Ideal and reality: do countries adopt and follow recommended procedures in comprehensive multiyear planning guidelines for national immunization programmes?

BACKGROUND: Meticulous steps and procedures are proposed in planning guidelines for the development of comprehensive multiyear plans for national immunization programmes. However, we know very little about whether the real-life experience of those who adopt these guidelines involves following these procedures as expected. Are these steps and procedures followed in practice? We examined the adoption and usage of the guidelines in planning national immunization programmes and assessed whether the recommendations in these guidelines are applied as consistently as intended. METHODS: We gathered information from the national comprehensive multiyear plans developed by 77 low-income countries. For each of the 11 components, we examined how each country applied the four recommended steps of situation analysis, problem prioritization, selection of interventions, and selection of indicators. We then conducted an analysis to determine the patterns of alignment of the comprehensive multiyear plans with those four recommended planning steps. RESULTS: Within the first 3 years following publication of the guidelines, 66 (86%) countries used the tool to develop their comprehensive multiyear plans. The funding conditions attached to the use of these guidelines appeared to influence their rapid adoption and usage. Overall, only 33 (43%) countries fully applied all four recommended planning steps of the guidelines. CONCLUSIONS: Adoption and usage of the guidelines for the development of comprehensive multiyear plans for national immunization programmes were rapid. However, our findings show substantial variation between the proposed planning ideals set out in the guidelines and actual use in practice. A better understanding of factors that influence how recommendations in public health guidelines are applied in practice could contribute to improvements in guidelines design. It could also help adjust strategies used to introduce them into public health programmes, with the ultimate goal of a greater health impact.

Global surveillance of cancer survival 1995-2009 : analysis of individual data for 25 676 887 patients from 279 population-based registries in 67 countries (CONCORD-2)

BACKGROUND: Worldwide data for cancer survival are scarce. We aimed to initiate worldwide surveillance of cancer survival by central analysis of population-based registry data, as a metric of the effectiveness of health systems, and to inform global policy on cancer control. METHODS: Individual tumour records were submitted by 279 population-based cancer registries in 67 countries for 25·7 million adults (age 15-99 years) and 75 000 children (age 0-14 years) diagnosed with cancer during 1995-2009 and followed up to Dec 31, 2009, or later. We looked at cancers of the stomach, colon, rectum, liver, lung, breast (women), cervix, ovary, and prostate in adults, and adult and childhood leukaemia. Standardised quality control procedures were applied; errors were corrected by the registry concerned. We estimated 5-year net survival, adjusted for background mortality in every country or region by age (single year), sex, and calendar year, and by race or ethnic origin in some countries. Estimates were age-standardised with the International Cancer Survival Standard weights. FINDINGS: 5-year survival from colon, rectal, and breast cancers has increased steadily in most developed countries. For patients diagnosed during 2005-09, survival for colon and rectal cancer reached 60% or more in 22 countries around the world; for breast cancer, 5-year survival rose to 85% or higher in 17 countries worldwide. Liver and lung cancer remain lethal in all nations: for both cancers, 5-year survival is below 20% everywhere in Europe, in the range 15-19% in North America, and as low as 7-9% in Mongolia and Thailand. Striking rises in 5-year survival from prostate cancer have occurred in many countries: survival rose by 10-20% between 1995-99 and 2005-09 in 22 countries in South America, Asia, and Europe, but survival still varies widely around the world, from less than 60% in Bulgaria and Thailand to 95% or more in Brazil, Puerto Rico, and the USA. For cervical cancer, national estimates of 5-year survival range from less than 50% to more than 70%; regional variations are much wider, and improvements between 1995-99 and 2005-09 have generally been slight. For women diagnosed with ovarian cancer in 2005-09, 5-year survival was 40% or higher only in Ecuador, the USA, and 17 countries in Asia and Europe. 5-year survival for stomach cancer in 2005-09 was high (54-58%) in Japan and South Korea, compared with less than 40% in other countries. By contrast, 5-year survival from adult leukaemia in Japan and South Korea (18-23%) is lower than in most other countries. 5-year survival from childhood acute lymphoblastic leukaemia is less than 60% in several countries, but as high as 90% in Canada and four European countries, which suggests major deficiencies in the management of a largely curable disease. INTERPRETATION: International comparison of survival trends reveals very wide differences that are likely to be attributable to differences in access to early diagnosis and optimum treatment. Continuous worldwide surveillance of cancer survival should become an indispensable source of information for cancer patients and researchers and a stimulus for politicians to improve health policy and health-care systems. FUNDING: Canadian Partnership Against Cancer (Toronto, Canada), Cancer Focus Northern Ireland (Belfast, UK), Cancer Institute New South Wales (Sydney, Australia), Cancer Research UK (London, UK), Centers for Disease Control and Prevention (Atlanta, GA, USA), Swiss Re (London, UK), Swiss Cancer Research foundation (Bern, Switzerland), Swiss Cancer League (Bern, Switzerland), and University of Kentucky (Lexington, KY, USA).

