This master thesis looks at the use of business capabilities within enterprisearchitecture, and investigates how the concept is used within the Swedish pension managingcompany Folksam. Based on interviews with stakeholders an enterprise architecture metamodelcentred on the business capability is constructed. The meta-model is then edited andrevised according to a questionnaire aimed at removing irrelevant elements, and a secondset of interviews discussing a capability's health status and well being. This second set ofinterviews resulted in the removal of elements not aecting the well being of a capability.The nal meta-model has the business capability and the capability health status at itscore. It consists of the Capability element, with two attributes, surrounded by nine otherelements connected by eleven relations in total. / Detta examensarbete undersoker hur verksamhetsformagor anvandsinom enterprisearkitektur, och vidare hur formage-konceptet anvands pa det svenska pensionsforetaget Folksam. Baserat pa intervjuer med intressenter skapas en metamodell medverksamhetsformagan i centrum. Metamodellen revideras och andras sedan enligt ett frageformular vars mal var att ta bort ej relevanta element, och enligt en andra omgang intervjuerdar en formagas halsa diskuteras. Denna andra omgang intervjuer resulterade i att elementsom inte paverkade formagans halsa togs bort. Den slutgiltiga metamodellen har verksamhetsformagan och dess halsostatus i fokus. Den bestar av formage-elementet, med tvaattribut, omgardat av nio andra element som binds ihop av totalt elva olika relationer.

Little is known about the healthcare experiences of lesbian, gay, and bisexual (LGB) young adults (ages 18-24) and even less is known about LGB college students (ages 18-24). Helping LGB college students effectively access appropriate, sensitive healthcare has the potential to reduce negative long-term health consequences. Therefore, the purpose of this study was to describe the healthcare experiences of LGB college students (ages 18-24) in the local college community using community-based participatory research (CBPR). Three online synchronous focus groups and one online individual interview were conducted with 19 LGB college students between January and February 2011. The focus groups were segmented into lesbian (n= 7), gay (n= 7), and female bisexual (n = 4) groups. One male bisexual was interviewed individually. The mean age of the sample was 20.7 years (SD = 1.2, range = 19-24). The sample was predominately White non-Hispanic (85%). Qualitative content analysis was used to describe the healthcare experiences of lesbian, gay, and bisexual college students in the local community. One overarching theme (not all the same), one main theme (comfort during the clinical encounter), three sub themes (personalizing the clinical encounter, deciding to disclose and social stigma, and seeking support of self-identified sexual orientation) and one preliminary sub theme (perceived confidentiality) emerged from the analysis. One major action emerged from the analysis and supported the development of the social network site (on Facebook) entitled: College Alliance Towards Community Health (CATCH). The mission of CATCH is to provide LGB college students in the local community with a comfortable forum to learn about various healthcare concerns of lesbian, gay, and bisexual college students. Additional implications for nursing practice and implications for further research in the LGB college community are addressed.

