>Magister Scientiae - MSc / Background: The explosion in the popularity and use of e- cigarettes over the last decade has raised concerns and incited intense discussions over their safety, efficacy and potential public health impact. Globally there is dramatic variation in the approach to regulation, with certain jurisdictions attempting to regulate e-cigarettes either as tobacco products, medicines, consumer products or poisons whilst others have banned their use and sale. The aim of this study was to review the e-cigarette regulatory strategies adopted by the World Health Organisation, Australia, European Union and United States in an attempt to identify feasible approaches to the regulation of e-cigarettes in South Africa within the context of existing institutional regulatory frameworks. Methods: The principles of an explorative comprehensive literature-based review using a thematic qualitative approach were employed. The primary method of data collection was documentation, collected and selected using document review and analysis. Results: The strategies between jurisdictions studied vary significantly in their approach to e-cigarette regulation with each equally facing challenges and massive criticism. The South African approach to the medicalisation of e-cigarettes when evaluated against the WHO FCTC regulatory objectives was found to be ineffective and warrants a change in strategy. Within the existing medicine and tobacco product regulatory frameworks, SA has the option to regulate e-cigarettes as: (1) medicine; (2) tobacco products; or (3) an amalgam of the two approaches. Conclusion: The most expeditious way for SA to regulate e-cigarettes immediately, in the absence of robust scientific data would be to implement a hybrid approach - regulation as a medicine when marketed for therapeutic use and as tobacco products when used recreationally.

The purpose of this paper is to document the results of the research required to conscientiously prepare a performance of The Diary of One Who Vanished, by Leos Janacek. Too often, vocalists and instrumentalists alike find themselves in a performance not knowing the bare essentials needed to produce an acceptable performance. Research is necessary in the following areas: life history of the composer as well as historical and political conditions of his surroundings, compositional style of the composer and specific tools which he used in the composition of the music to be performed and, if the composition is vocal, a thorough investigation of the text. Only after a complete study in these areas can a performance of any music be intelligently given.

Master of Public Health - MPH / Gay men and other men who have sex with men (MSM) and a subset within this group who are people who inject drugs (PWID) face difficulties when trying to access humanimmune deficiency virus (HIV)/ anti-retroviral treatment (ART) services and adhere to ART, due to the intersecting forms of oppression they face. Current interventions to address adherence to ART are mostly bio-medical in nature, and support the presumption that individual-level factors are the most pertinent barriers to adherence to ART. This mini-thesis presents findings from a qualitative study that explored individual, health systems and structural factors that shape experiences of adherence to ART amongst gay men and other MSM and a subset within this group who are PWID

Philosophiae Doctor - PhD / Studies on rational medicine use (RMU) have mainly focused on identifying, quantifying, and addressing irrational use without exploring reasons behind this irrational use. In addition, minimal work has been conducted on irrational use of medicines in the context of the growing burden of non-communicable diseases (NCDs). This PhD research examined medicine use in Eswatini, (previously Swaziland) between April 2017 and March 2019, with a focus on prescribing practices linked to specific diagnoses. It further explored factors influencing RMU, which included testing the effects of a short intervention - prescription audit and feedback coupled with small group education - on prescribing practices in health facilities.

Hepatitis C Virus (HCV) is an infection that can have grave consequences when left untreated. Hepatitis C can be easily eradicated with direct acting antiviral therapy. People who inject drugs (PWID) and inmates are among those with the highest incidence of HCV. However, cure rates among this population remains low. This is, in part, related to an interruption in the HCV care cascade such that only 30% of PWID are linked to care and only 8% of those receive treatment. Inadequate screening and failure to be linked to HCV care remain the largest impediments to treatment success. There is limited research on barriers and facilitators to primary care, where screening may take place, and linkage to HCV care among PWID. Few studies have evaluated vulnerable populations such as those living in rural communities or inmates. The purpose of this dissertation was to develop a broader understanding of barriers and facilitators to healthcare utilization among PWID at the primary care and specialist levels (linkage to care). Three manuscripts addressed important gaps in knowledge. The first was a review of the literature to describe the state of science on linkage to care among PWID. All but one reviewed study recruited from countries with universal healthcare, urban areas, and opioid substitution facilities. The review of the literature revealed that little is known about the barriers/facilitators to linkage to HCV care faced by rural-dwelling PWID from countries without universal healthcare. The second manuscript is a study to determine whether predictors of linkage to care identified in urban-dwelling PWID from countries with universal healthcare predicted seeking HCV care among PWID living in rural Appalachia. Data were obtained from a subsample of 63 HCV positive PWID who recently used opioids, were between the ages of 18-35 years, and lived in one of five rural counties in Kentucky. Logistic regression revealed that recent injection drug use was the only predictor of seeking HCV care. However, remote use of opioid substitution therapy and no transportation issues approached clinical significance. Although not evaluated in our second manuscript, seeing a primary care provider (PCP) is associated with an increased likelihood of being linked to care and higher rates of screening/diagnosis. Among rural dwelling PWID, there are subpopulations that may face unique barriers to linkage to care. One sub-population that may be particularly vulnerable are female PWID who are incarcerated. Therefore, the purpose of the third study was to determine predictors of primary care use using data from 302 female inmates from rural Appalachia with a history of injecting drugs. Age, insurance issues, and health problems that interfere with responsibilities were predictors of PCP use. In this dissertation, I have addressed important gaps in the literature by determining barriers and facilitators to seeking HCV care and primary care use among PWID from rural Kentucky. Additional studies are needed using a larger sample of rural PWID to confirm our findings. In addition, further studies should evaluate system and provider level barriers to linkage to care and PCP use among rural PWID.