Regional determinants of firm entry in a developing country

We analyse the determinants of firm entry in developing countries using Argentina as an illustrative case. Our main finding is that although most of the regional determinants used in previous studies analysing developed countries are also relevant here, there is a need for additional explanatory variables that proxy for the specificities of developing economies (e.g., poverty, informal economy and idle capacity).We also find evidence of a core-periphery pattern in the spatial structure of entry that seems to be mostly driven by differences in agglomeration economies. Since regional policies aiming to attract new firms are largely based on evidence from developed countries, our results raise doubts about the usefulness of such policies when applied to developing economies. JEL classification: R12, R30, C33. Key words: Firm entry, Argentina, count data models.

Molecular insight into heart development and congenital heart disease: An update review from the Arab countries.

Congenital heart defect (CHD) has a major influence on affected individuals as well as on the supportive and associated environment such as the immediate family. Unfortunately, CHD is common worldwide with an incidence of approximately 1% and consequently is a major health concern. The Arab population has a high rate of consanguinity, fertility, birth, and annual population growth, in addition to a high incidence of diabetes mellitus and obesity. All these factors may lead to a higher incidence and prevalence of CHD within the Arab population than in the rest of the world, making CHD of even greater concern. Sadly, most Arab countries lack appropriate public health measures directed toward the control and prevention of congenital malformations and so the importance of CHD within the population remains unknown but is thought to be high. In approximately 85% of CHD patients, the multifactorial theory is considered as the pathologic basis. The genetic risk factors for CHD can be attributed to large chromosomal aberrations, copy number variations (CNV) of particular regions in the chromosome, and gene mutations in specific nuclear transcription pathways and in the genes that are involved in cardiac structure and development. The application of modern molecular biology techniques such as high-throughput nucleotide sequencing and chromosomal array and methylation array all have the potential to reveal more genetic defects linked to CHD. Exploring the genetic defects in CHD pathology will improve our knowledge and understanding about the diverse pathways involved and also about the progression of this disease. Ultimately, this will link to more efficient genetic diagnosis and development of novel preventive therapeutic strategies, as well as gene-targeted clinical management. This review summarizes our current understanding of the molecular basis of normal heart development and the pathophysiology of a wide range of CHD. The risk factors that might account for the high prevalence of CHD within the Arab population and the measures required to be undertaken for conducting research into CHD in Arab countries will also be discussed.

Health care usage among immigrants and native-born elderly populations in eleven European countries: results from SHARE

Differences in health care utilization of immigrants 50 years of age and older relative to the native-born populations in eleven European countries are investigated. Negative binomial and zero-inflated Poisson regression are used to examine differences between immigrants and native-borns in number of doctor visits, visits to general practitioners, and hospital stays using the 2004 Survey of Health, Ageing, and Retirement in Europe database. In the pooled European sample and in some individual countries, older immigrants use from 13 to 20% more health services than native-borns after demographic characteristics are controlled. After controlling for the need for health care, differences between immigrants and native-borns in the use of physicians, but not hospitals, are reduced by about half. These are not changed much with the incorporation of indicators of socioeconomic status and extra insurance coverage. Higher country-level relative expenditures on health, paying physicians a fee-for-service, and physician density are associated with higher usage of physician services among immigrants.

