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.

Phosphorylation of unique domains of Src family of kinases

Members of the Src family of kinases (SFKs) are non-receptor tyrosine kinases involved in numerous signal transduction pathways. The catalytic, SH3 and SH2 domains are attached to the membrane-anchoring SH4 domain through the intrinsically disordered"Unique" domains, which exhibit strong sequence divergence among SFK members. In the last decade, structural and biochemical studies have begun to uncover the crucial role of the Unique domain in the regulation of SFK activity. This mini-review discusses what is known about the phosphorylation events taking place on the SFK Unique domains, and their biological relevance. The modulation by phosphorylation of biologically relevant inter- and intra- molecular interactions of Src, as well as the existence of complex phosphorylation/dephosphorylation patterns observed for the Unique domain of Src, reinforces the important functional role of the Unique domain in the regulation mechanisms of the Src kinases and, in a wider context, of intrinsically disordered regions in cellular processes.

The role of different factors related to social impact of heavy events: considerations about the intensity thresholds in densely populated areas

In the assessment of social impact caused by meteorological events, factors of different natures need to be considered. Not only does hazard itself determine the impact that a severe weather event has on society, but also other features related to vulnerability and exposure. The requests of data related to insurance claims received in meteorological services proved to be a good indicator of the social impact that a weather event causes, according to studies carried out by the Social Impact Research Group, created within the framework of the MEDEX project. Taking these requests as proxy data, diverse aspects connected to the impact of heavy rain events have been studied. The rainfall intensity, in conjunction with the population density, has established itself as one of the key factors in social impact studies. One of the conclusions we obtained is that various thresholds of rainfall should be applied for areas of varying populations. In this study, the role of rainfall intensity has been analysed for a highly populated urban area like Barcelona. A period without significant population changes has been selected for the study to minimise the effects linked to vulnerability and exposure modifications. First, correlations between rainfall recorded in different time intervals and requests were carried out. Afterwards, a method to include the intensity factor in the social impact index was suggested based on return periods given by intensity duration frequency (IDF) curves.

Case-Crossover Analysis of Air Pollution Health Effects: A Systematic Review of Methodology and Application

Case-crossover is one of the most used designs for analyzing the health-related effects of air pollution. Nevertheless, no one has reviewed its application and methodology in this context. Objective: We conducted a systematic review of case-crossover (CCO) designs used to study the relationship between air pollution and morbidity and mortality, from the standpoint of methodology and application.Data sources and extraction: A search was made of the MEDLINE and EMBASE databases.Reports were classified as methodologic or applied. From the latter, the following information was extracted: author, study location, year, type of population (general or patients), dependent variable(s), independent variable(s), type of CCO design, and whether effect modification was analyzed for variables at the individual level. Data synthesis: The review covered 105 reports that fulfilled the inclusion criteria. Of these, 24 addressed methodological aspects, and the remainder involved the design’s application. In the methodological reports, the designs that yielded the best results in simulation were symmetric bidirectional CCO and time-stratified CCO. Furthermore, we observed an increase across time in the use of certain CCO designs, mainly symmetric bidirectional and time-stratified CCO. The dependent variables most frequently analyzed were those relating to hospital morbidity; the pollutants most often studied were those linked to particulate matter. Among the CCO-application reports, 13.6% studied effect modification for variables at the individual level.Conclusions: The use of CCO designs has undergone considerable growth; the most widely used designs were those that yielded better results in simulation studies: symmetric bidirectional and time-stratified CCO. However, the advantages of CCO as a method of analysis of variables at the individual level are put to little use

The methodological criteria of counterpropositions within the Roman social legal framework

Partiendo de la difundida distinción, entre unos ordenamientos jurídicos abiertos, como el derecho inglés y el anglo americano, que se vinculan en el pasado al Derecho Romano, y otros cerrados o codificados, como los derechos del continente europeo, y tras detenernos en el origen terminológico de ambos sistemas y en su rígida contraposición, se procura destacar en este trabajo que Roma y su Derecho tampoco abrazan en toda su pureza, un sistema abierto.

Causation and dominance : a study of Finnish causative verbs expressing social dominance

En väsentlig fråga inom såväl lingvistiska som kognitiva teorier är, hur språket beskriver kausala relationer. I finskan finns det en speciell typ av kausativa verb avledda med suffixet (U)ttA som används för att uttrycka att handlingen i fråga utförs av någon annan än subjektreferenten, t.ex. Maija haetuttaa Matilla kirjastosta kirjan ’Maija låter Matti hämta boken från biblioteket’ och Matti juoksuttaa Maijan kaupunkiin ’Matti låter Maija springa till staden’. Syftet med denna avhandling var att med exempel av sociala dominansens kausativer undersöka ordbildningens natur samt begreppet ’socialt förorsakande’. För att beskriva avledningars regelbundna argumentstruktur i form av kopplingen mellan syntaxen och semantiken upprättades deras prototypiska strukturer. Dessa verb har emellertid också specifika användningsområden som framhäver variationer i sociala relationer. Säregna egenskaper hos den sociala dominansens kausativer inkluderades i undersökningen och definierades som konstruktioner. Konstruktionerna omfattar speciella syntaktiska och/eller semantiska element och utöver det också pragmatiska värderande implikationer. Uppbyggnaden av den sociala dimensionen hos de undersökta verben består av egenskaper förbundna med typen av förorsakande, argumentens agentiva egenskaper (aktivitet eller passivitet, dominans, kontroll, viljestyrdhet och ansvarighet) samt konventionaliserade attityder och tolkningar. Ett exempel på en s.k. 'tolkningskonstruktion’ är den negativa dominansens uttryck som i avhandlingen kallas Maktmissbrukskonstruktionen. Denna konstruktion inkluderar talarens starkt kritiska hållning till den uttryckta situationen, t.ex. Asiakas juoksuttaa lentoemäntää ’Kunden låter flygvärdinnan springa’. Dessa konstruktioner fyller en viktig funktion i språklig kommunikation: att beskriva avvikande av sociala normer och att foga expressivitet till budskapet. Metodologiskt kombinerar denna avhandling teorier som baseras på det aktuella språkbruket och teoretisk lingvistisk analys. Verbens samt konstruktionernas konceptuella lexikala struktur och prototypstrukturerna analyserades med hjälp av den konceptuella semantikens verktyg, som har utvecklats av Jackendoff, Nikanne och Pörn.

