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.

Facilitating coordination improvement efforts in cross-functional process development programs

Business process improvement is a common approach in increasing the effectiveness of an organization. It can be seen as an effort to increase coordination between units. Process improvement has proved to be challenging, and most management consultation firms facilitate organizations in this kind of initiatives. Cross-functional improvement is one of the main areas for internal consultants as well. However, the needs, challenges and means of cross-functional help have been rarely discussed in the literature. The objective of this thesis is on one hand to present a conceptual and descriptive framework to help understand the challenges of facilitating coordination improvement efforts in cross-functional improvement programs, and on the other hand to develop and test feasible solutions for some facilitation situations. The research questions are: 1. Why and in what kind of situations do organizations need help in developing coordination in cross-functional processes? 2. How can a facilitator help organizations in improving coordination to develop cross-functional processes? The study consists of two parts. The first part is an overview of the dissertation, and the second part comprises six research publications. The theoretical background for the study are the differentiation causing challenges in cross-functional settings, the coordination needed to improve processes, change management principles, methods and tools, and consultation practises. Three of the publications introduce tools for helping in developing prerequisites, planning responsibilities and supporting learning during the cross-functional program. The three other papers present frameworks to help understand and analyse the improvement situation. The main methodological approaches used in this study are design science research, action research and case research. The research data has been collected from ten cases representing different kinds of organizations, processes and developing situations. The data has been collected mainly by observation, semi-structured interviews and questionnaires. The research contributes to the rare literature combining coordination theories and process improvement practises. It also provides additional understanding of a holistic point of view in process improvement situations. The most important contribution is the addition to the theories of facilitating change in process improvement situations. From the managerial point of view, this study gives advice to managers and consultants in planning and executing cross-functional programs. The main factors increasing the need for facilitation are the challenges for differentiation, challenges of organizational change in general, and the novelty of initiatives and improvement practices concerning process development. Organizations need help in creating the prerequisites to change, in planning initiatives, easing conflict management and collaboration between groups, as well as supporting the learning of cross-functional improvement. The main challenges of facilitation are combining the different roles as a consultant, maintaining the ownership for the improvement project with the client, and supporting learning in the client organization.

Five year trends in dyslipidaemia prevalence and management in Switzerland: The CoLaus study.

BACKGROUND AND AIMS: Data from prospective cohorts describing dyslipidaemia prevalence and treatment trends are lacking. Using data from the prospective CoLaus study, we aimed to examine changes in serum lipid levels, dyslipidaemia prevalence and management in a population-based sample of Swiss adults. METHODS AND RESULTS: Cardiovascular risk was assessed using PROCAM. Dyslipidaemia and low-density lipoprotein cholesterol (LDL-C) target levels were defined according to the Swiss Group for Lipids and Atherosclerosis. Complete baseline and follow up (FU) data were available for n = 4863 subjects during mean FU time of 5.6 years. Overall, 32.1% of participants were dyslipidaemic at baseline vs 46.3% at FU (p < 0.001). During this time, lipid lowering medication (LLM) rates among dyslipidaemic subjects increased from 34.0% to 39.2% (p < 0.001). In secondary prevention, LLM rates were 42.7% at baseline and 53.2% at FU (p = 0.004). In multivariate analysis, LLM use among dyslipidaemic subjects, between baseline and FU, was positively associated with personal history of CVD, older age, hypertension, higher BMI and diabetes, while negatively associated with higher educational level. Among treated subjects, LDL-C target achievement was positively associated with diabetes and negatively associated with personal history of CVD and higher BMI. Among subjects treated at baseline, LLM discontinuation was negatively associated with older age, male sex, smoking, hypertension and parental history of CVD. CONCLUSIONS: In Switzerland, the increase over time in dyslipidaemia prevalence was not paralleled by a similar increase in LLM. In a real-life setting, dyslipidaemia management remains far from optimal, both in primary and secondary prevention.

Iron metabolism and incidence of metabolic syndrome.

