The thesis aims: - to analyse the extent of alcohol-related problems in Hungary, - to assess available policy options to reduce the incidence of alcohol-related problems - to understand Hungarian policy making in the alcohol field - to prepare recommendations for alcohol policy that are relevant to the Hungarian situation It consists of eight chapters. Chapters follow the aims by first introducing the target and the place of the study (Chapter 1), second providing evidence about the extent of alcohol related problems in Hungary and in comparison to other countries (Chapter 2), third summarising policy means to influence the incidence of alcohol related problems based on experiences of other countries and locate alcohol policy in the broader policy context (Chapter 3), then presenting the framework and the methods used for the analysis (Chapter 4), analysing the policy environment by looking at the legislative background (Chapter 5), the organisational structure and major alcohol policy movements of the past decades (Chapter 6), characteristics of public policy making in general and public health and alcohol policy making in particular (Chapter 7), and the current situation of alcohol policy through actors - their understanding, interests, influence, relation to each other and to specific alcohol policy instruments - (Chapter 8), finally summarising the findings and preparing feasible policy recommendations for Hungary (Chapter 9).

In the 1990s, the coordination and management of aid in the health sector became more firmly established on policy agendas as a result of concern that the increased volume of aid and increasing number and diversity of donors in the sector was leading to an unmanageable proliferation of demands on recipient Governments. Global interest in coordination, coupled with a dearth of critically-informed, conceptual or empirical, analyses of the subject, gave impetus to this in-depth examination of the processes at work. Based on a review of the literature, this study began by defining the issues and developing a typology of instruments used to coordinate aid. A conceptual framework was developed for assessing coordination mechanisms. The framework was tested through an historical analysis of aid coordination revealing the enabling and constraining factors governing progress in this area of development management. Bangladesh was chosen as a case study, primarily due to a long-standing, concerted effort of the World Bank to coordinate a number of bilateral donors through a country-based Consortium. Drawing upon interviews with stakeholders, documentary analysis, as well as a questionnaire survey, an entrenched, non-comprehensive system of aid coordination and management exercised by donors was exposed. Caution on the part of Government officials in assuming a prominent role in aid management was exacerbated by fragile systems and weak capacity. This was reinforced by aid agency practices. Evidence suggests that coordination may be less concerned with the purported aims of rationalising external assistance to Government's programmes, than with the desire among competing agencies for leadership in the sector. Aid agencies and Government recognise that aid coordination provides a powerful tool with which to exercise leverage over the policy process. This consideration has coloured their desire to lead coordination processes and conditioned the extent and manner they wish to be involved in coordination arrangements. Given the findings of this study, the prospects for improvements and government leadership in aid coordination and management appear equivocal at best.

This study sought to examine the economic structure of the Philippine health care system, in the light of recent legislative initiatives in the country and global managed market reforms. In the context of a market-orientated system in the Philippines, the study modelled the interaction of health care agents in three markets: regulations, financing or insurance and health services. The bulk of the research examined the nature of exchange in the health services market, using neo-classical economics. Theories in industrial organization and public choice served as organizing frameworks for explaining other market elements. The study' s methodology used primary and secondary data analysis, as well as findings of other research, to bring together a coherent picture of the market structure of health care in the Philippines. The analysis of the regulatory market showed that the rent-seeking nature of Philippine social, political and medical institutions has weakened regulatory structures in health care. Compared to its Asian neighbours, the relative position of the country in the 60s in terms of major health indicators, has been eroded. Limited resources and allocative inefficiencies have affected the government's ability to fulfil its constitutional mandate to ensure minimum levels of care, especially for the poor. The performance of the market was examined in terms of health policy objectives of efficiency and equity in the financing of health care. Private sources, with households forming the bulk, comprised 64 percent of health care expenditures. The position of concentration curves drawn to illustrate the equity of household financing, showed inequities in health and health expenditures. The largely fee-for-service system operating in the health insurance market had caused risks to be borne largely by consumers and funders. Low coverage of the population and weak utilization rates, may have encouraged some providers to behave opportunistically. An examination of the prospects for an alternative system of compulsory health insurance, illustrated through a project with health maintenance organizations indicated the problems of contracting. Estimates of health service market conditions on the demand-side, from an outpatient provider choice model, showed low price and time cost elasticities, with the poor being more responsive than the rich. Simulations showed that the introduction of user fees in public services were likely to drive demand towards private care in urban areas, and out of the market in rural areas. The welfare effect estimates showed that if public hospitals were to charge one-half the price of private doctors, the welfare loss would be about 10 percent of household budget of the lowest income group. The amounts needed to compensate losers from the policy change can be transformed into contributions for risk -sharing schemes. From the supply-side, the distribution of facilities, productive resources and technology were shown to have wide variations across regions and types of facilities. The study cited research that showed that total cost structures in hospital firms were largely determined by the volume of services rendered. Moreover, variable costs were shown, by other research, to be neither influenced by scale nor by the scope of operations. The analysis of the market structure, based on a modified Hirschman-Herfindahl measure, showed that no hospital-firms had a dominant share of the market. Regression results, from the same research on total cost functions, showed that hospital outputs were unresponsive to actual competition. Price competition appeared to be swamped by nonprice competition. An examination of pricing behaviour showed widespread cost-price mark-ups, reflecting the 'market power' of providers. The co-existence of competitive and monopolistic tendencies in the health care market, combined with weak and/or distortive incentive structures, suggests that the tenets of contestability analysis were not fulfilled. The last chapter showed the limitations of the analysis in providing conclusive evidence on the behavioural underpinnings of the health care market in the Philippines. Conceptual and methodological difficulties, arising from data and measurement problems, imply that the results are at best exploratory; and that further work can use the issues raised as starting points. For health policy reforms in the Philippines, recent legislative initiatives could improve health sector performance from a three-pronged approach: enhancing access, agency and co-ordination.

