regression using oral health indicators collected from SB Brasil 2010, of socioeconomic conditions from Brazilian Census 2010 and related to water?s supply fluoridation from SISAGUA. Factor analysis with indicators of living conditions revealed two common factors, economic deprivation and socio-sanitary condition. Economic deprivation showed statistically significant positive correlation with DMFT 12 years (p= 0,03) and mean missing teeth (p = 0,002) and negative correlation with caries-free population (p=0,012). Socio-sanitary negatively correlated with DMFT (p <0,0001) and a positive correlation with caries-free population (p = 0.002). Fluoridated water had a significant association with DMFT (p <0,0001), mean missing teeth (p <0,0001) and caries free population (p <0.0001). Multiple linear regression analysis for the DMFT of capital was estimated by socio-sanitary condition and fluoridation, adjusted by economic deprivation, whereas the model for the mean missing teeth was estimated only by fluoridation and economic deprivation, and finally the model the rate for the population free of caries in Brazilian capitals was estimated by economic and socio-sanitary status adjusted fluoridated water supply. Therefore, factors related to living conditions and public policies are intrinsically linked to tooth decay issues. Thus, actions, beyond dental care assistance, must be development to impact positively in social and economic conditions, especially, between the most vulnerable populations / Apesar da melhoria das condi??es de vida dos brasileiros nas ?ltimas d?cadas, esta ocorreu de forma polarizada entre grupos de melhor posi??o social. Assim, persiste um panorama de iniquidades em sa?de no Brasil que abrange, inclusive, a situa??o de sa?de bucal. Tal panorama instigou a realiza??o deste estudo ecol?gico que visou avaliar a rela??o das condi??es socioecon?micas (SE), bem como de pol?ticas de sa?de p?blica com as condi??es de sa?de bucal nas capitais brasileiras. Para tanto, foram realizadas an?lise fatorial e de regress?o linear utilizando indicadores de sa?de bucal coletados do SB Brasil 2010, de condi??es socioecon?micas do Censo Brasileiro 2010 e relativos ? fluoreta??o das ?guas de abastecimento do Sisagua. A An?lise fatorial com os indicadores de condi??es de vida revelou dois fatores comuns; depriva??o econ?mica e condi??o s?cio-sanit?ria. Depriva??o econ?mica apresentou correla??o positiva estatisticamente significativa com o CPO-D 12 anos (p=0,03) e m?dia de dentes perdidos (p=0,002) e correla??o negativa com popula??o livre de c?rie (p=0,012). Condi??o s?cio-sanit?ria mostrou correla??o negativa com CPO-D (p<0,0001) e correla??o positiva com popula??o livre de c?rie (p=0,002). ?gua de abastecimento fluoretada teve associa??o significativa com CPO-D (p<0,0001), m?dia de dentes perdidos (p<0,0001) e popula??o livre de c?rie (p<0,0001). An?lise de regress?o linear m?ltipla para o CPO-D das capitais foi estimado pelas condi??es s?cio-sanit?rias e fluoreta??o, ajustado pela depriva??o econ?mica; enquanto que o modelo para a m?dia de dentes perdidos foi estimado apenas pela fluoreta??o e depriva??o econ?mica, e por fim, o modelo para a taxa da popula??o livre de c?rie nas capitais brasileiras foi estimado pela condi??o econ?mica e s?cio-sanit?ria ajustadas pelo abastecimento de ?gua fluoretada. Portanto, quest?es relativas ?s condi??es de vida e ?s pol?ticas p?blicas est?o intrinsecamente associadas ? c?rie dent?ria. Assim, ? preciso desenvolver a??es, para al?m da assist?ncia odontol?gica, para impactar positivamente nas condi??es econ?micas e sociais, sobretudo, das popula??es mais vulner?veis

RESUMO OLIVEIRA, M. F. S. Avaliação da cobertura vacinal em Menores de cinco anos em Bom Jesus, Província do Bengo Angola, 2010. 111f. 2011. (Dissertação) Faculdade de Medicina de Ribeirão Preto-USP, Ribeirão Preto, 2011. Este estudo tem como objetivo avaliar a cobertura vacinal em crianças menores de cinco anos na comuna de Bom Jesus, Bengo, Angola e descrever as relações entre esse indicador com algumas características do contexto sócio econômico e demográfico local, do saneamento do meio, dos agregados familiares, das crianças e das mães ou responsáveis das mesmas. Material e Métodos: trata-se de uma pesquisa descritiva, transversal e censitária, com 1205 crianças menores de cinco anos residentes em Bom Jesus no 1° semestre de 2010, razão pela qual não estabelecemos relações de associação entre as variáveis em estudo. As fontes de dados foram: 1) O inquérito domiciliar por entrevistas as mães ou responsáveis das crianças e aos chefes de família. 