BACKGROUND AND AIMS: Whether iron metabolism affects metabolic syndrome (METS) is debated. We assessed the association between several markers of iron metabolism and incidence of METS. METHODS AND RESULTS: Data from 3271 participants (1870 women, 51.3 ± 10.4 years), free of METS at baseline and followed for 5.5 years. The association of serum iron, ferritin and transferrin with incident METS was assessed separately by gender. Incidence of METS was 22.6% in men and 16.5% in women (p < 0.001). After multivariate adjustment, a positive association was found between transferrin and incident METS in men: odds ratio (OR) and 95% confidence interval for the fourth relative to the first quartile 1.55 (1.04-2.31), p for trend = 0.03, while no association was found for iron OR = 0.81 (0.53-1.24), p for trend = 0.33 and ferritin OR = 1.30 (0.88-1.92), p for trend = 0.018. In women, a negative association was found between iron and incident METS: OR for the fourth relative to the first quartile 0.51 (0.33-0.80), p for trend<0.03; the association between transferrin and incident METS was borderline significant: OR = 1.45 (0.97-2.17), p for trend = 0.07 and no association was found for ferritin: OR = 1.11 (0.76-1.63), p for trend = 0.58. CONCLUSION: Transferrin, not ferritin, is independently associated with an increased risk of incident METS; the protective effect of iron in women should be further explored.

Body donations today and tomorrow: What is best practice and why?

There is considerable agreement that the use of human bodies for teaching and research remains important, yet not all universities use dissection to teach human gross anatomy. The concept of body donation has evolved over centuries and there are still considerable discrepancies among countries regarding the means by which human bodies are acquired and used for education and research. Many countries have well-established donation programs and use body dissection to teach most if not all human gross anatomy. In contrast, there are countries without donation programs that use unclaimed bodies or perhaps a few donated bodies instead. In several countries, use of cadavers for dissection is unthinkable for cultural or religious reasons. Against this background, successful donation programs are highlighted in the present review, emphasizing those aspects of the programs that make them successful. Looking to the future, we consider what best practice could look like and how the use of unclaimed bodies for anatomy teaching could be replaced. From an ethical point of view, countries that depend upon unclaimed bodies of dubious provenance are encouraged to use these reports and adopt strategies for developing successful donation programs. In many countries, the act of body donation has been guided by laws and ethical frameworks and has evolved alongside the needs for medical knowledge and for improved teaching of human anatomy. There will also be a future need for human bodies to ensure optimal pre- and post-graduate training and for use in biomedical research. Good body donation practice should be adopted wherever possible, moving away from the use of unclaimed bodies of dubious provenance and adopting strategies to favor the establishment of successful donation programs. Clin. Anat. 29:11-18, 2016. © 2015 Wiley Periodicals, Inc.

Improving the molecular diagnosis of Chlamydia psittaci and Chlamydia abortus infection with a species-specific duplex real-time PCR.

Chlamydia psittaci and Chlamydia abortus are closely related intracellular bacteria exhibiting different tissue tropism that may cause severe but distinct infection in humans. C. psittaci causes psittacosis, a respiratory zoonotic infection transmitted by birds. C. abortus is an abortigenic agent in small ruminants, which can also colonize the human placenta and lead to foetal death and miscarriage. Infections caused by C. psittaci and C. abortus are underestimated mainly due to diagnosis difficulties resulting from their strict intracellular growth. We developed a duplex real-time PCR to detect and distinguish these two bacteria in clinical samples. The first PCR (PCR1) targeted a sequence of the 16S-23S rRNA operon allowing the detection of both C. psittaci and C. abortus. The second PCR (PCR2) targeted the coding DNA sequence CPSIT_0607 unique to C. psittaci. The two PCRs showed 100 % detection for ≥ 10 DNA copies per reaction (1000 copies ml- 1). Using a set of 120 samples, including bacterial reference strains, clinical specimens and infected cell culture material, we monitored 100 % sensitivity and 100 % specificity for the detection of C. psittaci and C. abortus for PCR1. When PCR1 was positive, PCR2 could discriminate C. psittaci from C. abortus with a positive predictive value of 100 % and a negative predictive value of 88 %. In conclusion, this new duplex PCR represents a low-cost and time-saving method with high-throughput potential, expected to improve the routine diagnosis of psittacosis and pregnancy complication in large-scale screening programs and also during outbreaks.

