Essays in health economics: Volume-Outcome Effect, upcoding behaviour and the evaluation of a short-term intervention program

Evidence in the literature suggests a negative relationship between volume of medical procedures and mortality rates in the health care sector. In general, high-volume hospitals appear to achieve lower mortality rates, although considerable variation exists. However, most studies focus on US hospitals, which face different incentives than hospitals in a National Health Service (NHS). In order to add to the literature, this study aims to understand what happens in a NHS. Results reveal a statistically significant correlation between volume of procedures and better outcomes for the following medical procedures: cerebral infarction, respiratory infections, circulatory disorders with AMI, bowel procedures, cirrhosis, and hip and femur procedures. The effect is explained with the practice-makes-perfect hypothesis through static effects of scale with little evidence of learning-by-doing. The centralization of those medical procedures is recommended given that this policy would save a considerable number of lives (reduction of 12% in deaths for cerebral infarction).

Role of Intersectoral Collaboration in Mental Health Policy Formulation And Service Delivery in Saint Lucia

RESUMO: Santa Lúcia pequena ilha de país em desenvolvimento com recursos limitados e é confrontada com uma série de desafios socioeconômicos que exigem soluções criativas e inovadoras. É comprovado que a combinação de recursos entre setores para estabelecer os determinantes social, econômico e ambiental da saúde são uma estratégia útil para melhorar a saúde da população, principalmente a sua saúde mental. Este estudo, o primeiro do seu tipo em Santa Lúcia, procurou examinar até que ponto a disponibilidade de uma política nacional de saúde mental levou a ação intersetorial para o fornecimento de serviços e promoção da saúde mental. Além disso, o estudo examinou o nível de colaboração intersetorial que existe entre as agências que prestam cuidados diretos e serviços de suporte para pessoas com doenças mentais e problemas sérios de saúde mental. O estudo também teve como objetivo identificar os fatores que promovem ou dificultam a colaboração intersectorial e gerar recomendações que possam ser aplicadas para países muito pequenos e com perfis socioeconômicos semelhantes. Os dados gerados a partir de três (3) fontes foram sintetizados para formar uma visão ampla das questões. Uma avaliação da política de saúde mental de 2007, uma avaliação que identifica até que ponto a ação intersetorial atualmente deixa a prestação de serviços de saúde mental e a administração de entrevistas semiestruturadas nas mãos de gestores do programa de diferentes agências em todos os setores. O estudo concluiu que, apesar da disponibilidade de uma política de saúde mental, que articula clara e explicitamente a colaboração intersetorial como área prioritária para ação, quase não existe no sistema de fornecimento atual do serviço. Os provedores de serviços em todos os setores reconhecem que há os benefícios da colaboração intersectorial e com entraves significativos em relação à colaboração intersetorial, que por sua vez, impede uma abordagem nacional para o planejamento e o fornecimento do serviço. A colaboração intersetorial não será possível se os próprios setores dependerem da abordagem direta do setor da saúde ou se a atmosfera geral for ofuscada pela estigmatização das doenças mentais.------------------------------------------------------------------------ABSTRACT: Saint Lucia a small island developing country with limited resources, is faced with a number of socio-economic challenges which require creative and innovative solutions to address. Combining resources across sectors to address the social, economic and environmental determinants of health has proven to be a useful strategy for improving population health in particular mental health. This study, the first of its kind for Saint Lucia sought to examine the extent to which the availability of a national mental health policy led to intersectoral action for mental health promotion and service delivery. In addition the study examined the level of intersectoral collaboration which actually exist between agencies which provide direct care and support services to people with mental illnesses and significant mental health problems. The study also aimed to identify the factors which promote or hinder intersectoral collaboration and generate recommendations which can be applied to extremely small countries with similar socio-economic profiles. Data generated from three (3) sources was synthesized to form a broad picture of the issues. An evaluation of the mental health policy of 2007, an assessment of the extent to which intersectoral action currently exist in mental health service delivery and the administration of semi-structured interviews with program managers from different agencies across sectors to identify implementation issues. The study concluded that despite the availability of a mental health policy which clearly and explicitly articulates intersectoral collaboration as a priority area for action, very little exists in the current service delivery system. Services providers across sectors acknowledge the benefits of intersectoral collaboration and that there are significant barriers to intersectoral collaboration, which in turn hinders a national approach to service planning and delivery. Intersectoral collaboration is not possible if sectors themselves are dependent on a top-down health sector driven and dominated approach, or if the general atmosphere is clouded by stigmatization of mental health illnesses.