Since securitization processes are agued to be able to create excessive power to actors, there are arguments that claim that securitization is a negative process. By combining aspects of the original securitization theory with Juha Vuoir’s theory of illocutionary force, this thesis makes an attempt at finding what different actors claimed was threatened in their respective securitization of the issue terrorism. The motive behind the actors are also investigated and argued to be made visible through the different speech acts each actor employs when trying to securitize an issue. The thesis concludes that all three securitizing actors use some traditional notions of what is being threatened, namely the state. However, they are all found to use less traditional referent objects in addition to the state. The thesis also concludes that the motives of the different actors are found. These are showcased through the president of the USA trying to create deterrence for attackers of his state and trying to create control on the international arena. The High Representative of the EU, trying to legitimize future acts of more integration in the Union. Finally the World Health Organization’s motive is argued to have been to put the issue on the agenda.

Background: Binge drinking (BD) is common in Peru, but may not be routinely detected by standard assessments of hazardous drinking. Objectives: We describe prevalence and risk behaviors of men who have sex with men (MSM) and transgender women (TW) in Peru who met criteria for BD as compared with those who met criteria for hazardous drinking. Methods: In a cross-sectional sample of MSM and TW from Lima (2012-2014), we calculated prevalence of BD (consuming ≥6 alcoholic drinks per occasion by AUDIT-3 criteria), conducted bivariate analyses of associations of BD with demographic and behavioral characteristics, and compared prevalence and behaviors of BD to those of hazardous drinkers (identified by AUDIT-10 criteria). Results: Of 1,520 MSM (n = 1,384) and TW (n = 137) with median age 27 years, 74.4% of MSM and 86.9% of TW met criteria for BD. Among MSM, BD was associated with a greater likelihood of using alcohol (41.6% vs. 13.8%; p <.01) or drugs (7.8% vs. 2.8%; p <.01) prior to a recent sexual contact. Among TW, BD was associated with greater frequency of alcohol use (44.9% vs. 11.1%; p <.01) or unprotected anal intercourse (58.8% vs. 33.3%; p =.04) during ≥1 of their three most recent sexual contacts. There was a higher prevalence of BD (75.5%) than hazardous drinking (53.2%) in our sample, with binge drinkers exhibiting similar sexual risk behaviors to hazardous drinkers. Conclusions: Binge drinking is common among MSM and TW in Lima, associated with risky sexual behavior, and may not be adequately captured by AUDIT-10 criteria. / Revisión por pares

This master thesis is focused on decreasing levels of vaccination as a new health risk. In recent years it has become a new trend that we can observe in European countries. Low vaccination levels amongst population are one of the reasons for new epidemics or pandemics happening. When immunization rises above 95 % then a collective immunization comes into effect. Collective immunization lowers the chances of diseases spreading. For this reason, World health organization supports immunization and tries to make immunization affordable reachable for everyone everywhere. This these analyses measles which can be stopped by vaccinating the population. Therefore, the World health organization prepares strategic plans aimed at eradication of this disease. Each member state has a task to apply these plans in their specific environment. This thesis focuses on the Czech Republic and its implementation of strategic plans happening 2005-2010 and 2011-2020. This thesis is structured into 5 chapters focused on theory of international relations, hesitancy to vaccinate, strategic plans of World health organization and the Czech Republic.

The purpose of this project was to implement the newly revised International Classification of Functioning, Disability and Health (ICIDH-2) developed by the World Health Organization (WHO), to establish specific aural rehabilitation goals. Five graduate clinicians in speech language pathology and audiology interviewed ten participants with adult onset hearing loss. A modified version of the General Questions for Participation and Activities (i.e., a structured interview technique) from the ICIDH-2 Checklist, was developed. Prior to completing this checklist, the students attended a brief training session to become familiar with the major components of the ICIDH-2, specifically the ICIDH-2 Checklist. Completion of the ICIDH-2 Checklist, Version 2.1a, clinician form (prefinal draft, December 2000), allowed the students to classify and qualify disability and health according to the constructs of Activity and Participation, (i.e., what a person can and cannot do as a result of hearing loss and what a person does and does not do as a result of hearing loss, respectively). Following completion of Parts 2 (Activities and Participation) and 3 (Environmental Factors) of the Checklist for each of the ten clients interviewed, aural rehabilitation goals were developed. Four participants are highlighted to illustrate how the ICIDH-2 is used to objectify the impact of hearing loss and to establish specific treatment goals. The results support the use of the modified version of the General Questions for Participation and Activities in development of aural rehabilitation goals for clients with adult onset hearing loss. Graduate clinicians demonstrated the ability to complete the checklist with little assistance, suggesting that the use of the ICIDH-2 by experienced clinicians should be a relatively easy task. Goal development was also a relatively easy task using the checklist ratings, and the ratings related directly to the individual participant's quality of life in their current situation.

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