Learning in later life: participation in formal, non-formal and informal activities in a nationally representative Spanish sample

This article examines the participation of Spanish older people in formal, non-formal and informal learning activities and presents a profile of participants in each kind of learning activity. We used data from a nationally representative sample of Spanish people between 60 and 75 years old (n = 4,703). The data were extracted from the 2007 Encuesta sobre la Participación de la Población Adulta en Actividades de Aprendizaje (EADA, Survey on Adult Population Involvement in Learning Activities). Overall, only 22.8 % of the sample participated in a learning activity. However, there was wide variation in the participation rates for the different types of activity. Informal activities were far more common than formal ones. Multivariate logistic regression indicated that education level and involvement in social and cultural activities were associated with likelihood of participating, regardless of the type of learning activity. When these variables were taken into account, age did not predict decreasing participation, at least in non-formal and informal activities. Implications for further research, future trends and policies to promote older adult education are discussed.

Integrating eco-innovation principles into regional strategy and policy: case of Päijät-Häme region, Finland

This study focuses on the integration of eco-innovation principles into strategy and policy at the regional level. The importance of regions as a level for integrating eco-innovative programs and activities served as the point of interest for this study. Eco-innovative activities and technologies are seen as means to meet sustainable development objective of improving regions’ quality of life. This study is conducted to get an in-depth understanding and learning about eco-innovation at regional level, and to know the basic concepts that are important in integrating eco-innovation principles into regional policy. Other specific objectives of this study are to know how eco-innovation are developed and practiced in the regions of the EU, and to analyze the main characteristic features of an eco-innovation model that is specifically developed at Päijät-Häme Region in Finland. Paijät-Häme Region is noted for its successful eco-innovation strategies and programs, hence, taken as casework in this study. Both primary (interviews) and secondary data (publicly available documents) are utilized in this study. The study shows that eco-innovation plays an important role in regional strategy as reviewed based on the experience of other regions in the EU. This is because of its localized nature which makes it easier to facilitate in a regional setting. Since regional authorities and policy-makers are normally focused on solving its localized environmental problems, eco-innovation principles can easily be integrated into regional strategy. The case study highlights Päijät-Häme Region’s eco-innovation strategies and projects which are characterized by strong connection of knowledge-producing institutions. Policy instruments supporting eco-innovation (e.g. environmental technologies) are very much focused on clean technologies, hence, justifying the formation of cleantech clusters and business parks in Päijät-Häme Region. A newly conceptualized SAMPO model of eco-innovation has been developed in Päijät-Häme Region to better capture the region’s characteristics and to eventually replace the current model employed by the Päijät-Häme Regional Authority. The SAMPO model is still under construction, however, review of its principles points to some of its three important spearheads – practice-based innovation, design (eco-design) and clean technology or environmental technology (environment).

Serum neutralization with different types and subtypes of bovine herpesvirus 1 and 5

The serum neutralization (SN) test is the gold standard method to measure neutralizing antibodies to bovine herpesviruses. However, in view of the further subdivisions of bovine herpesviruses in types/subtypes, defining which virus to use at challenge in SN tests may be difficult. In view of that, this study was carried out to re-evaluate (SN) sensitivity with different types/subtypes of bovine herpesviruses types 1 (BoHV-1) and 5 (BoHV-5) as challenge viruses. Bovine sera (n=810) were collected from two distinct geographic regions and tested by SN with three type 1 viruses (BoHV-1.1 strains "Los Angeles" and "EVI123/98"; BoHV-1.2a strain "SV265/96") and three type 5 viruses (BoHV-5a strain "EVI88/95"; BoHV-5b strain "A663" and BoHV-5c "ISO97/95"). SN tests were performed with a 1 hour incubation of the serum-virus mixtures at 37ºC against 100 TCID50 of each of the viruses. SN sensitivity varied greatly depending on the challenge virus used in the test. The highest sensitivity (327 positive/810 total sera tested; 40.37%) was attained when the positive results to the six viruses were added together. No association could be found between any particular type or subtype of virus and the sensitivity of the test. When positive results to each single strain were considered, SN sensitivity varied from 41.7% to 81.7%, depending on the virus and the geographic region of origin of the sera. Variation was detected even when challenge viruses belonged to the same subtype, where disagreement between positive results reached 41%. These results indicate that one hour incubation SN tests against single viruses, as performed here, may display a significantly low sensitivity (p=0.05); performing SN tests against a number of different viruses may increase considerably SN sensitivity. Furthermore, the choice of virus used for challenge is critical in SN tests. In addition, sera from different geographic regions may give rise to disagreeing results with different strains of BoHV-1 and BoHV-5. This might be particularly relevant for control programs and in international trade, were maximum sensitivity should be targeted.

