The incidence of adverse birth outcomes, such as low birth weight and preterm births, has steadily risen in recent years in Canada. Despite the fact that numerous individual and neighbourhood risk factors for low birth weight and preterm births have been identified and various person-oriented intervention strategies have been implemented, uncertainties still exist concerning the role that place and space play in determining adverse birth outcomes. In order to succeed in producing community-oriented health policy and planning guidelines to reduce both the occurrence and inequalities of adverse birth outcomes, the research presented in this thesis provides an approach to examining the pathways of various socio-economic, environmental, and psycho-social risks to LBW and preterm births. Using a modified multilevel binary-outcome mediational analysis method, case studies are conducted within three public health units in Ontario, namely the Wellington-Dufferin-Guelph Health Unit, the Windsor-Essex County Health Unit, and the Halton Region Health Unit. Different pathways are investigated given the available data and the theoretical assumptions of three health inequality pathway models, namely the behavioural model, the psycho-social model, and the materialist model, and the geographical and planning perspectives of health inequalities. A local spatial analysis process is also used to identify spatial clusters of incidence and to assess possible associated reasons in order to support public health polices and planning in community-oriented health interventions. Using Bayesian spatial hierarchical analysis and spatial clustering analysis, local clustering of high risks of adverse birth outcomes and spatial variations of associated individual risks within the study areas are identified. The analysis is framed around five hypotheses that examine personal vs. spatial, compositional vs. contextual, psycho-social vs. material, personal vs. cultural, and global vs. local effects on the determinants of adverse birth outcomes. The results of testing these hypotheses provide evidence to assist with multi-component multi-level community-oriented interventions. Possible improvements of current prenatal care policies and programs to reduce the spatial and social inequalities of adverse birth outcomes are suggested. Potential improvements, including early stage prenatal health education, local healthy food provision, and cross-sector interventions such as the combination of social mixing strategies with bottom-up community-based health promotion programs, are also suggested.

Workplace bullying is recognised as a major psychosocial stressor in various professions and can have severe effects on health. Teachers are distinguished as an occupational group that is severely affected by this phenomenon. The general objectives of this research study were to firstly investigate teachers’ experiences of workplace bullying and its effects on health, and secondly, to develop a multi-level intervention programme that can be implemented to address workplace bullying and its effects on health in this context. This research study was conducted in two phases. The biopsychosocial model was applied as a theoretical foundation in the first phase. Participants were sampled by means of informative and educational articles that were placed online and in printed media. Selection criteria were applied to sample a group that was representative of victims of workplace bullying. Ultimately, twenty-seven teachers were included in this study. A qualitative, phenomenological research design was used to explore teachers’ experiences of workplace bullying and its effects on health. Data was specifically gathered by means of semi-structured interviews and personal documents. Semi-structured interviews were audio-recorded and data was transcribed verbatim. Methods of Interpretative Phenomenological Analysis were applied to analyse and present the data. Findings were supported with verbatim quotes and a literature control. Teachers’ reports indicated that workplace bullying is mostly perpetrated by principals and that colleagues are often also involved in the process. Bullying behaviours were aimed at attacking the character, as well as the work of teachers. Organisational channels were often exploited to bully teachers. Certain behaviours were an infringement of teachers’ human and labour rights. Findings are also analogous to the theory and dynamics that is depicted by the biopsychosocial model. Escalating stress and trauma were reflected in teachers’ physical, psychological and social health. The experience of workplace bullying firstly impacted on their psychological health, which was also accompanied by various physical health problems. Major depressive episodes and/ or symptoms of depression were mostly reported. Some teachers also reported symptoms of posttraumatic stress disorder, complex-posttraumatic stress disorder, and panic attacks. Teachers’ ill-health experiences further negatively impacted on their social and professional relationships. The school organisation is affected. The result is teachers with a lost passion for the profession, lowered work performance, increased absenteeism, and teachers’ intention to leave the profession. Findings finally indicated that certain personal and organisational characteristics facilitate and sustain workplace bullying. Relevant literature, field notes during the research process and findings in the first phase of this study guided the development of a multi-level intervention programme for the South African teaching profession. Strategic intervention activities were suggested to address some of the causes, as well as the physical, psychological and social health effects of workplace bullying. A strategic and methodological approach to multi-level intervention was also developed and proposed. Strategic intervention activities were ultimately suggested for the professional, social/ community, individual/ familial, dyadic, organisational, managerial, and work group level. / Thesis (PhD (Educational Psychology))--North-West University, Potchefstroom Campus, 2013

