No description available.

No description available.

Patients and staff who participate in PNC were surveyed by postal questionnaires and interviews to obtain a complete picture of the structures, processes and experiences which comprise it. 1249 newly delivered mothers and 648 health professional staff involved in PNC responded to the surveys (response rates 90.2% and 83.4% respectively). Maternal morbidity was reported by 85% of women in hospital, 87% at home in the first two months and 76% subsequently. Excess anxiety affected up to 27% of women, and depression occurred in around 16%. These factors influenced parental attitudes to their babies, as did aspects of babies' behaviour. 3% of women were readmitted to hospital for puerperal complications within the first two months, and 5% subsequently. At least one health problem occurred in 76% of babies in hospital, 82% in the first two months at home and 88% in the year thereafter, and the proportion treated increased with time. Readmission was necessary for 4% of babies in the first two months and 15% subsequently. Problems in PNC identified by respondents included lack of staff time, lack of continuity of care (resulting in conflicting advice), unrecognised maternal morbidity and need for support, high (and increasing) use of NHS services by babies, care focused on physical health problems rather than psychological and emotional ones, and deficiency in the quality of care after the first two months. Reorganisation of PNC so that the care of the patients (mother and baby) was its focus might enable the delivery of more effective and efficient care. A redefinition of the role of the midwife, greater autonomy and better professional recognition would increase job satisfaction and improve care. Forms of care which have been shown to be ineffective or harmful should be discontinued, and those which improve postnatal outcomes should be promoted.

In this study an economic analysis is conducted into the cost of the Scottish hospital sector from 1951 to 1981. The analysis is based upon data gathered from the Summarised Accounts of the Scottish Health Service, and additional published and unpublished data. The study suggests that many existing hypotheses on hospital cost inflation are inappropriate to the characteristics of the Scottish hospital sector, and that others have been overemphasised. The analysis presents a detailed account of changes in aggregate expenditure and, its components, showing these changes in current and constant prices and demonstrating the magnitude of the relative price effect. Using data on the changing conditions of service of hospital employees, the study then calculates an index of labour inputs to the hospital sector, which reveals that routinely published labour statistics considerably overstate the increase in working hours. Thus although wages and salaries have taken an increasing share of total hospital expenditure, the volume increase in labour inputs has been outstripped by that of non-labour inputs. In order to evaluate the hypothesis that hospital costs have increased as a result of the pay of hospital employees catching-up with other groups, the study compiles pay indices for the main hospital occupational groups and considers the influences on the patterns of settlement. The formal catching-up hypothesis is not supported by the evidence. Similarly, the study shows that the impact of compositional change in the hospital labour-force on total costs has not been significant, although substantial compositional changes are revealed. Finally, the study calculates the impact of demographic changes on hospital costs between 1951 and 1981, and concludes that, although the direct impact has not been great, such changes coupled to changes in rates of use may have brought about major long-term alterations in patterns of hospital care and resource allocation. Drawing on these and previous findings, the analysis is concluded with a discussion of policy and research implications.

Background. Implementation research is the scientific study of methods to promote the uptake of research findings in clinical practice. Cluster randomised trials are commonly adopted in implementation research, where interventions are generally targeted at health professionals or policymakers, in order to protect against contamination that would occur if individual patients were randomised. The application of cluster randomisation has important implications for design and analysis of trials evaluating implementation strategies. Case study: The Urological referral guidelines evaluation (URGE) has been used throughout this thesis, to explore the design and analysis issues of adopting a cluster randomised trial design in implementation research. URGE aimed to evaluate the effectiveness and efficiency of a guideline-based open access urological investigation service. This cluster randomised study adopted a 2X2 balanced incomplete block (BIB) design and collected data both prior to and following introduction of the intervention. The unit of randomisation was general practice and patients were recruited upon referral to secondary care. Aim: To investigate the implications of cluster randomisation for the design and analysis of trials evaluating implementation strategies. Objectives: This thesis has four distinct components. 1. A review of published cluster randomised trials in the field of implementation research. The methodological quality of these studies is assessed (Chapter 2). 2. An exploration of clustering within the URGE trial. Estimates of clustering and the imprecision in these estimates are considered for a number of endpoints, including process and outcome of care indicators and costs (Chapters 4 and 7). 3. The application of statistical methods in the analysis of cluster randomised trials. A number of approaches to the analysis of cluster randomised trials are described, applied and compared empirically. Incorporation of the BIB design and pre-intervention performance are also considered (Chapters 5 and 6). 4. Analysis of cost data collected from the economic evaluation conducted within the URGE trial. The analysis of skewed cost data collected within a cluster randomised trial design is considered (Chapter 7).