Creating generation Y sources of motivation for enhanced performance

New challenges have been created in the modern work environment as the diversity of the workforce is greater than ever in terms of generations. There will become a large demand of generation Y employees as the baby boomer generation employees retire at an accelerated rate. The purpose of this study is to investigate Y generation specific characteristics and to identify motivational systems to enhance performance. The research questions are: 1. What are Y generation characteristics? 2. What motivational systems organizations can form to motivate Y generation employees and in turn, create better performance? The Y generation specific characteristics identified from the literature include; achievement oriented; confident; educated; multitasking; having a need for feedback; needing management support; sociable and tech savvy. The proposed motivational systems can be found in four areas of the organization; HRM, training and development, communication and decision making policies. Three focus groups were held to investigate what would motivate generation Y employees to achieve better performance. Two of these focus groups were Finnish natives and the third consisted of international students. The HRM systems included flexibility and a culture of fun. It was concluded that flexibility within the workplace and role was a great source of motivation. Culture of fun was not responded to as favorably although most focus group participants rated enjoyableness as one of their top motivating factors. Training and development systems include training programs and mentoring as sources of potential motivation. Training programs were viewed as a mode to gain a better position and were not necessarily seen as motivational systems. Mentoring programs were not concluded to have a significant effect on motivation. Communication systems included keeping up with technology, clarity and goals as well as feedback. Keeping up with technology was seen as an ineffective tool to motivate. Clarity and goal setting was seen as very important to be able to perform but not necessarily motivating. Feedback had a highly motivating effect on these focus groups. Decision making policies included collaboration and teamwork as well as ownership. Teams were familiar and meet the social needs of Y generation employees and are motivating. Ownership was equated with trust and responsibility and was highly valued as well as motivating to these focus group participants.

Quality, Productivity and Economy in Welding Manufacturing - Case Study: West Africa

This thesis studies quality, productivity and economy in welding manufacturing in West African states such as Ghana, Nigeria and Cameroon. The study consists of two parts: the first part, which forms the theoretical background, reviews relevant literature concerning the metal and welding industries, and measurement of welding quality, productivity and economy. The second part, which is the empirical part, aims to identify activities in the metal manufacturing industries where welding is extensively used and to determine the extent of welding quality, productivity and economy measurements in companies operating in the metal manufacturing industries. Additionally, the thesis aims to identify challenges that companies face and to assess the feasibility of creating a network to address these issues. The research methods used in the empirical part are the case study (qualitative) method and the survey (quantitative) method. However, the case study method was used to elicit information from companies in Ghana, while the survey method was used to elicit information from companies in Nigeria and Cameroon. The study considers important areas that contribute to creating awareness and understanding of the current situation of the welding industry in West Africa. These areas include the metal manufacturing industrial sector, metal products manufactured, metal production and manufacturing systems deployed, welding quality, productivity and economy measurement systems utilized, equipment and materials on the markets, general challenges facing companies in welding operations, welding technology programs and research in local universities, and SWOT analysis of the various West African states. The notable findings indicate that majority of the companies operate in the constructionindustrial sector. Also, majority of the companies are project manufacturing oriented, thus provide services to customers operating in the growing industries such as the oil and gas, mining, food and the energy industry. In addition, only few companies are certified under standards such as ISO 9001, ISO 3834, and OHSAS 18001. More so, majority of the companies employ manual welding technique, and shielded metal arc welding (SMAW) as the commonly used welding process. Finally, welder salary is about € 300 / month as of June 2013 and the average operations turnover of medium to large companies is about € 5 million / year as at 2012. Based on analysis of the results of the study, it is noted that while welding activities are growing, the availability of cheap labor, the need for company and welder qualification and certification, and the need to manufacture innovative products through developmental projects (transfer of welding expertise and technology) remain as untapped opportunities in the welding industry in the West African states. The study serves as a solid platform for further research and concludes with several recommendations for development of the West African welding industry.

Computer programs for analysis of droplets sprayed on water sensitive papers

The use of water-sensitive papers is an important tool for assessing the quality of pesticide application on crops, but manual analysis is laborious and time-consuming. Thus, this study aimed to evaluate and compare the results obtained from four software programs for spray droplet analysis in different scanned images of water-sensitive papers. After spraying, papers with four droplet deposition patterns (varying droplet spectra and densities) were analyzed manually and by means of the following computer programs: CIR, e-Sprinkle, DepositScan and Conta-Gotas. The diameter of the volume and number medians and the number of droplets per target area were studied. There is a strong correlation between the values measured using the different programs and the manual analysis, but there is a great difference between the numerical values measured for the same paper. Thus, it is not advisable to compare results obtained from different programs.