Workplace bullying is recognised as a major psychosocial stressor in various professions and can have severe effects on health. Teachers are distinguished as an occupational group that is severely affected by this phenomenon. The general objectives of this research study were to firstly investigate teachers’ experiences of workplace bullying and its effects on health, and secondly, to develop a multi-level intervention programme that can be implemented to address workplace bullying and its effects on health in this context. This research study was conducted in two phases. The biopsychosocial model was applied as a theoretical foundation in the first phase. Participants were sampled by means of informative and educational articles that were placed online and in printed media. Selection criteria were applied to sample a group that was representative of victims of workplace bullying. Ultimately, twenty-seven teachers were included in this study. A qualitative, phenomenological research design was used to explore teachers’ experiences of workplace bullying and its effects on health. Data was specifically gathered by means of semi-structured interviews and personal documents. Semi-structured interviews were audio-recorded and data was transcribed verbatim. Methods of Interpretative Phenomenological Analysis were applied to analyse and present the data. Findings were supported with verbatim quotes and a literature control. Teachers’ reports indicated that workplace bullying is mostly perpetrated by principals and that colleagues are often also involved in the process. Bullying behaviours were aimed at attacking the character, as well as the work of teachers. Organisational channels were often exploited to bully teachers. Certain behaviours were an infringement of teachers’ human and labour rights. Findings are also analogous to the theory and dynamics that is depicted by the biopsychosocial model. Escalating stress and trauma were reflected in teachers’ physical, psychological and social health. The experience of workplace bullying firstly impacted on their psychological health, which was also accompanied by various physical health problems. Major depressive episodes and/ or symptoms of depression were mostly reported. Some teachers also reported symptoms of posttraumatic stress disorder, complex-posttraumatic stress disorder, and panic attacks. Teachers’ ill-health experiences further negatively impacted on their social and professional relationships. The school organisation is affected. The result is teachers with a lost passion for the profession, lowered work performance, increased absenteeism, and teachers’ intention to leave the profession. Findings finally indicated that certain personal and organisational characteristics facilitate and sustain workplace bullying. Relevant literature, field notes during the research process and findings in the first phase of this study guided the development of a multi-level intervention programme for the South African teaching profession. Strategic intervention activities were suggested to address some of the causes, as well as the physical, psychological and social health effects of workplace bullying. A strategic and methodological approach to multi-level intervention was also developed and proposed. Strategic intervention activities were ultimately suggested for the professional, social/ community, individual/ familial, dyadic, organisational, managerial, and work group level. / Thesis (PhD (Educational Psychology))--North-West University, Potchefstroom Campus, 2013

The purpose of this qualitative study is to describe how child and youth care practitioners experience their engagement in community level interventions. Five child and youth care practitioners, who identified themselves as engaging in community level interventions in their work, were interviewed and data were analysed using a combined narrative and thematic approach. Eight themes emerged from the data that describe participants’ experience with community, community change and community level interventions. Results show how community level interventions have a tendency to target the micro, meso and occasionally exo, rather than macro, levels of communities. Thus, multi-level interventions are recommended as a way to shift child and youth care practice from an emphasis on interventions with individuals, towards greater emphasis on interventions that are aimed at the multiple levels of the child and youth’s ecological system. The study identifies implications for post-secondary curriculum, professional practice, agency mandates and job descriptions. / Graduate

Universiẗat, Diss.--Mannheim, 2007.

In order to understand the role of discourse in a system of multi-level governance, this thesis performs a case study of Sweden’s response to the 2015-2016 refugee crisis. Initially praised as the European country who accepted the highest number of asylum applications per capita, by the end of 2015 Sweden had limited its asylum policy to the minimum levels under EU law. The abrupt policy change coincided with the emergence of two primary refugee discourses among media and politicians: a solidarity-oriented discourse and a problem-oriented discourse. While both discourses are visible at each level of governance, the national government expressed a commitment to solidarity through its humanitarian ideology while the local municipalities often described the challenges of accommodating the refugees as problematic. To analyze the impact of contrasting discourses at multiple levels of governance, a critical discourse analysis is conducted of news media in Sweden at the national level and the local level and discussed with reference to the theory of postcolonialism. The discourse analysis is then compared to the major changes to refugee policy at the national level and refugee reception at the local level. The results indicate a strong relationship between refugee policy/reception and media discourse at each level of governance, but a much weaker relationship between the levels of governance. This research provides new insight into the theory of multi-level governance and migration studies through its comparison of refugee governance at multiple levels.

This thesis is about the reasons for an involvement in the European Union. The thesis addresses this topic using the case of Region Jönköping County (RJL) and their involvement in the European Union. The method is content analysis to explore if the activity by RJL can be explained by the theories Europeanization and Multi-level governance using documentation from the region. Based on this, one should be able to answer the purpose of this study. The documentation under review is the 2013 Regional Development Strategy, which is valid until 2025, the Regional budget and the Operational plan for 2018, as well as the Multiannual plans for 2019-2010. Based on these theories, several specific issues were addressed that all addressed the Europeanization Upload-, Download- and Crossload-dimension, as well as the Resource Push and Pull factors were represented. These issues were later used in the examination of the documentation to answer the issues and the purpose of the study. A conclusion or conclusions of the study are concluded that there are some connections between the regional documentation and the theories used in this study. Which makes it possible to start drawing conclusions about the more general issues. The conclusions drawn in this thesis will be that the connections seen between the regional documentation and the theories. This means that the theories can explain what lies behind the involvement to the European Union. These theories and what they represent can also put words and underlying understanding into what lies behind and why we see some action from Region Jönköping County. This can also explain how theories can help us understand similar cases like this region.