2) Cartão de saúde infantil e de saúde materna para os dados referentes ao estado vacinal das crianças e a vacinação antitetânica das mães ou responsáveis, respectivamente. 3) Registros sobre vacinações dos serviços de saúde de Bom Jesus e da província do Bengo. Para o processamento, analise e tratamento dos dados foi utilizado o software Epi-Info, versão 3.5.2. Resultados: Das 1205 crianças, 67,5 não possuíam cartão de vacina; a cobertura vacinal de Bom Jesus foi de 36,6%, sendo mais elevadas nos bairros Coxe e Matabuleiro com 65,2% e 65%, respectivamente e sem diferença entre os sexos; para a VOP, DTP e Hep B, 72,4%, 69,9% e 67,1% das crianças fizeram as doses com intervalos corretos; a maior cobertura vacinal ocorreu nos menores de 30 dias, com 67,9%, sendo esses valores muito menores que a meta de 90%, do PAV/Angola.A cobertura vacinal específica para a BCG, DTP, VOP, contra Hep B, Sarampo, Febre Amarela e antitetânica foi de 90,8%, 47,2 %, 51%, 14,2 %, 43%, 41,5% e 59%%, respectivamente e podem ser consideradas muito baixas com exceção para a BCG; a taxa de abandono para a DTP, VOP e Hep B foi de 32,2%, 32,8% e 25,4% respectivamente, valores muito superiores a meta que OMS/África recomenda é de até 10%; se constatou que aparentemente a cobertura vacinal aumentava conforme houvesse um incremento da escolaridade do chefe de família da e da mãe ou responsável pela criança, quando o chefe de família fosse o pai, mãe doméstica, com a presença da avó, os pais fossem de etnia kimbundo, melhores condições habitacionais, usuários dos serviços públicos de abastecimento de água e de coleta de lixo; os dados sugerem o decréscimo desse indicador conforme aumenta a idade da mãe ou responsável, o tamanho da família, o número de filhos vivos, a ordem de nascimento e a idade da criança. Conclusões: Os resultados indicam a importância dos inquéritos domiciliares como ferramentas indispensáveis na avaliação da cobertura vacinal real e a probabilidade de alguns fatores contextuais, individuais e familiares influenciarem a variabilidade desse indicador, para além de puderem subsidiar a decisão sobre o aperfeiçoamento de programas locais de imunização. Palavras Chaves: Avaliação, Determinantes sociais de Saúde, Vacinação, Programas de Imunização, Cobertura Vacinal e Taxa de Abandono. / ABSTRACT OLIVEIRA, M. F. S. Evaluation of the vaccine covering in Minors of five years in Bom Jesus, Province of the Bengo Angola, 2010. 111f. 2011. (Dissertation) College of Medicine of Brook Black Color, Ribeirão Preto, 2011. This study it has as objective to evaluate the vaccine covering in minors of five years in Good Jesus ,Bengo, Angola and to describe the relations between this pointer with some characteristics of the context economic partner and demographic place, of the sanitation of the way, the family units, the children, the mothers or responsible of the same ones. Methodology: one is about an evaluative, descriptive research and tax, with 1205 lesser children five year residents in Good Jesus in the first semester of 2010. The sources of data had been: 1) the domiciliary inquiry for interviews the responsible or mothers of the children e to the family heads, through the application of a form elaborated for the effect. 2) Card of infantile health and maternal health for the referring data to the vaccine state of the children and the against the tetanus vaccination of the responsible mothers or, respectively. 3) Registers on existing vaccinations in the local services of health of Good Jesus and the province of the Bengo. For the processing, it analyzes and treatment of the data was used software Epi-Info, version 3.5.2. RESULTS: Of the 1205 children, 67,5 do not passim vaccine card; the vaccine covering of Good Jesus was of 36,6%, being more raised in the quarters Coxe and Matabuleiro with 65,2% and 65%, respectively; it was observed that the children with less than 30 days had presented the biggest vaccine covering with 67,9%, without difference between the sexes. These values are placed very on this side of the 90% goal, established for the PAV/Angola. The specific vaccine covering for the BCG, DTP, Antipóliomielite, against Hepatitis B, Measles, Yellow Fever and antitectanic was of 90,8%, 47.2%, 51%, 14.2%, 43%, 41.5% and 59%, respectively and can be considered very low with exception for the BCG; the tax of abandonment for the DTP, Antipóliomielite and Hepatite B was of 32,2%, 32.8% and 25.4% respectively, very superior values the goal that OMS/Africa recommends is of even 10%; if it evidenced