No description available.

No description available.

MA by course work and research report, Community-Counselling Psychology, Faculty of Humanities, University of the Witwatersrand, 2010

Les nations développées contemporaines sont souvent décrites comme des économies de services. Dans la majorité des pays de l’OCDE (Organisation de Coopération et de Développement Economiques), plus des deux tiers de l’emploi et de la valeur ajoutée sont issus du secteur des services. Les services occupent une place extrêmement importante dans les nations tournées vers l’économie du savoir. Ils sont également un des principaux moteurs de la croissance économique, et participent activement à la compétitivité du secteur industriel (Nordås and Kim, 2013). La figure IV.9 illustre l’importance croissante des services dans l’emploi et la valeur ajoutée de l’économie française entre 1970 et 2007. Les valeurs utilisées sont prises en référence à l’année de base (1970), et renseignent donc sur le taux de croissance de chaque secteur en terme de valeur ajoutée et d’emploi. Le message est clair sans ambiguïté. Les services professionnels (immobilier, location, services aux entreprises et intermédiation financière) contribuent le plus à la croissance de l’économie française. Ces services, aussi appelés “services complémentaires” par Katouzian (1970) car ils complémentent les activités industrielles, ont connu une croissance de leur valeur ajoutée beaucoup plus forte que le secteur industriel et que les autres secteurs de services (grossistes/détaillants, hôtels et restaurants par exemple). En 2007, le secteur des services professionnels comptait pour un tiers de la valeur ajoutée générée en France, soit deux fois plus que le secteur industriel. Du côté de l’emploi, le constat est encore plus frappant. Les services professionnels contribuent encore une fois fortement à la croissance de l’emploi (avec également les secteurs de l’hôtellerie et de la restauration) alors que le secteur industriel n’a cessé de perdre des emplois sur cette période. En 2007, les services professionnels regroupaient 20% de l’emploi, contre 14% pour le secteur industriel. [...] / Today’s developed economies are often described as service economies. More than two thirds of employment and value added is generated by the service sector in OECD countries. Services are increasingly important in today’s knowledge based economies, are a crucial component of economic growth and contribute to the competitiveness of the industrial sector (Nord ås and Kim, 2013). Figure IV.9 plots the evolution of value added and employment in France between 1970 and 2007. It shows that the professional service industries (Real estate/renting/business services and financial intermediation) are the main contributors to the growth of the French economy. These services (also called “complementary services” by Katouzian (1970)), have been growing much faster than the manufacturing sector, and much faster than the other service sectors (wholesale/retail, hotels and restaurant services). These fast growing services accounted for 33% of the total value added in 2007 (twice as much as the manufacturing sector) and 20% of the overall employment (14% for the manufacturing sector). [...]

Objectives: To contribute to knowledge on the reliability and validity of the contingent valuation method (CVM) and explore the role of context-specific CVM question formats in Southeast Nigeria. Other objectives were to determine the factors that will explain actual willingness to pay (WTP) for insecticide-treated nets (ITNs). Methods: There was an extensive review of theoretical, methodological and empirical literature. A novel WTP question format that mimics price-taking behaviour in south- east Nigeria (called the structured haggling technique (SH)) was developed and compared with the bidding game (BG) and binary with follow-up technique (BWFU). The comparisons were for inter-rater and test-retest reliability, content, construct and criterion validity and the study conducted in three villages in Nigeria. Stated WTP was determined using a questionnaire administered to 810 household heads, while actual WTP was evaluated by offering the ITNs for sale to all respondents after one month of the first survey. Findings: There were considerable gaps in the literature regarding the reliability and validity of the CVM. In the empirical study, BG, BWFU and SH elicited reliable and valid estimates of WTP. The SH was the most content valid, while the BG and SH were the most construct-valid for ITNs and re-treatment respectively. The BG and SH were similarly criterion-valid while the BWFU was the least criterion-valid. All question formats were similar for tests of reliability. There were genuine reasons for divergences between the stated and actual WTP and for test and retest. Low-income status and physical accessibility were the major impediments to ITNs acquisition. Conclusion: The CVM could be used to elicit valid and reliable WTP estimates in the study area, but it was not clearly proven that better content-valid question formats would lead to more valid and reliable estimates of WTP. It is necessary to further determine how the validity and reliability of the SH and other WTP question formats could be improved. Finally, future studies should establish the content validity of question formats in settings where they will be used, and use bigger sample sizes, along with allowing less time between the survey and administering the criterion, for comparing stated and actual WTP.