Background: Previous research states that chronic widespread pain (CWP) has a negative impact on health status and daily life activities. Risk factors for developing CWP are, e.g. female sex, other chronic diseases, smoking, inactivity, sleeping problems and obesity. The average prevalence of CWP is 9.6-15% in the general population. The results vary regarding sex differences in prevalence, pain experience, impact on daily life, work, and health status. Therefore, the overall aim was to investigate CWP’s impact on health status and long-term lifestyle predictors for better health when having CWP. Method: The study is a general population cohort study including 975 participants (442 men, 533 women) at the age of 35-54 years with a 12- and 21-year follow-up. CWP was defined according to the American College of Rheumatology’s (ACR) definition stating pain must be present for at least three months, below and above the waist, on both sides of the body, and the axial skeleton to be classified as widespread. Using a pain mannequin and additional questions the individuals were sorted in three different pain groups: no chronic pain (NCP), chronic regional pain (CRP), and CWP. The questionnaire included questions about lifestyles factors (personal support, friendship circuit, smoking, alcohol intake, physical activity and sleeping habits) and SF-36 measuring health status. Differences in health status were analysed by independent samples t-test and health predictors by logistic regression analysis. The results were further analysed using Tengland’s two-dimensional health theory and the relational gender theory. Results: The prevalence of CWP was higher among women during all time points, but health status was statistically significant reduced for both women and men with CWP (p <0.001) showing no sex differences of clinical relevance. At the 12-year follow-up, 58% of the women and 53% of the men had persistent CWP (p <0.001). At the 21-year follow-up, 59% of the women and 29% of the men had persistent CWP (p <0.001). Health predictors for better health when having persistent CWP were male sex (OR 3.03-6.76), having social support (OR 9.27), no sleeping problems (OR 3.48-4.76), being a former smoker (OR 4.38-7.83) and a weekly intake of alcohol (OR 4.94). Conclusion: More women reported persistent CWP in a 12- and 21-year perspective than men, but when having CWP the health status was equally as bad among women and men. Modifiable health factors such as having no sleeping problems was strongly associated with better mental health, and personal support could be of importance for a better vitality. The higher prevalence reported among women and male sex as a health predictor seems to be influenced by the psychosocial mechanisms of gender. However, health status did not show any association with the relational gender theory. The results suggests, even though men have less prevalence of CWP the condition should be regarded as having the same impact for women and men in health care. Further research should continue studying persistent CWP and possible confounders to establish the sex and gender differences in the long-term perspective. / Bakgrund: Tidigare forskning visar att långvarig generell smärta (CWP) har en negativ påverkan på hälsostatus och dagliga aktiviteter. Riskfaktorer för att utveckla CWP är t.ex. kvinnligt kön, andra kroniska sjukdomar, rökning, inaktivitet, sömnproblem och övervikt. Den genomsnittliga prevalensen av CWP i den allmänna befolkningen är 9,6–15 %. Resultat på könsskillnader varierar gällande prevalens, upplevelse av smärta, påverkan på det dagliga livet, arbetslivet samt hälsostatus. Det övergripande syftet var därför att undersöka CWP:s påverkan på hälsostatus samt långsiktiga livsstilsfaktorer för en bättre hälsa för dem med CWP. Metod: Studien är en befolkningskohort med 975 deltagare (442 män, 533 kvinnor) i åldern 35–54 år med en 12- och 21-års uppföljning. CWP definierades enligt American College of Rheumatology (ACR) definition som säger att smärta ska vara närvarande i minst tre månader, under och över midjan, på båda sidorna av kroppen samt axialskelettet för att klassificeras som generell. Med hjälp av en ritad smärtfigur och ytterligare frågor sorterades deltagarna in i tre olika smärtgrupper: ingen långvarig smärta (NCP), långvarig regional smärta (CRP) och CWP. Frågeformuläret bestod av frågor om livsstilsfaktorer (personligt stöd, vänskapskrets, rökning, alkoholintag, fysisk aktivitet samt sovvanor) och SF-36 som mäter hälsostatus. Skillnader i hälsostatus analyserades genom ett oberoende t-test och hälsoprediktorer genom logistisk regressionsanalys. Resultatet analyserades ytterligare utifrån Tenglands två-dimensionella hälsoteori och den relativa genusteorin. Resultat: Prevalensen av CWP var högre bland kvinnor vid samtliga tidpunkter och hälsostatus var statistiskt signifikant lägre för både kvinnor och män med CWP (p < 0.001). Det fanns inga könsskillnader av klinisk relevans. Vid 12 års uppföljningen hade 58 % av kvinnorna och 53 % av männen långvarig CWP (p < 0.001). Vid 21 års uppföljningen hade 59 % av kvinnorna och 29 % av männen långvarig CWP (p < 0.001). Hälsoprediktorer för bättre hälsostatus för CWP-drabbade var manligt kön (OR 3,03–6,76), socialt stöd (OR 9,27), inga sömnproblem (3,48–4,76), före detta rökare (4,38–7,83) och att varje vecka dricka alkohol (OR 4,94). Slutsats: Fler kvinnor än män rapporterade långvarig CWP i ett 12- och 21-års perspektiv, men bland de som hade CWP var hälsostatusen lika dålig hos kvinnor och män. Att inte ha några sömnproblem var starkt förknippat med en bättre mental hälsa och personligt stöd kan vara av betydelse för en bättre vitalitet. Den högre prevalensen bland kvinnor samt manligt kön som hälsoprediktor verkar vara påverkade av de psykosociala mekanismerna för genus. Hälsostatus visade emellertid inte någon koppling till den relativa genusteorin. Resultet innebär att även om män har en lägre prevalens av CWP bör tillståndet betraktas detsamma för män som hos kvinnor i vården. Vidare forskning bör studera långvarig CWP och möjliga confounders för att faststlå köns- och genusskillnader i ett långsiktigt perspektiv.

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This study aimed to investigate associations between psychosocial factors, obesity, and oral health in a study population of 10- to 18-year-old adolescents who participated in the LIFE Child study. Psychosocial information (socioeconomic status (SES) based on parents’ education, occupation and household income, Strengths and Difficulties Questionnaire (SDQ), health-related quality of life) and physical activity behavior were obtained. Nutritional status was classified based on age- and sex-adjusted body mass index into underweight, overweight, normal weight and obese. Clinical dental examinations were performed and scored with respect to caries experience (CE), oral hygiene (OH), and periodontal status (periodontal health score: PERIO-S). Age-adjusted regression analysis under the assumption of a double Poisson distribution was performed with and without adjusting for SES (α = 5%). A total of 1158 study participants (590 girls, 568 boys; mean age 13.2 ± 2.3 years) were included (17.2% were classified as obese). CE was 20% higher for moderate and 60% higher for low SES compared to high SES (p < 0.05). PERIO-S was 10% higher for moderate and 30% higher for low compared to high SES (p < 0.05). Poor OH was associated with higher CE (Ratio R = 2.3, p < 0.0001) and PERIO-S (R = 3.1, p < 0.0001). Physical activity in a sports club was associated with lower CE-S and PERIO-S (R = 0.85, p < 0.001). Obesity was associated with increased CE (R = 1.3, p < 0.001) compared to normal weight. For low but not high SES, more reported difficulties were associated with higher CE. In conclusion, low SES, poor OH, and obesity are associated with unfavorable oral health conditions, whereas physical activity and high SES are potentially protective.