that apparently the vaccine covering increased as had an increment of the schooling of head of family, the schooling of the responsible mother or for the child, when the family head was the father, mother domesticates, with the presence of the grandmother, the parents was speakers of the local language (Kimbundo), with better house conditions and using conditions of the public services of supplying of water and basic sanitation of the environment; the data suggest the decrease of this in agreement pointer it increases the age of the responsible mother or, the size of the family, the number of children livings creature, the increment in the birth order and the age of the child. CONCLUSIONS: The results indicate the importance of the inquiries domiciliary as indispensable tools in the evaluation of real the vaccine covering and the probability of some contextual, individual and familiar factors to influence the variability of this pointer, stops beyond will be able to subsidize the decision on the perfectioning of local programs of immunization. Key Words: Evaluation, Determinative social of Health, Vaccination, Programs of Immunization, Vaccine Covering and Tax of Abandonment.

Abstract The purpose of this study was to describe and understand the individualised integration of social and health services for frequent attenders by customer profile from the perspective of knowledge-based management. The study was carried out using the multi-method approach. Sub-study (Ⅰ) described what kind of customer profiles could be identified among municipal residents based on diaries (n=15) at the planning stage of the social and health care centre. Sub-study (Ⅱ) identified the customer profiles of frequent attenders based on service plans (n=56). Sub-study (Ⅲ) described, in the form of a register study, based on four customer profiles, the use of primary healthcare, emergency care and specialised healthcare services by frequent attenders (n=2388) and the social services decided to them. The data of the sub-studies was analysed by means of content analysis and systematic analysis as well as statistically. As a result of the study, customer profiles were generated both for municipal residents and for frequent attenders. The purpose of identifying customer profiles for municipal residents was to seek preunderstanding for the definition of frequent attenders’ customer profiles. With frequent attenders, physical, mental and social service needs are intertwined. The use of social and health services was highly individualised according to the customers’ current life situation. The study highlighted from the perspective of knowledge-based management the need for individualised integration of social and health services for frequent attenders and for the multi-disciplinary social and health information and the flow of information between different social and health service operators it requires. The results of the study can be utilised in the construction and management of the integration of social and health services for frequent attenders. / Tiivistelmä Tutkimuksen tarkoituksena oli kuvailla ja ymmärtää paljon palveluja tarvitsevien asiakkaiden yksilöityä sosiaali- ja terveyspalvelujen (sote) integraatiota asiakasprofiileittain tietoperustaisen johtamisen näkökulmasta. Tutkimus toteutettiin monimenetelmäisesti. Osatutkimus (Ⅰ) kuvasi, millaisia kuntalaisten asiakasprofiileja oli tunnistettavissa päiväkirjojen (n = 15) avulla hyvinvointikeskuksen suunnitteluvaiheessa. Osatutkimuksessa (Ⅱ) palvelusuunnitelmien (n = 56) perusteella tunnistettiin paljon palveluja tarvitsevien asiakasprofiileja. Osatutkimuksessa (Ⅲ) kuvailtiin rekisteritutkimuksena neljään asiakasprofiiliin perustuen paljon palveluja tarvitsevien asiakkaiden perusterveydenhuollon, päivystyksen ja erikoissairaanhoidon palvelujen käyttöä (n = 2 388) sekä heille myönnettyjä sosiaalipalveluja. Osatutkimusten aineistot analysoitiin sisällönanalyysillä, systemaattisella analyysillä sekä tilastollisesti. Tutkimuksen tuloksena syntyi sekä kuntalaisten että paljon palveluja tarvitsevien asiakkaiden asiakasprofiileja. Kuntalaisten asiakasprofiilien tunnistamisella haettiin esiymmärrystä paljon palveluja tarvitsevien asiakkaiden asiakasprofiilien määrittelyyn. Paljon palveluja tarvitsevilla asiakkailla fyysiset, psyykkiset ja sosiaaliset palvelutarpeet kietoutuivat toisiinsa. Sote-palvelujen käyttö oli vahvasti yksilöity asiakkaiden oman elämäntilanteen mukaan. Tutkimus nosti esille tietoperustaisen johtamisen näkökulmasta perusteen paljon palveluja tarvitsevien asiakkaiden yksilöityyn sosiaali- ja terveyspalvelujen yhteen kokoamiseen ja sen edellyttämään monialaiseen sote-tietoon ja tiedon liikkumiseen eri sote-toimijoiden välillä. Tutkimuksen tuloksia voidaan hyödyntää paljon palveluja tarvitsevien asiakkaiden sote-integraation rakentamisessa ja johtamisessa.