Families of the traumatically brian-injured : a case study approach to perceptions of quality of service, degree of satisfaction, and family needs /

The purpose of this qualitative research study was to foster an understanding of the rehabilitation counselling practice offamilies of the brain-injured. Specifically, the study explores the perceptions of stakeholders in regards to the degree of satisfaction with the quality of service received. Questionnaires were administered, and semi-structured, openended interviews were conducted, with six participating families (n=8). Preliminary data were collected via two instruments: (i) the Family Participant Questionnaire, consisting of participants' sample characteristics, information pertaining to the history of the family, details of the injury, and information relating to the type, use, and need offamily services utilized; and (ii) the Community Integration Questionnaire, a measurement of the degree of social displacementllevel of community integration of the injured family member. Utilizing the procedural steps outlined by Colaizzi's (1978) method of protocol analysis, recommendations for a future program based on related and current family needs are discussed in detail. Substantiating and supporting information are offered to rehabilitation practitioners, educational planners, and policymakers alike, concerning the degree of satisfaction with rehabilitative service, and the means of improving upon the overall quality of health care to families of the brain-injured. Implications for clinical practice and research are also raised for discussion.

Novice teachers' perceptions of the extent to which the Brock University teacher education program focused on methods of promoting responsibility in students

The purpose of this study was to determine novice t~ache~s' perceptions of th~ extent to which the Brock University teacher education program focused on strategies for promoting responsibility in students. Individual interviews were conducted with ten randomly selected teachers who were graduates of this teacher education program between the years of 1989 and 1992, and a follow-up group discussion activity, with the same teachers, was also held. Findings revealed that the topic of personal responsibility was discussed within various components of the program, including counselling group sessions, but that these discussions were often brief, indirect and inconsistent. Some of the strategies which the teachers used in their own classrooms to promote responsibility in students were ones which they had acquired from those counselling group °sessions or from associate teachers. Various strategies included: setting ~lear expectations of students with positive and negative consequences for behaviour (e.g., material rewards and detentions, respectively), cemmunic?ting'with other teachers an~ parents, and -. suspending students from school. A teacher's choice of any particular strategy seemed to be affected by his or her personality, teaching sUbject and region of employment, as well as certain aspects of the teacher education program. It was concluded that many of the teachers appeared to be controlling rude and vio~ent- behaviour, as opposed to promoting responsible behaviour. Recommendations were made for the pre-service program, as well as induction and inservice programs, to increase teacher preparedness for promoting responsible student behaviour. One of these recommendations addressed the need to help teachers learn how to effectively communicate with their students.

The assessment of self-directed learning among pre-service students in an Ontario faculty of education

The study determined students' perceptions of self-directed learning in their courses. Tests to assess perceptions are not being used in many programs. Assessments such as the Self-Directed Readiness Scale (SDLRS) and the Oddi continuing Learning Inventory (OCLI) have weaknesses that may have affected the use of tests. In this study, the creation of the Self-Directed Learning Test (SDLT) monitored students' perceptions by addressing what students were told before registration, how much input students had in developing the structure of the course, how much input students have in determining the evaluation for the course, what style of learning is taking place, and the characteristics of learning found among students. Fifty-one students in the pre-service program at Brock University completed the SDLT. Results showed that 47.1% of the sample liked self-directed learning. Several students who stated that they did not like selfdirected learning did not know what self-directed learning was. Results supported Brookfield's (1986) claim for more education on what self-directed learning is. The study did not support Knowles' (1980) assumption that adult students know and want to follow self-directed approaches to learning. The SDLT is a good method for monitoring self-directed learning and how students perceive their courses.

The quality of life in the Master of Education program, Brock University

This study addressed the problem of the quality of life in the Brock Master of Education program. Survey and interview data were used to gain an understanding of satisfaction with the learning achieved and student life experienced. Eighty-seven percent of the study sample reported satisfaction with the program overall. Results suggested the higher the overall satisfaction with a program, the greater the likelihood learning and student life satisfaction were also more positive. Student reflections suggested satisfaction with the quality of life in the program was associated with the program's focus on the student, the use of self-directed learning, and the support of professors to meet student needs. Comparison of the Brock Master of Education survey with the Brock Pre-Service Teacher Education program showed both student groups shared a similar satisfaction with student life in the Faculty. Comparison of Master of Education programs suggested the difference between two programs, a difference which may be influenced by time in the program. The results from the three programs suggested that students beyond the first undergraduate degree favored the school domains of learning acquisition. Supplementary data on the relationship between cognitive and affective opinions suggested the more positive the affective dimension of learning, the greater the likelihood the cognitive dimensions of student life were also more positive. It was concluded that time was a chief factor influencing part-time student satisfaction with both learning and student life in the program. Part-time students, as. the majority in the survey, expressed comments about the need for clarity of communication between the organization and student to promote the effective use of limited time.

