Objectives: There are four primary goals for this research project: <ol><li>To develop an objective index of health care quality which represents, in the best practical way, a comprehensive range of services provided at the health region level. <li>To develop a comparable measure representing physician assessments of health care quality, and compare this measure with the objective index. <li>To develop an understanding of the relationships between physician ratings on the workplace issues of professional autonomy, stress, sense of equity and satisfaction and their views on health care quality.<li>Based on the understanding of this research, provide recommendations to health care policy makers about the use of both physician viewpoints and objective measures of quality.</ol> Background: Health care in Canada has grown and evolved from a relatively simple offering of services, provided primarily by doctors and hospitals, to a complex conglomeration of programs and services, provided by a loose network of both public and private providers. As a result, physicians are under pressure to adapt to these changes and a power struggle which has always pitted physicians against policy makers. In dealing with changes to the health care system the use of statistics and evidence is gaining prominence as the basis for policy decisions, in addition to the less formal tools of rhetoric and politics.<p>Design: Data from the 2004 Canada-wide survey Emerging Issues in the Work of Physicians is compared to a single index score of health care quality based on objective data from the annual Health Indicators Report published by Canadian Institute of Health Information and Statistics Canada (2005). These reports include a number of measures of quality and access to health care by health region and by province, using mandatory standardized data collection and reporting procedures. <p>Measures: Nine reliable measures of health care quality were selected from the Health Indicators Reports for inclusion in the index: 30 day AMI risk; 30 day stroke risk; AMI readmission risk; asthma readmission risk; ACSC rate; hysterectomy readmission rate; prostatectomy rate; in-hospital hip fracture rate; and C-section rate. Index scores were developed for each of the measures, which were then assigned weights based on importance, resulting in a single overall index of health care quality. These scores are compared to a similar index score which is based on physician views on quality, as collected in the national survey.<p>Results: Physician views on health care quality are aligned with the objective data when examined on an aggregate basis. However, there is a high degree of variability in physician responses which results in differences when examining the data on regional or individual bases. In addition, physician views on quality are influenced by factors in their work lives including autonomy, stress, equity and satisfaction. On each of these factors, those reporting high and low levels will generally over and under-rate health care quality as compared to those reporting moderate levels.<p>Discussion: As policy makers make decisions on how to shape the future of health care, they must grapple with conflicting viewpoints of different stakeholder groups, and they must decide on the degree to which they rely on evidence (in the form of objective data) versus influence (as exerted by physicians and/or other stakeholder groups). This research shows that, while physician views on how well the health care system is performing are generally aligned with the objective data, those opinions vary greatly between individuals, and are influenced by work related factors including autonomy, stress, equity and satisfaction.

Objectives: There are four primary goals for this research project: <ol><li>To develop an objective index of health care quality which represents, in the best practical way, a comprehensive range of services provided at the health region level. <li>To develop a comparable measure representing physician assessments of health care quality, and compare this measure with the objective index. <li>To develop an understanding of the relationships between physician ratings on the workplace issues of professional autonomy, stress, sense of equity and satisfaction and their views on health care quality.<li>Based on the understanding of this research, provide recommendations to health care policy makers about the use of both physician viewpoints and objective measures of quality.</ol> Background: Health care in Canada has grown and evolved from a relatively simple offering of services, provided primarily by doctors and hospitals, to a complex conglomeration of programs and services, provided by a loose network of both public and private providers. As a result, physicians are under pressure to adapt to these changes and a power struggle which has always pitted physicians against policy makers. In dealing with changes to the health care system the use of statistics and evidence is gaining prominence as the basis for policy decisions, in addition to the less formal tools of rhetoric and politics.<p>Design: Data from the 2004 Canada-wide survey Emerging Issues in the Work of Physicians is compared to a single index score of health care quality based on objective data from the annual Health Indicators Report published by Canadian Institute of Health Information and Statistics Canada (2005). These reports include a number of measures of quality and access to health care by health region and by province, using mandatory standardized data collection and reporting procedures. <p>Measures: Nine reliable measures of health care quality were selected from the Health Indicators Reports for inclusion in the index: 30 day AMI risk; 30 day stroke risk; AMI readmission risk; asthma readmission risk; ACSC rate; hysterectomy readmission rate; prostatectomy rate; in-hospital hip fracture rate; and C-section rate. Index scores were developed for each of the measures, which were then assigned weights based on importance, resulting in a single overall index of health care quality. These scores are compared to a similar index score which is based on physician views on quality, as collected in the national survey.<p>Results: Physician views on health care quality are aligned with the objective data when examined on an aggregate basis. However, there is a high degree of variability in physician responses which results in differences when examining the data on regional or individual bases. In addition, physician views on quality are influenced by factors in their work lives including autonomy, stress, equity and satisfaction. On each of these factors, those reporting high and low levels will generally over and under-rate health care quality as compared to those reporting moderate levels.<p>Discussion: As policy makers make decisions on how to shape the future of health care, they must grapple with conflicting viewpoints of different stakeholder groups, and they must decide on the degree to which they rely on evidence (in the form of objective data) versus influence (as exerted by physicians and/or other stakeholder groups). This research shows that, while physician views on how well the health care system is performing are generally aligned with the objective data, those opinions vary greatly between individuals, and are influenced by work related factors including autonomy, stress, equity and satisfaction.