Background Over the past three decades, social relationships have been shown to have important effects upon health. However, many different definitions and aspects of social relationships have been considered in the various studies, making comparison of findings difficult. Furthermore, the effects of social relationships upon different health outcomes have rarely been investigated within the same cohort of older people. In addition, there is a paucity of information concerning the effects of social relationships upon health of older Australians. Aim This thesis aims to investigate the effects of the structural aspects of social relationships – that is, social networks – on health among older Australians. The three specific health outcomes considered in this thesis were disability, residential care use and death. The specific aims of the thesis were to: 1. Develop a measurement model of social networks. 2. Examine the effects of total and specific social networks upon disability. 3. Determine the effects of total and specific social networks upon use of residential care. 4. Investigate the effects of total and specific social networks upon survival. An additional aim was to determine if there were threshold effects of social networks on the three specific health outcomes. Methods The study drew on six waves of data from 1477 participants in the Australian Longitudinal Study of Ageing. A range of statistical techniques, including binary and multinomial logistic regression and survival analysis, were used in the analysis of the data. Propensity score adjustment was used to control for the effects of a broad range of covariates that encompassed sociodemographic, health, psychological and lifestyle characteristics of participants. Results A measurement model with social networks for children, relatives, friends and confidants was validated using confirmatory factor analysis. A variable that measured total social networks was also derived. Better social networks with relatives were protective against developing mobility disability over the nine year follow-up period (odds ratio (OR) 0.77; 95% confidence interval (95%CI) 0.62 – 0.96). A similar result was found for Nagi disability (OR 0.76; 95%CI 0.62 – 0.93). Other specific social networks did not have significant effects on either measure of disability. There were no significant effects of social networks on use of low-level residential care overall. There was a significant effect of social networks with confidants and total social networks, such that participants in the upper category of social networks with confidants appeared to be protected against use of high-level residential care (OR 0.53; 95%CI 0.35 – 0.81) compared to participants in the lower category of confidants social networks. Similarly, participants in the upper category for total social networks appeared to be protected against use of high-level residential care (OR 0.68; 95%CI 0.46 – 0.99). In terms of mortality, better social networks with confidants and with friends appeared to be protective against death during the decade following the Wave 1 interview. The hazard ratio (HR) for participants in the upper category for confidants was 0.74 (95%CI 0.63-0.88) compared to participants in the lower category. For friends networks, the analogous HR was 0.75 (95%CI 0.63-0.89). Better total social networks also appeared to be protective against death over the 10 years of follow-up (HR 0.83; 95%CI 0.70- 0.99). There were few significant effects of social networks with children on the three health outcomes considered. There was little evidence of threshold effects of the specific social networks on the health outcomes. Discussion There are important and differing effects of specific social networks on the three health outcomes of disability, residential care and mortality that were considered in this thesis. Policymakers may need to reconsider whether specific kinds of social relationships, beyond spouses and children, have been given adequate weight in current policy frameworks that address the health of older people. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1321011 / Thesis (Ph.D.) -- University of Adelaide, School of Mathematical Sciences, 2008

Thèse (M.A.)--Université Laval, 1999. / Comprend des réf. bibliogr.