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This thesis reports a study that aimed to create a better understanding of nursing models. It set out to explore nursing models from the qualified nurse's perspective. Such perspective is of interest to the debate about nursing models which has often been conducted at the rhetorical rather than evidence based level. The methodological approach is that of grounded theory (Glaser and Strauss, 1967) with a three stage interview process as the data collection method. The sample comprised qualified nurses in Scotland who were undertaking educational programmes which included input on nursing models. The central themes from the interview stages were: first interview: operationalising the model; second interview: contextualising the model; and the third interview: nursing models and the reality of practice. These central themes were the foundation for the development of a three model typology distinguishing between: the theoretical model which is the conceptual model of the theorist, is abstract, general and developed through inductive and deductive approaches and presented as a potential picture of nursing; the mental model which is the personal pattern or schema of the individual nurse and represents the way nursing is described by the individual; and the Surrogate model which is a functional representation used by nurses to collect data, communicate and through which the organisation can standardise and audit practice. It is concluded that nursing models should not be seen as pertaining to a single entity but be described in the typologies described above. In this way some of the confusion about the way nursing models have been introduced and taught can be addressed. This is especially viewed in the context of models as forms of truth, external objects, adaptable, tools for use or tools for thought, as having individual or collective value and requiring evaluation from the individual's perspective.

Palm oil has been categorised as a saturated fat and to have a deleterious effect on the risk of CHD. In the present study, the habitual Scottish diet was replaced with palm oil (RBDPO) diet (26% en) and its effects on the indices of CHD risk was compared with the hydrogenated rapeseed (HRSO) and soya oil (HSO) diets. The result showed that RBDPO diets increased plasma total- and LDL- cholesterol concentrations but similarly increase the plasma HDL-cholesterol concentrations. In contrast, the above parameters were decreased in the hydrogenated oil diet groups. Changes in the indicators of lipid peroxidation were not different between groups although plasma conjugated dienes concentrations were shown to increase significantly in the HSO diet group at the end of the study period. Plasma glutathione peroxidase activity was also shown to increase in both hydrogenated oil diet groups. Plasma total Lp(a) concentrations were decreased in the RBDPO diet group whereas they were increased in the hydrogenated oil diet groups. The present study suggested that the effects of RBDPO in decreasing the plasma total Lp(a) concentrations might be due to its effects in increasing the clearance of plasma postprandial TRP-apo(a) by the B/E receptor pathway. It is concluded in the present study that despite the high content of RBDPO incorporated into the Scottish diet (65% of total fat intake), the ingestion of this diet did not confer deleterious effects on the risk of CHD when compared with the HRSO and HSO diets.