The word infection is a term which causes uncertainty among people. After all, it is not too long ago when people were dying in pandemics of plague, cholera or influenza. A human can be infected by viruses, bacteria, fungal organisms or parasites, many of which can infect several animal species. Diseases transmissible from animals to humans are called zoonoses. For efficient surveillance of zoonoses the cooperation of both veterinary and hygienic services is required. Its aim is timely detection and elimination of infection sources. It is based primarily on pointed veterinary and hygienic-epidemiological surveillance. In this thesis, I focused on the importance of collaboration of veterinary and public health services in the prevention of infectious diseases. One of the objectives of this work is to compare the occurrence of selected human zoonosis diseases in South Bohemia in the years 2002-2010. The second objective is to compare the extent of anti-epidemic measures adopted by veterinary services and public health authorities. In this thesis, a qualitative-quantitative research was utilized. The research aimed to determine the importance of cooperation of public health authorities and veterinary services in the prevention of infectious diseases. The quantitative part of the survey was conducted through the method of secondary data analysis. In the qualitative part of the survey, a semi-structured interview was held with the head of the epidemiology department of the District Hygienic Station of České Budějovice and with the director of the Regional Veterinary Administration for the South Bohemian Region. On the basis of the results of the research and implemented interviews I came to this conclusion: 1) The co-operation during the transmission of infectious diseases is ensured sufficiently. 2) The range of anti-epidemic measures adopted in the veterinary field and in the field of public health is sufficient. This thesis can serve as an educational material for students studying Bachelor or Master Degree of public health protection, because as public health service employees they will deal with issues related to veterinary supervision in practice.

This thesis applies the econometric projection approach to forecast the numbers of general practitioners (GPs) in Saskatchewan for the next 15 years at both provincial and the Regional Health Authorities (RHAs) levels. The projection results will provide the estimated level of GPs up to 2021 for policy makers to adjust their decision on health professionals planning.<p> Three hypothesized scenarios, which include the changes in population proportion, average income for GPs and a combination of both, are used for projections based on the regression results. The projections suggest a 4.34% expected annual increase of GPs if the proportions of children and seniors increase or decrease according to prediction for the next 15 years for Saskatchewan. At the RHAs level, 4.5% to 10.7% expected annual rate of increase for numbers of GPs is projected for the northern RHAs and Saskatoon RHA, while the expected increase for other urban RHAs will experience less than 1.5% increases.<p> The predicted changes in average income for GPs show insignificant effect for the expected changes in numbers of GPs. However, the second and third scenarios are not extended to the RHAs level due to lack of information, which requires additional data for both Saskatchewan physicians and population for further projection analysis.

This thesis applies the econometric projection approach to forecast the numbers of general practitioners (GPs) in Saskatchewan for the next 15 years at both provincial and the Regional Health Authorities (RHAs) levels. The projection results will provide the estimated level of GPs up to 2021 for policy makers to adjust their decision on health professionals planning.<p> Three hypothesized scenarios, which include the changes in population proportion, average income for GPs and a combination of both, are used for projections based on the regression results. The projections suggest a 4.34% expected annual increase of GPs if the proportions of children and seniors increase or decrease according to prediction for the next 15 years for Saskatchewan. At the RHAs level, 4.5% to 10.7% expected annual rate of increase for numbers of GPs is projected for the northern RHAs and Saskatoon RHA, while the expected increase for other urban RHAs will experience less than 1.5% increases.<p> The predicted changes in average income for GPs show insignificant effect for the expected changes in numbers of GPs. However, the second and third scenarios are not extended to the RHAs level due to lack of information, which requires additional data for both Saskatchewan physicians and population for further projection analysis.

This case study explores participation in Aboriginal health planning as perceived by members of the Aboriginal Health and Wellness Advisory Committee of the Interior Health Authority, a regional health authority in British Columbia. By prominently featuring the voices of Committee members as recorded in personal interviews, this research identifies issues and tensions in participatory Aboriginal health planning. Document review and personal observations enrich and support the analysis. The research findings convey that, although Committee members express a range of perceptions and beliefs about Aboriginal health planning, the Committee provides a foundation for meaningful participation. Strengthening accountability relationships and employing Aboriginal population health approaches are suggested means by which meaningful participation in Aboriginal health planning can be actualized. This study emphasizes the importance of genuine relationship building between the health authority and Aboriginal communities for achieving gains in Aboriginal health.