Understanding space, place and leisure of women over 85 living in the community

There is an increase in the number of older adults 85 and over, who are choosing to live alone within the community. Moreover, older adults who live alone are reportedly spending an extensive amount of time alone within the home environment. In an effort to provide additional support and resources to older adults living in the community, a compliment of services are being offered through public and private organizations. These in-home supports focus on the instrumental or functional tasks of daily living, such as personal and rehabilitative care, nourishment, maintenance and upkeep of the home, as well as volunteer social visitation. However leisure resources and programs are not included among these services. Consequently, this creates a gap in leisure provision among this segment of the population. Throughout the life course, an individual's identity, role and purpose are developed and sustained through instrumental work roles in the formal and informal sector, as well as through personally meaningful leisure pastimes and experiences. Although roles shift post retirement, participation in instrumental and expressive activities can provide opportunities through which older adults are able to fulfill their need for agency (individuality and autonomy) and affiliation (social relatedness). Therefore barriers that inhibit instrumental or leisure experiences can negatively impact older adults' quality of life. This study explored the leisure lifestyles of four older adults, all of whom were over 85, lived alone within the community and were oriented to person, time and place. It became apparent that participants ordered their lives around a routine that consisted of instrumental, expressive and socially integrated tasks and activities. Moreover participants purposely chose to remain at home because their home environment facilitated freedom, choice and independence. As a result all four participants viewed their independence within the home as a critical determinant to their overall quality of life. Challenges associated with the home environment, participants' personal capacities and relationships were negotiated on a daily basis. Failure to positively adapt to these challenges inhibited meaningful engagement and personal fulfillment. Traditionally, leisure service delivery has been offered within institutions and through various community based venues. As a result leisure provision has been focused on the needs of the frail elderly who reside in institutions or the well elderly who are able to access leisure amenities within the community. However the growing number of older adults electing to live alone is on the rise. As individuals age the home becomes the preferred context for leisure experiences. If older adults are choosing to live alone, then both their instrumental and leisure needs must be addressed. As a result, it is imperative that leisure professionals extend the scope of service delivery to include home centered older adults.

Analyzing the learning of the taking personal and social responsibility model within a new physical education undergraduate degree program in El Salvador

EI Salvador presents an unfortunate history that includes a military regime and a civil war that together created a legacy of violence in which the country still struggle nowadays. Salud Escolar Integral (SEI) was created in 2005 as a program to combat youth violence throughout the re-formulation of physical education (PE) classes in public schools, promoting life skills learning that supports the resolution of conflicts with nonviolent ways. In 2007, SEI supported the creation of a physical e~ucation teacher education (PETE) degree at the Universidad Pedag6gica de EI Salvador (UPES), having the goal to assist pre-service teachers with a better understanding of humanistic principles. The present research analyzed if after attending all three years ofUPES PETE program, students presented high self-perception levels of competence and confidence related to attitude, skills and knowledge to teach PE within humanistic principles. Taking Personal and Social Responsibility (TPSR) was the theoretical framework used to analyze the development of humanistic principles. The study had a mixed-method longitudinal design that included questionnaires, reflection templates and interviews. In conclusion, although it is suggested that UPES should provide better support for the development of the teaching principles of empowering students and transfer learning, most of the humanistic principles were highly promoted by the program. At last, it is suggested that future research should track teachers' progress while teaching in schools, in order to analyze if the theory of promoting humanistic principles have also become a daily practice.

A Basis for Understanding Volunteer Coach Retention in Youth Sports

Youth sport organizations depend on volunteers to coach the teams in the organization. The purpose of this quantitative study was to develop a further understanding of volunteer coach retention in youth sport. The data was collected through a quantitative questionnaire which used close-ended and Likert-scale questions. The questionnaire collected data on the modified Model of Volunteer Retention in Youth Sports, reasons to withdraw from coaching and human resource management. There were 126 surveys collected from members of the three largest youth sport associations in the town of Aylmer, Ontario. The study found that Person-Task fit was the best predictor of volunteer coach retention as it significantly correlated to one’s intention to continue coaching (p< 0.01). Furthermore, additional reasons were found to explain withdrawal from coaching - if one’s child stops playing the sport or if coaching is too time consuming. The retention of volunteer coaches in youth sport organizations requires a multi-dimensional approach in understanding how to best retain volunteer coaches.

