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This thesis explores the tensions between policy and practice in community participation in Health Improvement Programmes (HImPs). The HImP is used as a vehicle through which partnership working and public participation is health planning in the ‘new NHS’ may be explained, The literature review discusses key theories and models of community participation, power and policy implementation which informed the development of my key research questions and strategy. A review of the global, national and local influences upon a community participation in health planning is supplemented with primary research in the form of a detailed case study of one locality’s response to the national requirement to involve the public in the development of their HImP. A multi-method case study was employed using the following methods of data collection: observation, interviews, questionnaires and documentary analysis. The research presented identifies a number of issues as significant in affecting a locality’s approach to public participation, including: power; the organisational cultures(s) within the HImP partnership; the attitudes and capacity of those charged with developing participatory activities; and the impact of national priorities on local flexibility to respond to community identified priorities. The application of Alford’s (1975) structural interests theory to the findings provides a useful framework for assessing power relations and understanding why the HImP fails to represent community interests in the way that had been hoped. A number of recommendations are made to facilitate participation in health planning in the future, including: the need to address the national culture of risk avoidance; the need for better training in public participation skills for personnel charged with developing participatory opportunities; and the need for a mandatory performance framework related to community participation as a mechanism to ensure that participation issues are given the same attention as other nationally monitored issues.

There have been a considerable number of studies that have examined the potential benefits of companies investing in corporate fitness (CF) programmes and the results have been well publicised. However, in the UK, little research has investigated the development, implementation and management of CF and how this has impacted upon programmes and their effectiveness. The aim of this thesis was to begin to fill this void of research and understanding and to examine whether CF is regarded as an initiative that contributes to organisational success. Therefore, the management of CF was evaluated so its role within corporate philosophy and its relevance to research on business management could be assessed. The research analysed the perceptions of both users (n=149) and non-users (n=122) of CF, through two separate questionnaires, that sought to gain both qualitative and quantitative information. To examine the experiences and perceptions of individuals working within CF, semi-structured, qualitative interviews (n=25) with CF consultants (n=7), managers (n= 11), company representatives (n=5), a member of the Health Development Agency (n= I), and a member of the Association of Workplace Health Promotion (n= I) were also conducted. In addition, a group discussion was held between key CF industry figures to discuss further issues raised during the interviews. The results indicated that CF has become increasingly popular amongst employees and prevalent within companies, arguably as a result of general changes in attitude towards health, fitness, and lifestyle. CF has begun to develop a more holistic approach to health and fitness and has been commonly rebranded 'Corporate Wellness' (CW). However, CW is not significantly different from CF and the effectiveness of programmes in positively impacting upon the majority of the workforce is doubtful. CW tends not have a high profile within companies and providers are restricted from developing more effective management and marketing practices, partly due to a lack of resources. In addition, companies fear that instead of improving work performance, through improved well-being, employee productivity could actually deteriorate as individuals spend less time working. Currently, companies lack an understanding of the role CW plays within the workplace and, as a result, programmes lack direction and do not have any clear objectives. The future of CW, as a beneficial initiative, will be dependent upon the development of effective management strategies that will encourage company-wide participation and demonstrate that its associated benefits are a reality. In conclusion, the research suggests that CW is predominantly used as a perk for those individuals who have an interest in health and fitness. Consequently, contrary to previous research, the evidence indicates that CW, in the UK, is not an essential initiative within corporate management.

<p>The aim of this project was to measure changes in dimension of the first three primary rugae and to evaluate tooth movement in the maxilla during orthodontic treatment in patients treated with and without premolar extractions.</p>

Thesis (M. P. A.)--Texas State University-San Marcos, 2007. / "Summer 2007." Includes bibliographical references (leaves 53-56).

Thesis (Ph. D.)--University of Wisconsin--Madison, 1972. / Vita. Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Thesis (M.Psych.Org.) - University of Queensland, 2005. / Includes bibliography.