Cardiovascular disease and the changing face of global public health : a focus on low and middle income countries

Eighty percent of the global 17 million deaths due to cardiovascular disease (CVD) occur in low and middle income countries (LMICs). The burden of CVD and other noncommunicable diseases (NCDs) is expected to markedly increase because of the global aging of the population and increasing exposure to detrimental lifestyle-related risk in LMICs. Interventions to reduce four main risks related to modifiable behaviors (tobacco use, unhealthy diet, low physical activity and excess alcohol consumption) are key elements for effective primary prevention of the four main NCDs (CVD, cancer, diabetes and chronic pulmonary disease). These behaviors are best improved through structural interventions (e.g., clean air policy, taxes on cigarettes, new recipes for processed foods with reduced salt and fat, urban shaping to improve mobility, etc.). In addition, health systems in LMICs should be reoriented to deliver integrated cost-effective treatment to persons at high risk at the primary health care level. The full implementation of a small number of highly cost effective, affordable and scalable interventions ("best buys") is likely to be the necessary and sufficient ingredient for curbing NCDs in LMICs. NCDs are both a cause and a consequence of poverty. It is therefore important to frame NCD prevention and control within the broader context of social determinants and development agenda. The recent emphasis on NCDs at a number of health and economic forums (including the September 2011 High Level Meeting on NCDs at the United Nations) provides a new opportunity to move the NCD agenda forward in LMICs.

The Outcry of the Periphery? An Analysis of Ticino's No to Immigration

When the popular initiative "against mass immigration" was accepted by the Swiss people and cantons on 9 February 2014, Ticino had by far the highest approval rate. The Italian-speaking canton thus once more confirmed its singular position, assumed since the 1990s, on popular votes regarding immigration and foreign policy. This seems to be indicative of wider crises and changes in both the economic and political spheres that have favoured the emergence of a political opposition between centre and periphery. The results of a survey among 1400 citizens of Ticino after the vote of 9 February confirm this. In essence, on top of the question of immigration, the vote was influenced by a fearful perception of Ticino as a "double periphery" vis-à-vis both Berne and Lombardy.

Development of a Business Model that Supports Mobile Value-Added Services Market Creation in Emerging Countries

Tutkielman tavoitteena on luoda liiketoimintamalli, joka tukee langattomien matkaviestintäpalveluiden markkinoiden luomista kehittyvillä markkinoilla. Teoreettinen osa tarkastelee langattomien matkaviestintäpalveluiden liiketoimintamallin kehittämisen tärkeimpiä elementtejä CIS maissa. Teoreettisen kappaleen tuloksena saadaan puitteet, jonka avulla liiketoimintamalli matkaviestintäpalveluille voidaan kehittää. Tutkielman empiirinen osa on toteutettu case tutkimuksena, jonka tavoitteena on ollut langattomien matkaviestintäpalvelujen markkinoiden luominen CIS maissa. Pääasiallinen empiirisen tiedon lähde on ollut teemahaastattelut. Tuloksena saatuja empiirisen osan tietoja verrataan teoriakappaleen vastaaviin tuloksiin Tulokset osoittavat, että radikaalin korkean teknologian innovaation markkinoiden luominen on hidas prosessi, joka vaatii kärsivällisyyttä yritykseltä. Markkinoiden, teknologian ja strategian epävarmuustekijät tuovat epävarmuutta kehittyvälle toimialalle ja markkinoille, joka vaikeuttaa liiketoimintamallin kehittämistä. Tärkein tekijä on palvelujen markkinointi ennemmin kuin teknologian. Avain kyvykkyys markkinoiden luomisessa on oppiminen, ei tietäminen.

