Limit-setting in publicly funded healthcare is unavoidable, and increasingly important in the governance and management of the demand for health services. The work of limit-setting takes place in the organising of the provision of health services, where various health workers (professionals, administrators, unit managers, politicians) collectively exercise their skills. Limit-setting often creates tensions which impose the quest for legitimacy; it involves norms and values which are related to the interests of the health workers, and moreover to society at large. In that sense, limit-setting is related to internal processes of legitimacy within the healthcare organisation, i.e. internal legitimacy, and external processes of legitimacy where citizens are legitimating the activities in the healthcare organisation, i.e. external legitimacy. The purpose of this thesis was to discover, and increase the understanding of the dilemma associated with sustaining, generating and designing internal legitimacy, when working with a policy of limit-setting in healthcare, in relation to the provision of Assistive Technologies (AT). It has explored what health workers do when they are working with a policy, and in particular how they work out what they should be doing. Finally the role of mediating institutions in supporting and designing internal legitimacy, was explored in the thesis. Following a case-study design and a qualitative approach, where fifty-seven semi-structured open-ended interviews were conducted, data allowed the exploration of internal legitimacy in a context of complex interaction and construction of policy work in two Swedish county councils. This research produced a number of key findings; in an environment of finite resources health workers encountered situations that were characterised by conflicting pressures, and handled these by way of interaction, sense making, presenting arguments, negotiating and seeking support for an appropriate course of action and practices. The policy work with limit-setting can therefore be regarded as a dynamic interactive process, which incorporates several actors in different situations and locations, together negotiating and institutionalising the policy. Various policy sites, which had the role of mediating institutions, were identified, and were important in the interactive processes of forming a shared collective meaning in order to reach an appropriate act. Hence, designing legitimacy has to acknowledge the interactive policy work, and its contextual character, taking place at the different levels of a healthcare system.

The thesis was designed to gain insight into how Alzheimer’s disease influences selfhood from first-personal accounts of illness. The focus of the study was narrowed further by concentrating on the autobiographies of individuals diagnosed with Early-Onset Alzheimer’s disease (EOAD). The purpose of this thesis was to analyze the autobiographies of individuals with EOAD with the aim of understanding their selfhood. In this thesis I argue that, Alzheimer’s disease may influence a change in self, however, the self is not lost entirely. This thesis draws on the philosophical conception of narrated self as it allows for one perpetually constructed self, whereby a change in self does not necessarily mean the self is lost entirely. Through an interpretive analysis of six autobiographical accounts of Alzheimer’s, this thesis demonstrates that Alzheimer’s disease influences a loss of sense of self but that autobiography enables individuals with Alzheimer’s to (re)construct self.

Since the change in the political dispensation in South Africa in 1994, South Africans are under increasing pressure to accept the new, changing order as a given. The institution where the research was carried out, the South African Secret Service (SASS), has also not escaped these changes and there have been various developments which indicate that some employees are not adjusting to these changes. The purpose of this research has been to determine to what extent a relationship exists between the presence or absence of certain psychological forces in individuals and the coping strategies which they use. The psychological forces were researched and analysed from the fortigenic paradigm, which is aimed at focusing on the origin of certain forces/strengths within man that are of cardinal importance for effective functioning. In the literature study the main focus was on aspects such as coping with change, after which the coping p cess and the various coping types and strategies were addressed. An important element of the literature study consisted of the profiles of copers and non-copers, which focused on the cognitive, emotional and conative fields/areas. Three different psychological approaches, namely pathogenesis, salutogenesis and fortigenesis were addressed, with emphasis on the latter. The fortigenic approach was analysed from the perspective of a number of forces, as identified by Strümpfer. A combination of a quantitative survey design and a qualitative research design (the phenomenological method) was used, with a sample population of 50 persons from the research environment within the SASS. In the research five qualitative measuring instruments (the Locus of Control Questionnaire of Scheepers, the Life Orientation Questionnaire of Antonovsky, the Personal Views Survey of Kobasa, the Self-Efficacy Questionnaire of Sherer & Maddux and the Self-Control Scale of Rosenbaum) and a qualitative instrument (the phenomenological interview) were used to determine the presence or absence of the fortigenic forces in the respondents. The measuring instruments were applied to the whole population, after which a stanine scale was used to identify persons with low and high scores according to the fortigenic construct. An interview based on the phenomenological approach was done with five persons with low and five with high scores. According to the results of the empirical study a statistically significant difference exists between the stanine scores of the five respondents with the highest scores and the five with the lowest scores and it is possible to subject these respondents to the qualitative measuring instrument. According to the qualitative measuring instrument (interview) there is a moderate to strong relationship between the strength of the employees' fortigenic forces and their ability to cope with organisational change. Three of the five employees with low stanine scores showed a strong resemblance to the profile of a non-coper, while two of the respondents showed a moderate resemblance. All five the respondents who achieved high stanine scores showed a strong resemblance to the profile of a coper. Recommendations are made for future study. / Thesis (MCom)--PU for CHE, 1999.