Thesis (M.S.)--Ohio University, March, 2006. / Title from PDF t.p. Includes bibliographical references (p. 130-151)

Background and Importance: There has been much debate recently over rapidly growing drug expenditures. Cancer medicines, in particular, have driven new brand spending over recent years, and US oncological expenditures have risen faster than for many other disease areas, in part because of rapidly growing drug prices, as well as increased rates of use. Objective: In the face of ongoing debates on how to reasonably control growth in pharmaceutical spending, while also providing patients with the best possible care, this thesis sets out to help address the question of whether growing pharmaceutical expenditures are providing value-for-money to patients and society. Novelty and Empirical Contributions: This thesis is based in part on a systematic review with narrative synthesis of English-language HTA appraisals of the comparative clinical risks and benefits of new cancer medicines, as well as on the novel use of methods to generate comparative evidence on their use and cost. Adapting established methods, these data are then used to examine existing questions over whether growing expenditures are worth the cost to patients and society. This thesis makes five major contributions to the literature on value-based spending on cancer medicines: 1) approximately one in three newly licensed cancer medicines provide no known overall survival benefit, while one in five provide no known overall survival, quality of life, or safety benefit; 2) novel use of methodologies to model treatment course and duration reveals that cancer drug use and costs vary greatly between individual medicines, and across Australia, France, the UK, and the US; 3) the monetized value of survival gains attributable to cancer drug innovation, net of growth in cancer drug spending, varies across individual medicines, and, at a country-level, remains unambiguously positive in Australia, France, and the UK, but negative in the US; 4) spending on new cancer medicines is often only weakly associated with their clinical benefits; and 5) the strength of this association nevertheless varies across countries, with the UK demonstrating the strongest evidence of value-based spending on new cancer medicines. Clinical and Policy Implications: Findings from this thesis provide a resource for valuebased clinical decision-making by patients and physicians. Moreover, growing expenditures on cancer medicines may only weakly be associated with meaningful clinical benefits, though the extent to which this is true differs across countries. These findings highlight the important role that health policy can have in encouraging valuebased cancer drug spending. In particular, it is argued that managed access schemes promoting access and evidence development, as well as the use of value-based spending policies, can help expedite access to new treatments, incentivize the development of clinically meaningful medicines, and rationalize growing cancer drug expenditures. Future Research Directions: The comparative clinical risks and benefits from new cancer medicines using real-world data, and how they compare with trial-based results; how evidence on the comparative impact from new treatments is measured, weighted, and rewarded in decision-making by regulators and payers; and how it is effectively linked through policy and regulation to cancer drug spending.

From 28 October 1999 to 26 September 2000 Mbeki publically endorsed the position of ‘denialist’ AIDS scientists – a marginal group who oppose the claim that HIV causes AIDS – and used their views as the basis for a policy of not providing ARVs (antiretrovirals – the treatment that prevents HIV from replicating) via the public health system. This policy persisted until 2004, with severe consequences – best estimates indicate that it resulted in 171,000 avoidable new infections and 343,000 deaths over the 1999 – 2002 period. I use this case to address two questions. First, is it reasonable for policy makers to consult non-mainstream scientists in the process of policy development? Second, can they be held personally morally responsible for the consequences of having done so when things go very badly wrong? I begin by providing a motivation for why philosophers should be interested in real-world cases. Having justified the philosophical “methodology” of this thesis, I move on to describing the specific case of South African AIDS denialism in the early 2000s. I then take a chronological step back in order to assess the rationality of accepting HIV as the sole cause of AIDS in 1984, when the virus was first identified. I argue that it was rational, but that some explanatory power was lost when other competing accounts of the disease’s aetiology were discarded. I argue that this explanatory loss can be accounted for by re-considering the way causation is understood in biomedicine and epidemiology. Having settled the scientific issues of the case, I then move on to the question of moral responsibility. I specifically look at when an agent can be held morally responsible for their ignorance, and the role of suppressed disagreement in the production of that ignorance.