A platform for assessing the current state of data repositories in Korea, Japan and China

Presentation at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014

Diphtheria toxin IgG levels in military and civilian blood donors in Rio de Janeiro, Brazil

Serologic data on diseases that are preventable by vaccines are necessary to evaluate the success of immunization programs and to identify susceptible subgroups. In the present study, we determined serum IgG levels against diphtheria toxin of military and civilian blood donors (N = 75; 69.3% males and 30.7% females) aged 18-64 years, from the Brazilian Army Biology Institute, Rio de Janeiro, using a commercial diphtheria kit (Diphtheria IgG ELISA; IBL, Germany). Most (63%) unprotected military donors were from the older age group of 41 to 64 years. In contrast, the majority (71%) of young military donors (18 to 30 years) were fully protected. About half of the military donors aged 31 to 40 years were protected against diphtheria. Among the civilians, about 50% of persons aged 18 to 30 years and 31 to 40 years had protective antibody levels against diphtheria as also did 64% of individuals aged 41 to 64 years. All civilians had a similar antibody response (geometric mean = 0.55 IU/mL) independent of age group. Military donors aged 18-30 years had higher IgG levels (geometric mean = 0.82 IU/mL) than military donors of 41-64 years (geometric mean = 0.51 IU/mL; P > 0.05). In conclusion, the existence of a considerable proportion of susceptible adults supports the position that reliable data on the immune status of the population should be maintained routinely and emphasizes the importance of adequate immunization during adulthood.

The Construction of ‘Disciplinary’ Violence Against Children — Social Workers’, Police Officers’ and Parents’ Rationales

This dissertation examines parental disciplinary violence against children in authority records and in the criminal procedure in Finland. The main aim is to analyze disciplinary violence, how it is defined, and how it is constructed as a crime by social workers, the police, and parents. This dissertation consists of four sub-studies and a summary article. In the first sub-study, I examine how disciplinary violence appears in child welfare documents and analyze the decision-making processes and measures taken by the child welfare workers. The second sub-study, utilizing police interview data, examines police officers’ perceptions of disciplinary violence, its criminalization, and its investigation. In addition to this analysis of police officers’ own perceptions, in the third sub-study, I use reports of crime and pre-trial investigation documents to look at what a typical suspicion of disciplinary violence coming to the attention of the police is and examine the decision-making processes of the police. Utilizing authority data, the fourth sub-study analyzes how parents rationalize the use of disciplinary violence to the authorities investigating these suspicions. The research provides findings that are unprecedented in Finland. Firstly, it was shown that social workers’ decision-making processes in suspicions of disciplinary violence follow three pathways of reasoning, with many factors taken into consideration; and in less than one-third of the cases, a request for criminal investigation has been made to the police. Secondly, it was verified that police officers hold different perceptions of disciplinary violence, and these perceptions have multiple effects on the investigation of these cases and the construction of disciplinary violence as a crime. Thirdly, the analysis of the reports of crime and pre-trial investigation documents showed that almost two-thirds of the cases of disciplinary violence had been sent to a prosecutor by the police and, thus, defined as a crime. However, in many cases, acts of disciplinary violence were often seen as ‘educational, petty one-off incidents’ and a possible trial and punishment for the perpetrator were seen as unreasonable. Fourthly, it was found that parents often try to neutralize and rationalize the violence they have used against their children, for example, either by denying the victim, the criminal intent, or the entire act, or relying on the necessity of the forbidden act. The dissertation concludes that disciplinary violence is defined and constructed in authority policies and practices, first and foremost, by the severity of the act, the nature of the act as continuous or singular, the perceived harm caused by the act to a child, and the perceptions of authorities regarding physical punishment of children. The asymmetrical power setting present in disciplinary violence and parents’ legitimized right to raise and discipline their children partly seem to explain why criminal-law processing of these suspicions of violence and understanding these as crimes is difficult. Finally, this research calls for more coherent and consistent authority practices and policies, achieved by educating authorities and increasing awareness on disciplinary violence, questions the need for a concept like ‘disciplinary’ violence, and suggests more emphasis on unambiguous perceptions of a child’s best interest.