An examination of employment precarity and insecurity in the UK

Employment precarity and insecurity are major topics of discussion within the sociology of work and in society at large. This thesis demonstrates the limits to the growth of precarity in the UK labour force. It contests the view that employment is becoming relentlessly more precarious in the neoliberal period. Furthermore, it challenges the view expressed by some theorists, including many on the radical left, that precarity is part of a recasting of class relations undermining the capacity of workers to challenge capital. Precarity is defined here as an objective condition whereby employment becomes more contingent. It is measured through a study of non-standard employment and employment tenure, using surveys of the UK labour force. Non-standard employment has not grown substantially. Mean employment tenure has remained stable overall, having fallen a little for men and risen for women since the 1970s. While there are areas of precarious work, these tend to be hemmed in by permanent, long-term jobs. This is explained through a Marxist theorisation of labour markets, emphasising the interdependence of capital and labour, and the role of the state in securing the reproduction of labour-power. To help understand the resonance of the concept of precarity, subjective job insecurity is measured. Survey data shows little evidence of a secular rise in insecurity. However, in the 1990s, and again after the 2008-9 recession, concerns about the loss of valued features of work combined with a wider ideological climate of uncertainty to increase generalised job insecurity. The findings of this thesis contest widespread pessimism regarding the capacities of the working class under neoliberalism, leading to practical implications for the orientation of the labour movement and the radical left. Finally, the research suggests changes to surveys of the labour force that would improve measures of precarity and insecurity in the future

Factors affecting the use of malaria prevention methods among pregnant women in Kenya.

Abstract Background In sub-Saharan Africa, malaria is the leading cause of morbidity and mortality. An estimated 15 million malaria cases and 40 000 malaria deaths were reported in Kenya. Malaria during pregnancy is associated with adverse health outcomes for both the mother as well as her foetus. The purpose of this study was to examine the relationship between socioeconomic correlates and the uptake of malaria prevention methods during pregnancy. Methodology: Data was drawn from the 2008-2009 Kenya Demographic and Health Survey. A total of 8098 women aged 15-49 were analysed. Stata version 12 was used for the management and analysis of data. Univariate, bivariate and multivariate analysis was carried out to meet the objectives of this study. Results: Forty-eight percent of women made use of Insecticide Treated Net (ITNs), 52 percent were administered with Intermittent Preventative Therapy (IPTp) and 36 percent made use of both measures during pregnancy. Multivariate results indicate that urban women were found to display slightly higher odds of ITN usage (1.13) and the combined usage of ITNs and IPTp (1.22) during pregnancy in comparison to rural women. Women with higher levels of education and women from middle income and rich households displayed higher odds of the uptake of these malaria prevention methods during pregnancy. Conclusion: This study has shown that socioeconomic indicators influence the usage of malaria prevention methods during pregnancy. It is therefore imperative that these factors be considered when designing and implementing policies aimed at improving the uptake of these measures during pregnancy

Anti-epileptic drug toxicity in children

Anti-epileptic drugs (AEDs) have had a major impact on children, improving their quality of life and significantly reducing both morbidity and mortality. They are, however, associated with significant toxicity. Behavioural problems and somnolence are the most frequent adverse drug reactions for many AEDs. Unfortunately, the comparative risk of drug toxicity for different AEDs has been inadequately studied. Drug toxicity is poorly reported in randomised controlled trials. Prospective cohort studies are the best way to study drug toxicity. There have been a few prospective cohort studies of children with epilepsy, but the numbers of children have been small. Systemic reviews of the toxicity of individual AEDs have been helpful in identifying the risk of drug toxicity. Parents of children with epilepsy and the children and young people who are due to receive AED treatment have the right to know the likelihood of them experiencing drug toxicity. Unfortunately, the evidence base on which health professionals can provide such information is limited

Medication errors in infants at home

The study by Solanki and colleagues involved interviewing 166 parents/grandparents at home regarding the medications that had been prescribed at discharge to their infants, by the hospital staff [1]. As part of the study, the parents were also asked to demonstrate how much medicine they would give. With this methodology, Solanki et al. estimated that two out of three of the infants in their study would have experienced medication errors at home. This is an alarmingly high proportion of medication errors. Fortunately, none of the infants experienced significant harm. The authors have suggested that this high rate may be due to lack of parental education and inadequate pre-discharge counselling. The study was performed in Pondicherry in India. It would be wrong, however, to dismiss the relevance of their findings when considering the possibility of medication errors among neonates discharged from centres from high income countries, such as the U.K

A comparative analysis of financial management practices at a district level in South Africa

A Thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Doctor of Philosophy. Johannesburg, 2017.Background: Effective financial management is required across developed and developing countries which face the dilemma of curbing health expenditure yet ensuring the delivery of quality health services. The health system in South Africa (SA) is no exception, and is described as facing a number of challenges ranging from service delivery to budgetary issues. Prior literature indicates that decentralisation in the country has been marred with numerous financial management challenges associated with health districts e.g. insufficient control/ authority delegated to the districts and a lack of skilled staff. Much literature has documented difficulties related to decentralised financial management both in SA and globally, yet these challenges continue to persist. The primary aim of this study is to provide a comparative analysis of financial management realities between two districts in province x of SA. It differs to previous studies, in that it has examined financial management through an organisational approach, drawing on a multitude of theoretical underpinnings including the sociocultural perspective, structures (rules, resources enacted through routines) and agency – actions of individuals (staff) going against and manoeuvring constraints. The organisational perspective extends to understanding hardware which refers to tangible aspects in the health system e.g. information technology (IT) or resources and software elements such as communication or interrelationships. The study draws out actual financial management routines linked to key processes (planning, resource allocation and budgeting and evaluation) as well as its associated challenges and successes at a district level. Finally, the thesis has set out to address gaps in decentralisation literature, by considering contextual influences such as history, politics and centralised bodies, particularly the Provincial Department of Health (PDoH). Methods: A qualitative research approach including a multiple case-study design was used. Primary data collection commenced in March 2014 and was completed in April 2015. A total of 58 participants were included in the study. Purposive sampling techniques were useful in identifying key participants involved in financial management at a district level. Key respondents at a sub-district and provincial level (PDoH) linked to district financial management, other support functions and external stakeholders from Non-Governmental Organisations (NGOs) were included. An in-depth interview was carried out with each participant and follow-up interviews were done when necessary. This was followed by non-participant and participant observations being conducted in each study site, which allowed for data triangulation. Ethical approval was granted by the relevant university, provincial and district boards. Rigorous thematic content analysis was carried out. Findings: The study begins by describing and providing a brief overview of key financial processes carried out in each district, for example District Health Planning (DHP) or the District Health Expenditure Review (DHER). Essentially these were the everyday routinised tasks or realities examined. In both districts, namely Indawo and Isikhala, weaknesses included expenditure tracking difficulties or financial management challenges such as payment delays or difficulties linked to centralised processes carried out by PDoH. Despite similarities, there were notable differences in the way most of these processes were carried out. For example in Indawo, poor planning and budget motivation processes as well as a ‘culture of compliance’ to meet prescribed processes were reported. In Isikhala, there was better coordination, oversight and engagement of these tasks e.g. province considering the district’s annual budget motivation to be one of the best. However, the findings reveal that even though prescribed financial tasks are carried out, effective financial management was still not achieved in both districts –difficulties with expenditure tracking. Procurement procedures require approval based on availability of financial resources; however requests were approved in both districts irrespective of budget availability. The thesis then shifted a step further to understanding these realities, particularly why dysfunctional routines such as poor planning or compliance to tasks persist and where the mechanisms for improvement/ strengthening lie. Findings revealed why the two districts differ in relation to carrying out these tasks. Structuration theory developed by Giddens (1984) considers the relationship between structure and agency in society (defined above). This thesis further expanded structuration theory to the notion of a structuration nexus–consisting of four key components of financial management, namely; structure, agency, hardware and software. The theory argues that in this case structure (rules and resources) similar to hardware are enacted through routine financial tasks necessary to shape human behaviour and organisational functioning. However, poorly coordinated routines were reported to exist and constantly enforced in system, especially in the case of Indawo. Agency within the nexus refers to individual actors and their actions to either reinforce such practices or transform them i.e. question, change and implement effective financial management. Health system concepts which refer to resources or equipment, such as IT / hardware elements were found to affect routines from being effectively carried out in both districts. While software, particularly communication including teamwork, motivation and personal development, was found to propel agency to deal with constraints, find solutions and shift some of the dysfunctional financial practices reported in Isikhala. Findings further revealed strategies for nurturing software, particularly informal learning through strategies such as delegation in Isikhala finance unit. However, while weaknesses and successes were noted in districts, they were inherently linked to the centralised level. Provincial participants provided insight into the rationale for centralisation of some financial functions. One of the primary reasons cited was the lack of district capacity and high levels of over expenditure in the province x making centralisation of some functions a perceived necessity. Although benefits of centralisation and expected gains were not realised as the central level itself was reported to have several weaknesses such as a loss of institutional memory (loss of skills in post-apartheid SA) or poor communication between units (software). Agency and system change at both levels were further compounded by political factors, post-apartheid restructuring and trade unionism which also affected routinised finance practices in both districts – poorly performing staff not being held accountable of political influences over vendor selection which increased financial costs. Conclusion and Recommendations: The country’s National Health Insurance (NHI) policy re-emphasises the importance of decentralisation and effective financial management. However, the NHI policy offers few recommendations or details around actually strengthening this core district function. This thesis offers a comprehensive account of district financial management and strategies for its improvement particularly linked to its adopted organisational perspectives and nurturing software factors (teamwork, communication, better relationships). The study moves beyond describing challenges associated with key financial routines, to offering a novel understanding in the SA context around why these practices exist and what are the factors necessary to transform practices which do not render effective financial management. Findings reveal that the four crucial elements of the structuration nexus (hardware, software, structure and agency) are particularly important in shaping financial management. It further argues and shows that these elements, if present, can contribute to organisational functioning within the health system, yet these elements are not necessarily considered during policy processes. Findings from the Isikhala finance unit points to specific practical strategies to nurture software in organisations - informal learning and delegation strategies linked to staff motivation and development. Lastly, financial management offered a lens to understanding decentralisation processes, specifically cognisant of its interlinkages and interdependent to functioning centralised levels and the complexities associated with contextual factors (history/ apartheid). Racial redress through key policies and legislation are undoubtedly important in addressing SA’s past injustices, however has further complicated the decentralisation process, compounded by the role of politics and trade unionism which also need consideration. In essence, this thesis has shown what elements are necessary and need to be nurtured not just for financial management but for health systems functioning. Key words: Decentralisation, District Financial Management, South AfricaLG201