<p> <b>BACKGROUND: </b> Though significant gains have been made in preventing cervical cancer over the past 30 years, it continues to cause morbidity and mortality among women in the United States, particularly among those women who are screened infrequently or not at all. More than half of cervical cancer deaths in the U.S. are among immigrants, and the incidence and mortality from cervical cancer is increasing among foreign-born women. Arab and Hispanic women living in the U.S. continue to have cervical cancer screening rates that are lower than the general population. Understanding what factors influence their cervical cancer screening practices and what new screening options may overcome their barriers to preventive screening may be effective in reducing disparities in the disease burden of cervical cancer. </p><p> HPV DNA testing has taken on a larger role in cervical cancer screening, and there is increasing evidence and support for the use of HPV testing alone as a primary cervical cancer screening test. Novel health screening devices have been developed that allow women to self-screen for HPV, which may offer opportunity to simplify the cervical cancer screening protocol and reach women who are not receiving recommended cervical cancer screening services. </p><p> <b>OBJECTIVE: </b>Because self-administered screening devices are not yet available and most women have not had exposure to them, there are limited quantitative and qualitative assessments of women's attitudes towards and likelihood to use such devices, particularly in the U.S. This study informs the development of culturally appropriate interventions and policies intended to improve cervical cancer screening rates among Arab and Hispanic women in the United States, and discusses implementation challenges and policy implications associated with incorporating self-administered HPV testing into the cervical cancer screening protocol in the U.S. </p><p> <b>METHODS:</b> A paper-based survey (n = 476) and individual interviews (n = 31) were used to explore Arab and Hispanic participants' screening behaviors, their likelihood to use HPV self-administered tests to screen for cervical cancer, their perceived self-efficacy in using self-screening tests, and the major concerns they have about self-screening. </p><p> <b>RESULTS:</b> Participants who were 1) uninsured, 2) knowledgeable about HPV and cervical cancer, 3) had high self-efficacy in their ability to use a self-screening test; and 4) had no concerns about the self-screening test were significantly more likely to use a self-screening test. Hispanic participants (74.0%) were significantly more likely than Arab participants (43.8%) to report they would be likely to use a self-administered cervical cancer screening test if it were available. Approximately half of uninsured (52.7%) and underscreened (47.1%) participants reported they would be more likely to get screened for cervical cancer if an at-home self-screening test were available. </p><p> <b>CONCLUSIONS:</b> A majority of participants responded positively to the option for HPV self-testing as a cervical cancer screening option, suggesting that it may an effective screening modality to reach women who are not accessing routine screening. More research is needed on implementing a self-screening option, particularly among underscreened populations.</p>

The evolution of fiscal spending in nutrition, health and education of children and adolescents between 2000–2005, has not been following the same pattern of growth as that of GDP in the same period of time in Peru. These important components of public policy in childhood and adolescence have not been properly attended with the larger resources collected by the State, specially in the nutrition area given that fiscal real expenditure in that area fell in spite of the rapid growth of GDP during the period of our study. With the figures found in the SIAF, the structure of publicexpenditure in the indicated components has been constructed, according to the expenditure budgetary functions, allowing us to establish a base that allows us to make proposals on improvements in public policy in the formation of the human capital since childhood. / La evolución del gasto público en nutrición, salud y educación de niños, niñas y adolescentes en el período 2000–2005 no ha seguido una tendencia similar al crecimiento del PBI para el mismo período en el Perú. Estos importantes rubros de la política pública en infancia y adolescencia no han sido fuertemente atendidos con los mayores recursos recaudados por el Estado, en particular el de nutrición que tuvo cada vez menos recursos del gasto público en proporción al crecimiento que experimentó el PBI en dicho período de estudio. Con las cifras encontradas en el SIAF se ha construido la estructura del gasto público en los rubros antes señalados,según las funciones presupuestales de gasto, lo que ha establecido una base que permite proponer mejoras en la política pública de formación de capital humano desde la infancia.