Denna studie, “Att leva ovetandes i det tysta”, är skriven av Elin Edman och Elina Hedin och handlar om personer som har varit medberoende. Medberoende är ett omdiskuterat begrepp inom vetenskapen, men har tidigare inte haft så stort fokus i samhället. Istället har fokus legat på exempelvis missbrukare eller psykiskt sjuka, men inte på deras anhöriga som också är drabbade. Syftet med denna studie är att ta reda på om insikten om att vara medberoende, kan få anhöriga att hantera sin livssituation och relationen till den beroende och/eller psykiskt sjuka annorlunda. För att ta reda på detta har fem livsberättelser hållits med personer över 18 år som har varit medberoende till någon med en beroendeproblematik inom alkohol eller narkotika, och/eller till en person med psykisk ohälsa. De två teorier som användes för att förklara resultatet är känslan av sammanhang samt copingteorin. Det resultat studien visade är att insikten om att vara medberoende fick alla informanter att hantera både sin livssituation och relationen med den beroende och/eller psykiskt sjuka annorlunda. Detta kunde bland annat ta sig till uttryck genom att man valde att bryta kontakten med den beroende och/eller psykiskt sjuka, för att förbättra livssituationen, eller ändra sitt eget beteende i syfte att hantera relationen bättre. / The present study entitled ”Living in silence without knowledge” presents and analyses the life stories by some persons living in close relations to relatives with drug abuse or mental disorder. The study is drafted by Elin Edman and Elina Hedin. Previously the main interest in society has been focused on the individuals suffering from mental disorders or being dependent on various substances. The particular social situation of co-dependence has in the past been dealt with in certain research studies but only recently become an issue of public discourse, lifting up the distress endured in silence by the e.g. family members and people around the addicts. The present study wanted to investigate whether if and how the understanding of the role of co-dependent facilitated the coping with and improvement of the existing situation. Five persons older than 18 years with experience of living close to an addict and/or mentally ill person were interviewed and asked to tell their life stories. In analyzing the information obtained the two theoretical perspectives of coping and the sense of coherence were taken into account. The present study shows that the participants of this study, by achieving an understanding of their acting as co-dependent and thereby their impact on the situation, made them change their behavior and relation both to the dependent and the social circumstances. In general the changes made, resulted in better life conditions for the whole social group and often real improvements for the victim of co-dependence.