Pain symptoms and sleep problems among school-aged children. Long-term prevalence changes, and pain symptoms as predictors of later mental health

Children’s pain symptoms and sleep problems are among the most common health complaints. They distract children from activities, decrease the quality of life, contribute to a significant economic burden, and have shown continuity into adulthood. The main aims of this thesis were to investigate long-term changes in the prevalence of pain symptoms and sleep problems among Finnish school-aged children, and the later mental health of those who in childhood experience pain. Prevalence, co-occurrence, and associated psychosocial factors of pain symptoms and sleep problems were also assessed. In study I, prevalence changes in eight-year-old children’s pain symptoms and sleep problems were investigated in three cross-sectional population-based samples (years 1989: n=1038, 1999: n=1035, and 2005: n=1030). In study II, cross-sectional associations between pain symptoms, sleep problems, and psychosocial factors were assessed among 13-18-year-old adolescents (n=2476). In studies III and IV, associations between pain symptoms at age eight (n=6017), and register-based data on antidepressant use and severe suicidality by age 24, were examined in a nationwide birth cohort. Pain symptoms and sleep problems were common and often co-occurred. A considerable number of children’s pain symptoms remained unrecognized by the parents. The prevalence of pain symptoms, sleep problems, and multiple concurrent symptoms approximately doubled from 1989 to 2005. Psychiatric difficulties or demographic factors did not explain the increase. Psychosocial factors that were associated with pain, sleep problems, and a higher number of symptoms, were female sex, psychological difficulties, emotional symptoms, smoking, victimization, and feeling not cared about by teachers. In longitudinal analyses, the child’s own report of headache, and to a smaller degree the parental report of the child’s abdominal pain predicted later antidepressant use. Parental report of the child’s abdominal pain predicted severe suicidality among males. If one of the symptoms is present, health care professionals should inquire about other symptoms as well. Questions should be directed to the children, not only to their parents. Inquiring about psychiatric difficulties, substance use, victimization, and relations with teachers should be included as a part of the assessment. Further studies are needed to clarify the reasons that underlie the increased prevalence rates, and the factors that may increase or decrease the risk for later mental health problems among pain-suffering children.

A simulation model of the optimal maintenance strategy: conceptual agent-based approach

In this Master’s thesis agent-based modeling has been used to analyze maintenance strategy related phenomena. The main research question that has been answered was: what does the agent-based model made for this study tell us about how different maintenance strategy decisions affect profitability of equipment owners and maintenance service providers? Thus, the main outcome of this study is an analysis of how profitability can be increased in industrial maintenance context. To answer that question, first, a literature review of maintenance strategy, agent-based modeling and maintenance modeling and optimization was conducted. This review provided the basis for making the agent-based model. Making the model followed a standard simulation modeling procedure. With the simulation results from the agent-based model the research question was answered. Specifically, the results of the modeling and this study are: (1) optimizing the point in which a machine is maintained increases profitability for the owner of the machine and also the maintainer with certain conditions; (2) time-based pricing of maintenance services leads to a zero-sum game between the parties; (3) value-based pricing of maintenance services leads to a win-win game between the parties, if the owners of the machines share a substantial amount of their value to the maintainers; and (4) error in machine condition measurement is a critical parameter to optimizing maintenance strategy, and there is real systemic value in having more accurate machine condition measurement systems.

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.

Spelling performance of third grade students : a comparison of whole-language-plus-strategy instruction, strategy instruction only, and the whole language approach

This study investigated three methods for teaching children how to spell. Third grade students were divided into three conditions for a one-week training period consisting of 15- to 20-minute lessons. One of the two experimental conditions used a whole language approach along with explicit strategy instruction. The second condition used strategy instruction within a traditional setting. The control used strictly a whole language approach to le~ing hO\\l to spell. The spelling perfonnance of all three conditions improved after the one-week training period. However, students in the strategy instruction groups did significantly better on the study "'7ords than the whole language only group. The students in whole-Ianguage-plusstrateg)! instruction outperformed both other groups. Significantly better spelling perfonnance was observed even at the nine-week posttest. This study frrst supported the hypothesis that children can make significantly greater improven1ents in their spelling when explicitly taught how to use spelling strategies. Secondl)', this study indicated that whole language provided a relevant context for the study words, clearly giving the students in the whole-Ianguage-plus-strategy condition an additional advantage.