This study describes self management behaviour and attitudes among asthmatics, in usual self care, in acute episodes and in behaviour in the month before admission. It relates these behaviours to morbidity, admission history (single admittees versus multiple admittees) and outpatient status (current, discharged or never outpatient). Two hundred and thirty four patients between 16 and 65 years old were interviewed for the study. One hundred and thirty were in hospital at interview, the remainder were not in hospital but had all had a hospital admission between January and December 1987. Details of admissions in the following twelve months were collected for the hospitalised interviewees. In both hospitalised and non hospitalised groups self management was related to being in current specialist care, rather than to admission history. Patients in current specialist care were more compliant and acted at earlier stages of deterioration. When care type was controlled for, patients with multiple admissions were more non compliant with regular medication, and non compliant patients had significantly more frequent episodes. Forty (30%) of the hospitalised group were readmitted within 12 months of interview. Readmission was not related to self management before the 1991 admission or asthma attitudes. It is argued that this is because patients are likely to be referred to specialist care after an admission (almost 50% of first admissions and almost 100% of second admissions) and that this referral will change both their medical management and their self management. Hence, pre admission behaviour and attitudes cannot predict post admission risk. The study concludes that patient behaviour is most strongly influenced by being in specialist care, and that differences in self management, particularly compliance with prophylaxis and early action in deterioration, affect the risk of severe episodes and hospital admission.

The aim of the study was to estimate the effect of the GRampian ASthma Study of Integrated Care [GRASSIC] (for adult asthma patients currently attending hospital clinics) on the care of those patients not attending outpatient clinics. In order to do so, a method was devised for identifying random samples of adult asthma patients treated by general practitioners, using GP10 prescription forms. A two-phase postal and interview survey was carried out in Grampian, where the changes in clinic care were introduced, and Highland, where no changes were planned. Responses to the first postal questionnaire (in 1989), at the start of GRASSIC, were received from 1054 patients (728 from Grampian and 326 from Highland), and 1138 replies to the second (in 1991) (792 from Grampian and 346 from Highland). Interviews were carried out with a subset of 50 patients in Aberdeen and 25 in Inverness, after each postal survey. Detailed analysis of the responses demonstrated that GRASSIC did not have an effect on those patients not attending an outpatient clinic. However, changes in the care of patients treated in the community occurred over the two year period of the study.

The results of the literature review and survey show that tremendous changes have taken place in the United Arab Emirates both in its economic as well as in the provision of health care, since its independence in 1971.  The country has extensive primary health care services that are easily accessible.  The range of services provided includes health promotion, preventive, curative and maternity and child health services. However, the philosophy of primary health care is not generally accepted and the emphasis remains on providing  a curative service and the use of high technology medicine.  There are many other difficulties with the current system including a shortage of manpower; poor co-ordination between primary care and hospital based services; rising cost of health care provision; inadequate provision of health education programmes; inadequately or inappropriately resourced primary health centres; and the lack of reliable and good quality data on primary health care. Several recommendations are made: 1.  Creating a task force dedicated to primary health care and involving all stakeholders in order to identify gaps and deficiencies, make recommendations for improvement and ensure that the recommendations are being implemented. 2.  Emphasising the importance of primary health care in the overall provision of health care. 3.  Establishing a correct balance and a better co-ordination between primary, secondary and tertiary levels of care.  This should include an improvement in the referral and feedback system between primary care and hospitals. 4.  Ensuring the establishment of an effective health education programme aimed at emphasising the  value of primary health care, simple low-cost technology, health promotion and prevention services so minimising the dependence on the use of hospitals and high technology medicine.  This should take into account the different cultural, religious and social backgrounds of both the expatriate community as well as local inhabitants. 5.  Improving the provision of maternal child health care, screening, health promotion, prevention services and the availability of equipment, facilities and resources to enable primary care health professionals to carry out the assessment and management of most common and treatable conditions. 6.  Producing doctors, nurses and other health professionals who will promote health for all people and meet the needs of the society they serve.  This will require a greater collaboration and partnership between medical schools and the Ministry of Health.  7.  Developing a system of continuing professional development with staff training programmes for health professionals, to ensure the maintenance of their competence. 8.  Forming a professional organisation, such as a College or Institute of general practice, in order to identify the professional needs of general practitioners, to represent the specialty on professional matters and on all relevant medical decision making bodies, and to promote professional development at both national and international levels.