Integraation vaikutus Euroopan unionin jäsenmaiden ulkomaankauppavirtoihin

Työn tavoitteena on selvittää Euroopan unionin integraation vaikutusta jäsenmaiden ulkomaankauppaan vuosien 1995 ja 2001 välillä. Pääpaino on unionin sisäkaupan tutkimuksessa, Euroopan unionin ulkopuolisiin maihin suuntautuvan kaupan tarkastelussa tutkitaan kauppaa muiden teollistuneiden maiden ja kehitysmaiden kanssa. Työ on jakautunut teoreettiseen osaan ja empiiriseen osaan. Teoreettisessa osassa esitellään ulkomaankaupan taloustieteellinen perusta sekä kauppapolitiikan vaikutus kaupankäyntiin. Empiirisessä osassa tutkitaan tilastollisin menetelmin Euroopan unionin jäsenmaiden ulkomaankauppavirtoja. Johtopäätöksissä empiirisiä tuloksia verrataan muodostettuihin hypoteeseihin. Tutkimustulosten perusteella Euroopan unionin integraatiolla ei näytä olevan suurta vaikutusta unionin sisäkauppaan. Muun maailman kaupassa kehitys on ollut huomattavasti suurempaa. Parhaiten unionin sisäkauppaa selittää gravitaatiomalli eli kauppa riippuu voimakkaasti maiden taloudellisista vetovoimista ja niiden maantieteellisestä ja kulttuurillisesta etäisyydestä. Myös ydin-periferiamallin merkitys näyttää kasvaneen. Ulkokaupassa kauppapolitiikan rajoittava vaikutus on vähentynyt erityisesti kehitysmaiden kanssa käydyssä kaupassa.

Building high technology complete products for the markets of humanitarian organizations and developing countries

Tämä tutkielma käsittelee high-tech kokonaisratkaisun rakentamista kehitysmaiden ja humanitääristen organisaatioiden markkinoille. Tavoitteena on löytää ne komponentit joita case-yritys Mediburner Ltd:n polttouuni tarvitsee rinnalleen. Jotta täydentävien elementtien määritteleminen olisi mahdollista, pitää ensin selvittää keitä ovat asiakkaat, ja mitkä ovat heidän tarpeensa. Tutkimusmetodina käytetään kuvailevaa case-tutkimusta. Empiirinen materiaali kerättiin henkilökohtaisissa- ja puhelinkeskusteluissa. Niihin henkilöihin, joiden tavoittaminen oli aikaeron vuoksi hankalaa, otettiin yhteyttä sähköpostitse. Toinen tietolähde olivat dokumentit. Tutkielmassa käytettiin internetsivuja, sairaalajätehuoltoon liittyvien kansainvälisten konferenssien ja kenttätutkimusten raportteja sekä humanitääristen organisaatioiden suosituksia ja lehdistötiedotteita. Tulokseksi saatiin kymmenen tarvittavaa tukevien elementtien ryhmää: lisälaitteet, astiat jätteen keräilyyn ja tilapäiseen varastointiin, polttoaine, sähkö, logistiset ratkaisut, asennus ja käyttöönotto, huolto- ja korjauspalvelut, koulutus, help-desk –palvelu ja rahoitus. Lisäksi tarvitaan imago, joka konkretisoi tarjotun ratkaisun hyödyt. Yksi toimivan imagotyylin perusta voisi olla vastuullisuus.

Daily activity patterns of 2316 men and women from five countries differing in socioeconomic development.