Exploring Reciprocity in International Service Learning Programs

Using aspects of grounded theory methodology, this study explored the perceptions and practical implementation of reciprocity in International Service Learning (ISL) Programs. Data were collected through interviews with nine ISL practitioners representing a variety of organizations offering international service learning programs. Findings suggest that multiple conceptualizations of ISL programs exist. ISL programs are interdisciplinary in nature and that using reciprocity as a guiding framework is problematic. Further attention is needed in relation to shifting the guiding framework of ISL programs from reciprocity to interdependence.

Examining Mentoring within a Particular Service Learning Context

My goal for this research project was to explore the levels of mentoring within a disability-focused service learning context known as the Special Needs Activity Program (SNAP). At present, research on mentoring within specific service learning contexts remains largely unexamined. In an effort to assess service learning and mentoring, I completed a comparative case study across three distinct years of SNAP. Undergraduate student leaders, known as coordinators, organize and implement SNAP as a thesis project. I focused specifically on the mentoring experience of particular coordinators of SNAP. My thesis presents and describes the findings of several levels of analysis across three SNAP coordinator cohorts. The analysis focused on key words, idiomatic expressions, patterns and dissonances. In my conclusion, I offer three metaphors that describe mentoring within the SNAP experience and relate these to my discussion about how mentoring functions as a component of service learning.

Retrospective Exploration of the 3Rs Education Program: Systemic Facilitators and Barriers to Implementation

Individuals with intellectual disabilities (ID) have historically been denied basic rights and thus have been subjected to abuse. The 3Rs: Rights, Respect and Responsibility Human Rights Education Program was implemented and researched through a partnership with Community Living Welland Pelham and Brock University initially and then cascade training on the program was provided to five developmental service sector agencies from across the Niagara Region. This research evaluated the role of the 3Rs education program on the shift to a rights-based service agenda across those five agencies. Interviews were conducted with the Executive Director and Liaison staff from each of the agencies and a thematic analysis was used to describe factors that facilitated organizational changes and a cultural shift. Systemic barriers to the change were also explored. The results indicated that the 3Rs education program provides the catalyst necessary for the shift to a rights-based service agenda and that the resultant changes in practices now embedded in the organizations are reflective of a shift to a rights-based service agenda.

Whose Voice Is Present?: An Examination of Power and Privilege in Service-Learning in Ontario Universities

This research paper examines themes of power and privilege that occur within service-learning as described by 3 Ontario universities on their service-learning websites. Due to size and time restrictions, this paper was able to examine only 3 Ontario universities: Brock, Wilfrid Laurier, and Lakehead. The purpose of this study is geared towards service-learning practitioners in order for the universities and students to become more self-aware of their immense place of privilege within the service-learning context. Qualitative narrative analysis research methods were employed in this purposeful sample to examine how each university’s story of service-learning reflected themes of power and privilege. The research found that each university posed a unique narrative of service-learning representing various stakeholders’ voices and presence in different ways on their website. Brock largely focuses on faculty and student voices. Laurier intentionally attempts to include all three stakeholder voices, although still favours students and the university as an audience over the community. Lakehead’s unique program includes a plethora of voices and intends much of their information for the community members, students, and the university. The implications of this research demonstrate that universities have a large amount of power and privilege, which is carried through to the students within the service-learning partnership.

A Handbook for Ontario J/I Pre-Service Teachers Developing Inclusive Pedagogy: Understanding Pre-Service Teachers' Thoughts and Feelings About Diversity

This project presents a handbook for Ontario Junior/Intermediate (J/I) pre-service teachers, Ontario J/I teacher education instructors, and J/I associate teachers that facilitates the identification, analysis, and reorganization of J/I pre-service teachers’ thoughts and feelings about diversity characteristics to develop inclusive teaching pedagogy. The handbook outlines collaborative and independent learning activities designed for integration into compulsory J/I Bachelor of Education (B.Ed.) program courses, practicum placements, and independent reflective situations. The handbook is composed of 5 sections: (a) Rationale for Importance; (b) Cross-Curricular Activities for J/I B.Ed. Courses; (c) Course-Specific Activities; (d) Practicum Placement Activities; and (e) Resources for Inclusive Educators. A critical content analysis of a 2011-2012 J/I B.Ed. program in Ontario enabled the creation of the handbook to address specific teacher education programming focused on helping pre-service teachers understand their thoughts and feelings about diversity for the development of inclusive teaching pedagogy. This research contributes to the advancement of theory and practice regarding development of teacher education programming that promotes J/I pre-service teachers’ inclusive pedagogy.

Order of Service for the Honour Roll Unveiling - 10 June, 1945

A dedication service program for those who gave their lives during World War II from the city of St. Catharines. The list of over 150 names was to be read aloud and an address made by the Mayor (W.J. Macdonald) with prayers and hymn to follow.