This thesis explores a recent innovation in First Nations health, the formation of Canada's First provincial-wide First Nations Health Authority (FNHA). Analyzing this service model against Indigenous assertions of a Treaty Right to Health expressed in the Numbered Treaties, I argue that the realizations of the Treaty Right to Health cannot solely be met under neoliberal models of increased Indigenous capacity in health care service administration. I assert that these models of devolution do not enable Treaty First Nations to achieve Indigenous self-determination in accordance with Treaty rights, relationships and responsibilities. The current discourse on First Nations health care only minimally accounts for the Treaty Right to Health, and where it does, it is devoid of Indigenous understandings of a Treaty Right to Health that encompasses access to healthy lands, waters, and livelihood for an achievement of holistic wellness. Mobilizing an Indigenous auto ethnographic approach which accounts for my own embodied positionally, this thesis problematizes the exclusion of holistic visions of health and well-being against settler governments' orientations toward a neoliberalized health care system. This thesis extends a comparative analytical lens to the political mobilizations of Indigenous advocacy bodies in the province of British Columbia, whose efforts under the New Relationship paradigm in Indigenous-state relations has resulted in an unprecedented practice of health care devolution. / Graduate

<p>Environmental management officers – leadership and employeeship in local environmental health authority</p><p>The purpose of this study was to illustrate the working situation of municipal environmental health management officers. This is a qualitative study where I have interviewed ten environmental officers in ten municipalities in Sweden. The interviews were based on a half structured interview guide with questions. I have interpreted the interviews through different leadership theories. The role of the management officers is divided into many roles. The management officers have many possibilities to get more education in leadership for example they can join a network for environmental management officers or participate in different courses that employer pay. Ten different styles of leadership were found in this study: the manager with focus on administration systems, the Jack-of-all-trades-manager, the coach, the administrative official, the parent-manager, the working too much manager, the manager that get “helicoptered” by higher management, the pragmatic manager, the find out manager and the manager as manager. The employee situation is sometimes turbulent and employee turnover is extensive. The efficiency is low when a lot of time is necessary to continually educate new staff all time. The turnover and lack of development for an environmental health officer is costly because the resulting efficiency is lower than necessary. Working as an environmental health officer is an occupation with external and internal conflicts. More research is needed to develop the area of municipal environmental health in many ways.</p>

Environmental management officers – leadership and employeeship in local environmental health authority The purpose of this study was to illustrate the working situation of municipal environmental health management officers. This is a qualitative study where I have interviewed ten environmental officers in ten municipalities in Sweden. The interviews were based on a half structured interview guide with questions. I have interpreted the interviews through different leadership theories. The role of the management officers is divided into many roles. The management officers have many possibilities to get more education in leadership for example they can join a network for environmental management officers or participate in different courses that employer pay. Ten different styles of leadership were found in this study: the manager with focus on administration systems, the Jack-of-all-trades-manager, the coach, the administrative official, the parent-manager, the working too much manager, the manager that get “helicoptered” by higher management, the pragmatic manager, the find out manager and the manager as manager. The employee situation is sometimes turbulent and employee turnover is extensive. The efficiency is low when a lot of time is necessary to continually educate new staff all time. The turnover and lack of development for an environmental health officer is costly because the resulting efficiency is lower than necessary. Working as an environmental health officer is an occupation with external and internal conflicts. More research is needed to develop the area of municipal environmental health in many ways.

Syftet med denna uppsats är att undersöka var studenter inhämtar information om coronarestriktionerna samt deras förtroende gentemot olika medier och medieaktörer. Studien tillämpar en kvantitativ forskningsmetod med en deduktiv ansats. Populationen avser studenter vid universitet och högskola mellan 18 - 40+ år. Data har samlats in via en webbaserad enkät. Enkäten resulterade i 135 godtagbara svar som har analyserats med hjälp av Google forms. Studiens resultat visar att studenterna huvudsakligen inhämtar information om coronarestriktionerna genom journalistiska nyhetsmedier. Folkhälsomyndigheten är det mest trovärdiga källan i frågan, medan studenterna hade lägst förtroende för influencers. För ett mer trovärdigt resultat hade det krävts fler respondenter i undersökningen. Studien bidrar till teoretisk kunskap angående studenternas val av medier och medieaktörer i rapporteringen om coronarestriktionerna. Studien bidrar även till en generell uppfattning om studenternas förtroende för olika medier och medieaktörer. Vidare forskning föreslås undersöka om dessa attityder gentemot medier och medieaktörer återspeglar deras beteenden. Det hade även varit intressant att studera andra grupper samt ta hänsyn till andra variabler som kan tänkas vara bakomliggande orsaker till val av medier och medieaktörer under en samhällskris. / The aim of this essay is to investigate where students obtain information about the coronarestrictions and how they rely on different media and media actors in the matter.  The study applies a quantitative research method with a deductive approach. Data were collected through a web-based survey and was answered by 135 students aged 18 - 41+. The questionnaire consisted of a total of 17 questions regarding the students' collection of information about the coronarestrictions. Collection of information regarding the coronarestrictions takes place mainly through journalistic news media. The public health authority information about the coronarestrictions proved to be the most credible source among the students. The results also showed that influencers were the least reliable. The conclusion of the study is not completely credible. The study required more extensive answers.  This contributes to a lack of factors which leads to the result of the study not being enough. The study contributes to theoretical knowledge about students' collection of information in the media about the coronarestrictions. The choice of media actors and attitudes towards them. Further research is suggested to investigate whether these attitudes towards the media and media actors reflect their behavior. It would also have been interesting to study other groups and take into account other variables that may be underlying reasons for the choice of media and media actors during a societal crisis.