Daily rhythmicity in the locomotor activity of laboratory animals has been studied in great detail for many decades, but the daily pattern of locomotor activity has not received as much attention in humans. We collected waist-worn accelerometer data from more than 2000 individuals from five countries differing in socioeconomic development and conducted a detailed analysis of human locomotor activity. Body mass index (BMI) was computed from height and weight. Individual activity records lasting 7 days were subjected to cosinor analysis to determine the parameters of the daily activity rhythm: mesor (mean level), amplitude (half the range of excursion), acrophase (time of the peak) and robustness (rhythm strength). The activity records of all individual participants exhibited statistically significant 24-h rhythmicity, with activity increasing noticeably a few hours after sunrise and dropping off around the time of sunset, with a peak at 1:42 pm on average. The acrophase of the daily rhythm was comparable in men and women in each country but varied by as much as 3 h from country to country. Quantification of the socioeconomic stages of the five countries yielded suggestive evidence that more developed countries have more obese residents, who are less active, and who are active later in the day than residents from less developed countries. These results provide a detailed characterization of the daily activity pattern of individual human beings and reveal similarities and differences among people from five countries differing in socioeconomic development.

Technology transfer at the periphery of the Mycenaean world: the cases of Mycenaean pottery found in central Macedonia (Greece) and the Plain of Sybaris (Italy)

The study of technology transfer in pottery production to the periphery of the Mycenaean world has been addressed by considering two different areas, southern Italy and central Macedonia. Technological features such as ceramic paste, decoration and firing have been determined for different ceramic groups established according to provenance criteria. The studies of technology and provenance have been performed following an archaeometric approach, using neutron activation analysis, petrographic analysis, X-ray diffraction and scanning electron microscopy. The results have revealed the existence of two different models. On the one hand, southern Italy seems to exhibit a more organized pottery production, which follows a Mycenaean-like technology, while in central Macedonia production is probably more varied, being based in part on the technology of the local tradition.

Diverse Routes from School, via Higher Education, to Employment. A Comparison of Nine European Countries

The central theme for this study is graduate employment and employability in European-wide discussion. In this study, the complex relationships between higher education and the world of work are explored from the vantage point of how individuals make use of the higher education system in their transition from education to employment. The variation among individual transition processes in nine European countries is analysed with the help of a comparable graduate survey. Countries in this study are Italy, Spain, France, Austria, Germany, the Netherlands, the United Kingdom, Finland, and Norway. The data used for the study is commonly known as the “CHEERS” or “Careers after Higher Education, A European Research Survey.” The data was collected in 1999. The study discusses the possibilities and limitations the higher education system has in supporting the initial education-to-work transitions of youth. The study also addresses problems with comparing national higher education systems in terms of enrolment and graduate employability. A central purpose for this study is to reflect on concerns about the prolongation of individual transitions with a framework that simultaneously considers both the graduate employability and the duration of the education-to-work transition process. The key concept for this study is the standard student/graduate; synonym concepts are the traditional and the conventional student/graduate. Standard graduates are relatively young individuals who are performing their initial transition from education to working-life and who complete the degree-earning process within the stipulated time frame. In all nine countries, standard graduates make up a considerable share of the student flow, passing from higher education to the labour markets. The share of standard graduates is by far the largest in France, where they comprise the overwhelming mass. The proportion of the standard graduates is the lowest in Italy, Finland, and Austria where approximately one in four graduates completed the process of higher education within the stipulated time frame. Of the nine countries compared, employability of the whole graduate population is the greatest in Norway, the UK, Finland, and the Netherlands. Compared with employability of the whole graduate population, variation among the countries is considerably reduced when reviewing the employability of only the standard graduates. Thereby, even though the ranking among countries remains largely unchanged, the variations among them are smaller when the duration of degree earning process is standardized. The study also discusses other ideal types of student careers (or transition processes) besides the standard student/graduate. Results of regression analyses indicate that that at the pan-European level analysis, the graduate labour markets are not heavily segmented in terms of the type of the individual transition process. When considering within-country differences between the graduates, the field of studies is clearly a more powerful explanatory variable than the type of the transition process. There are, nevertheless, clear indications that, irrespective of the country, chances of finding a high status job are, on the average, highest amongst those who graduate within the stipulated duration of the degree program and who thereby have experienced the standard student career, whereas, participating in working life while studying protects against unemployment after finishing one’s degree.