The effect of market distress on mutual fund performance: international evidence

In this paper, we use a comprehensive sample of equity mutual funds from 34 countries around the world during the 1999-2015 period to study the impact of market distress on mutual fund performance. Our results show that in periods of market distress mutual funds perform worse in more competitive countries. This is because, in these countries, investors are more sophisticated and, therefore, react more to market downturns by heavily withdrawing their money. As a result, mutual fund managers are forced to rebalance their portfolios selling assets immediately, particularly those with higher risktaking positions, at distressed or “fire sale” prices and therefore experiencing severe losses. Coval and Stafford (2007) show that “fire sales” in mutual funds that experience large outflows lead to a negative stock price pressure. “Fire sales” are therefore expected to more greatly affect fund performance in countries with more active investors.Neste trabalho, usamos uma amostra abrangente de fundos mútuos de ações provenientes de 34 países do mundo durante o período de 1999 a 2015, de forma a estudar o impacto da instabilidade de mercado na performance dos fundos de investimento. Os nossos resultados mostram que, em períodos de instabilidade de mercado, os fundos de investimento apresentam um desempenho inferior nos países mais competitivos. Isto acontece porque, nestes países, os investidores são mais sofisticados e, portanto, reagem mais às recessões de mercado, retirando intensamente o seu dinheiro. Como resultado, os gestores dos fundos mútuos são forçados a reequilibrar os seus portfólios vendendo imediatamente os ativos, particularmente aqueles com posições de risco mais elevadas, a preços de venda menores (“distressed or fire sale prices”) e, portanto, sofrendo perdas severas. Coval e Stafford (2007) mostram que as “fire sales” em fundos mútuos que experimentam grandes fluxos de saída levam a uma pressão negativa nos preços das ações. Portanto, espera-se que as “fire sales” afetem mais o desempenho dos fundos nos países com investidores mais ativos

Paediatric clinical pharmacology in the UK

Paediatric clinical pharmacology is the scientific study of medicines in children and is a relatively new subspecialty in paediatrics in the UK. Training encompasses both the study of the effectiveness of drugs in children (clinical trials) and aspects of drug toxicity (pharmacovigilance). Ethical issues in relation to clinical trials and also studies of the pharmacokinetics and drug metabolism in children are crucial. Paediatric patients require formulations that young children in particular are able to take. The scientific evidence generated from clinical trials, pharmacokinetic studies and studies of drug toxicity all need to be applied in order to ensure that medicines are used rationally in children

Licensed medicines, off-label use or evidence based: which is most important?

Medicines are licensed for use in humans by regulatory authorities. The concept of licensing is that it helps ensure that medicines are safe, effective and of an adequate quality for regular use.1 Licensing was introduced due to concerns about safety not to ensure that medicines are effective. It was a response to specific examples of drug toxicity, notably the grey baby syndrome in neonates following the use of the antibiotic chloramphenicol and phocomelia in the developing fetus following ingestion of thalidomide by pregnant women.2 Within the UK, the Medicines Act was passed in 1968. The licensing of medicines is both a control on products of public interest as well as an authorisation to sell for pharmaceutical companies. Pharmaceutical companies are only allowed to promote licensed medicines. Prescribers, however, are free to prescribe the most appropriate medicine for their patient. This should be based on the best available scientific evidence. Medicines can be licensed (authorised) by either national regulatory agencies (national route) or the European Medicines Agenc