How do organizations assess and explain their performance? Prior studies have attempted to demonstrate that, like individuals, organizations take credit for good performance and blame poor performance on influences in their environment. However, these studies have found only a weak relationship between performance and attribution at the level of the firm. This dissertation seeks to elucidate this relationship by conceptualizing firms as social agents and by combining aspiration and attribution theory for the first time at the level of the firm. Analysis of performance explanations by large, public manufacturing firms in 2004 and 2005 revealed that firms' performance explanations correlated with their cognitive experiences of success and failure. These findings further understanding of organizational cognition, attribution, and image management.

This study addresses the problems that arise when there are many newly arrived immigrants to Sweden in a short period of time and it becomes important to be quickly sealed into Swedish society by means of various establishment initiatives.This essay investigates local integration in Three Swedish municipality's by conducting Case studies. The purpose is to find factors that affect new immigrants' opportunities for work and self-sufficiency among the municipalities with high employment rates for newly arrived immigrants. Factors refer to implementation, governance, cooperation, labor market and integration efforts.To find out, the study has identified how integrations policy are implemented and what factors that can make a difference for immigrants' opportunities for work and self- sufficiency. The material that the study uses is derived from semi-structured inter views conducted with key people with extensive knowledge of the municipality's integration work and the method used for analysis is process- tracing. The conclusion is that possible factors that can affect are interaction between all actors involved in integration and a good labor market. / <p>2018-06-07.</p>

Rheumatoid Arthritis (RA) is a chronic auto-immune disease that causes in ammation in the joints. Left uncontrolled, this prolonged in ammation can lead to pain and structural damage, resulting in erosions to the bones and total breakdown of the surrounding cartilage. Structural joint damage, measured by plain radiographs, is an important outcome measure of RA. It provides an objective marker of disease activity to assess any improvements or failures of treatments in controlling for the disease. Increased long-term joint damage has been linked with increased functional disability and decreased quality of life for RA patients. While a range of studies have looked at radiographic outcomes from observational data, they tend to be restricted to historical cohorts, with little long-term data on how radiographic progression may have changed in line with changes in clinical management. Additionally, these studies have not used the appropriate statistical methods to account for non-normal data distributions and within-patient variation over time. As a result, the main aim of this thesis is to investigate the long-term progression of structural joint damage in patients with early RA. The speci c objectives were to; (1) investigate the current evidence base to identify common methods in measuring and analysing radiographic outcomes, (2) assess what statistical methods are most appropriate in modelling long-term radiographic data, (3) use these models to understand the natural progression of radiographic damage using data from two UK inception cohorts, and nally, (4) expand these models to investigate the long-term relationship of radiographic damage with two important clinical outcomes; disease activity and functional disability. The analysis is based on longitudinal data from two UK prospective, multi-centre, early RA observational cohorts. These cohorts represent two distinct eras in the management and treatment of RA, making them invaluable for investigating how key RA outcomes have progressed in clinical practice over time. Using multi-level count models, precise rates of radiographic progression for both cohorts are presented. The models look at how seropositive RA and increased disease activity are related to increased radiographic progression, and what impact this has on functional disability. The results show that rates of radiological damage have declined dramatically in recent years. Possible attributable factors to these declines include both milder disease and more e ective treatment strategies. Analysis of the earlier cohort (1986-2001) shows how seropositive RA and increased disease activity lead to clinically meaningful increases in radiological damage. Conversely, their impact on patients in the more recent cohort (2002-2011) suggest that their e ect on radiographic progression is reduced, where increases in radiological damage were not larger than clinically meaningful thresholds. This has large implications on the debate around the use of biologic therapies in patients with less severe RA. However more data is sorely needed, particularly long-term radiographic data from those patients on biologics treatments, before any de nitive conclusions can be made. The possible impact of these declines on functional disability appears to be relatively small. The analysis shows that radiographic damage is more strongly associated with functional disability in later disease, but there is little evidence to indicate that declines in radiographic damage has lead to large improvements in long-term functional disability. These ndings are explored within the framework of a dual-pathway model, which suggests that functional disability is caused by two distinct mechanisms, either structural joint damage, or through increased pain. Research so far has predominantly focused on pharmacological treatments in reducing in ammation. More research is needed to explore the role of psychosocial factors and pain perception in order to create a more holistic treatment programme for RA patients.