Co-evolution of Policy Sectors: Health Care and Public Health in five Countries

Cette thèse analyse la co-évolution de deux secteurs dans la politique de la santé: santé publique (public health) et soins aux malades (health care). En d'autres termes, la relation entre les dimensions curative et préventive de la politique de la santé et leur développement dans la durée. Une telle recherche est nécessaire car les problèmes de la santé sont complexes et ont besoin de solutions coordonnées. De plus, les dépenses de la santé ont augmenté sans arrt durant les dernières décennies. Un moyen de réduire une future augmentation des dépenses pourrait consister en davantage d'investissement dans des mesures préventives. En relation avec cette idée, ma recherche analyse les politiques de la santé publique et les soins aux malades de cinq pays: Allemagne, Angleterre, Australie, Etats-Unis et Suisse. En m'appuyant sur la littérature secondaire, des statistiques descriptives et des entretiens avec des experts et des politiciens, j'analyse la relation entre les deux secteurs depuis la fin du dix-neuvième siècle. En particulier, je me focalise sur la relation des deux champs sur trois niveaux: institutions, acteurs et politiques. Mes résultats montrent les similitudes et les différences d'évolution entre les cinq pays. D'un c^oté, lorsque la profession médicale est politiquement active et que le pays consiste en une fédération centralisée ou en un gouvernement unitaire, les deux secteurs sont intégrés au niveau institutionnel, ralliant les professions et groupes d'intérêt des deux secteurs la cause commune dans une activité politique. Par contre, dans tous les pays, les deux secteurs ont co-évolué vers une complémentarité malgré de la politisation des professions et la centralisation du gouvernement. Ces résultats sont intéressants pour la science politique en général car ils soulignent l'importance des professions pour le développement institutionnel et proposent un cadre pour l'analyse de la co-évolution des politiques publiques en général. -- This Ph.D. thesis analyzes the co-evolution of the health care and the public health sectors. In other words, the relation between preventive and curative health policy and its evolution over time. Such research is necessary, because current health problems are complex and might need coordinated solutions. What is more, health expenditures have increased continuously in the last decades. One way to slow down further increase in health spending could be to invest more in preventative health policies. Therefore, I am connecting individual health care and public health into a common analysis, taking Australia, Germany, Switzerland, the UK and the U.S. as examples. Based on secondary literature, descriptive statistics and interviews with experts and policymakers, I am analyzing how the two sectors' relations co-evolved between the late nineteenth and the early twenty-first century. Specifically, I am researching how health care and public health were related on the levels of institutions, actors and policies. My results show that there are differences and similarities in the co-evolution of policy sectors between these countries. On the one hand, when the medical profession was politically active and the country a centralized federation or a unitary state, there was institutional integration and common political advocacy of the sectors' interest groups and professions. On the other hand, in all countries, both sectors co-evolved towards complementarity, irrespectively of the politicization of professions and centralization of government. These findings are interesting for the political science literature at large, because they underline the importance of professions for institutional development and propose an analytical framework for analyzing the co-evolution of policy sectors in general.

Are traffic violators criminals? Searching for answers in experiences of European countries

The connection between road traffic safety and criminal behavior has recently become a topic of interest in the literature, although little emphasis placed on the relationship with road accidents. Evidence worldwide shows that people who commit other offences characteristic of antisocial attitudes, are more prone to suffer road traffic accidents and infringe traffic laws. Here we examine the records of the 28 current member states of the European Union over the period 1999 - 2010. Our aim is to test the hypothesis that crime rates (and specifically, motor vehicle-related crimes) may be considered as predictors of fatal road traffic accidents. If they may, this could justify, at least prima facie, the tendency in several countries to consider traffic offences as crimes in their penal codes and to toughen the punishment imposed on those who commit them. We also analyze the effect of the severity of the legal system applied to traffic offences. Our results reveal that road traffic fatality rates are higher in countries whose inhabitants have more aggressive behavior, while the rates are lower in countries with more severe penal systems.