The purpose of this research was to evaluate the causal relationships between job strain, the practice environment and the use of coping skills in order to assist in the prediction of nurses who are at risk for voluntary turnover. It was conducted at the level of the individual nurse employee in order to better understand the health consequences associated with job strain, the factors in the professional practice environment which may contribute to the propensity to leave and the influence of coping behaviors in response to workplace stressors. It was undertaken with the intention of identifying intervention strategies which will promote a healthy workforce and the retention of nurses in the workplace. An exploratory cross-sectional survey of 1235 staff nurses employed on the intensive, progressive and general medical-surgical nursing units of seven hospitals associated with a major Central Florida healthcare network tested a client-centered model in an effort to identify nurses vulnerable to the health consequences of job strain using structural equation modeling. Human subject protection was assured. An 82 item questionnaire was used to collect demographic data and measure responses to items associated with the constructs of health status, autonomy, collaboration, decentralization, coping, satisfaction, absenteeism and intent to leave. A variety instruments that were previously demonstrated as valid and reliable were used in the construction of the instrument. Subjects were also given the option of including additional written comments. A total of 325 surveys were returned, of which 308 met inclusion criteria, for a response rate of 25%. Data analysis determined that the measurement of job strain as a function of self-assessed generic health status was predictive of propensity to leave (ã = -.21). The experience of job strain shared a strong association with indicators of mental health status. Job strain was significantly influenced by coping behavior (ã = .56) which targeted activities associated with sustaining and balancing. Anecdotal remarks suggested that the need for balance influenced perceptions regarding stressors in the workplace. The professional practice environment was associated negatively with the propensity to leave (ã = -.58). Those staff nurses who experienced higher levels of autonomy expressed a greater degree of satisfaction and lower intent to leave. The variables of collaboration and decentralization contributed minimally to the construct of professional practice. Anecdotal remarks suggested that the low contribution of collaboration and decentralization contributed to a sense of powerlessness and frustration with work related circumstances. The influence of job strain, coping and the professional practice environment upon staff nurses suggests that health promotion strategies, efforts to enhance coping behavior and promotion of a professional practice environment will increase employee satisfaction and reduce intent to leave. Adoption of policies and procedures which support the health and well-being of individual staff members will benefit employees, strengthen the organizations in which they practice and promote the overall retention of nurses in the face of looming nurse shortages.

In 2019, diabetes affected approximately 283,000 individuals, aged 20 years or younger, in the U.S. Due to illness symptoms (e.g., hypo/hyperglycemia) and disease-related complications (e.g., nephropathy), individuals report poor health-related quality of life. However, individual-level, family-oriented, and health care system factors may affect perceptions of a child’s overall health status. For example, beliefs of having spent enough time with the doctor may predict proactive health behaviors and perceptions of health. Overall health status may also be indirectly related to time spent in medical conversations. For instance, perceptions of shared decision-making (e.g., exploring pros and cons of treatments together) between families and providers may, in turn, foster family empowerment and resiliency (i.e., ability to adapt, cope, and overcome challenges) in the context of caring for a child with a chronic illness, with positive implications for perceived health status of their child. This study aims to examine the relationships of these variables. At the bivariate level, it was hypothesized that time spent in visits, shared decision making, family resilience, and perceived health status of the child would all be positively related. At the multivariate level, it was hypothesized that doctors working collaboratively with parents and family resilience would serially mediate the relation between time spent in medical visits and perceived health, such that more time spent with the doctor would be associated with perception of collaborative decision making and, in turn, higher levels of resiliency and better overall health status from parents’ perspectives. Utilizing data from the National Survey of Child and Adolescent Health from 2020-2021, this study examined survey responses from 369 parents of children with a reported diabetes diagnosis. Responses were extracted from a larger survey for questions related to time spent with providers in prevention focused visits, collaborative decision-making, family resilience, and health status of the child. Bivariate correlations and serial mediation analyses, per Hayes (2013), were conducted, covarying age, sex, ethnicity of child, health insurance, family structure, income, and education level of parents. Bivariate analyses showed some variables were significantly related in hypothesized directions (p < .05). In serial mediation analyses (10,000 bootstrapped samples), the total effect of time spent with the doctor on overall health status was nonsignificant (t = 0.7767, p = 0.4383), and the direct effect was also nonsignificant when mediators (i.e., collaborative decision making, family resilience) were added (t = 0.805 CI= -0.0044, 0.0122), indicating no serial mediation. Controlling for the effects of the other mediator, a significant indirect effect was found through collaborative decision making (t= 1.9181 CI = 0.0015-0.0940) but not family resilience (t = 0.9565 CI=-0.0059-0.478). This study demonstrates that collaborative decision making with parents mediates the relationship between time spent in preventative health care visits and overall health status. Changes such as policies that incentivize quality of care rather than number of billable visits, or establishment of patient centered medical homes, could support appointments of sufficient length that would allow for collaboration and, in turn, better perceived health status for those affected by diabetes.

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