BAGGRUND: Antibiotikaresistens udgørentrussel mod folkesundheden. Antibiotikabruger hoveddrivekraften bag resistensudviklingen.Restriktiv antibiotikabrugi overens-stemmelse med de gældende retningslinjerer derfornødvendig. Tarmfloraenpåvirkes af antibiotika oghar betydning for helbredet.Den salutogene teori er et veletableretkonceptindenfor Public Health. Oplevelse af sammenhæng (OAS)udgør et centralt koncept indenfor den salutogene teori, afspejler en persons syn på livet og kapacitet til at respondere på stressfyldte situationerog indeholder komponenterne begribelighed, håndterbarhed og meningsfuldhed.OASudgøret værdifuldt værktøj ved problemstillinger, hvor målet er ”compliant”adfærd.Det kunne tænkes,at hvis befolkningen og lægerne manglede OAS vedrestriktiv antibiotikabrug, kunne dette bidrage til at derescompliance til retningslinjerne, der anbefaler forsigtig antibiotikabrug ikke var optimal. FORMÅL: At formulere forslag til, hvordan forsigtig antibiotikabrug kunne fremmes ved at optimere OAS. Baggrundener litteratur, der belyser (i) befolkningens og lægernesholdninger overfor antibiotika og antibiotikaresistens i Norden og (ii) antibiotikas påvirkning af tarmfloraen og mulige helbredsmæssige konsekvenser.Det undersøges om der er grund til at ændre holdning overfor antibiotika,hvilke faktorerderfremmer og hæmmer forsigtig antibiotikabrug og hvordan OASkunne optimeres. METODE: Litteraturstudie efter struktureret litteratursøgning i PubMed og PsychINFO. RESULTATER: Antibiotika betragtes som noget beskyttende. Det kan ikke udelukkes, at antibiotika ved at påvirke tarmfloraen, kan have negative konsekvenser for helbredet.Viden, vaner og kommunikation har betydning for hvordan antibiotika bruges og hvorvidt forsigtig antibiotikabrug opleves begribelig og håndterbar.Læger kan ved ordination af antibiotika opleve en konflikt mellem patienten,der skal behandles bedst muligtog samfundet, hvor tiltagende antibiotikaresistens skal begrænses. Dette kan være én grund til at forsigtig antibiotikabrug ikke opleves meningsfuld. KONKLUSION: Forsigtig antibiotikabrug kunne fremmes ved atfremme velfungerende kommunikationog ved atbruge antibiotikas påvirkning af tarmfloraenog mulige helbredsmæssige konsekvenser som motivation. Hensigtsmæssige vaneri sammen-hæng med antibiotikabrug skal støttes og uhensigtsmæssige vaner om lægges. Her kunnelæger følges af en mikrobiolog for en dag / BACKGROUND:Drug resistance resulting from the overuse of antibiotics poses a threat to public health. Consequently, antibiotics must be used more cautiously.Intestinal flora is important to health and antibiotics can disrupt intestinal flora. Salutogenic theory is a well-established concept in public health. Sense of coherence (SOC), which is a key concept insalutogenic theory, reflects a person ́s lifeviewand capacity to respond to stressful situations, includes three components: comprehensibility, manageability and meaningfulness. SOC is a valuable tool for problems that target “compliant” behavior. Lack of SOC in both physicians and the general public may contribute to poor compliance to current guidelines that recommend restricting the use of antibiotics. AIM: The study aimed to formulate proposals for promoting the prudent use of antibiotics by optimizing SOCbased on literature that illustrates(i) the attitudes of the general public and doctors regarding antibiotics and antibiotic resistance in Scandinavia and (ii) the influence and possible health consequences of antibiotics on intestinal flora. It is discussed whether there are reasons for looking at antibiotics in a different way, which factors that facilitate or hinder prudent antibiotic use and how SOC could be optimized. METHODS: A literature study aftera structured search of the PubMed and Psych INFOdatabases. RESULTS: Although antibiotics are generally considered protective, their effect on intestinal flora may have adverse health consequences. Knowledge, habits and communication affect how antibiotics are used and whether prudent antibiotic use is experienced comprehensible and manageable. Doctors may experience conflict when prescribing antibiotics between treating the patient in the best possible manner and the need to limit such treatment to protect the community from increased resistance to antibiotics. Doctors ́wish to guarantee that their patients receive the best possible treatment might be one reason why they do not adhere to guidelines that recommend more restrictive use of antibiotics. Doctors do not consider the cautious use of antibiotics as meaningful. CONCLUSION: Careful antibiotic use could be promoted by using the influence of antibiotics on intestinal flora as motivational strategy;promoting effective communication and supporting appropriate and unlearn undesirable habits related to antibiotic use. A possible approach would be teaming physicians with a microbiologist for a day / <p>ISBN 978-91-982282-8-1</p>

Emerging adulthood, the period between 18 and 30 years of age, is particularly relevant for identity development. During this time, relational disconnections such as intimate partner violence (IPV) can inhibit the growth that occurs within interpersonal relationships. There has been little in-depth exploration of how emerging adult women describe the impacts of IPV on their sense of self. Using qualitative case study methodology, six young women shared their stories of IPV during open-ended narrative interviews and completed an exploration of their Possible Selves. Thematic analysis identified impacts of IPV relating to participants’ sense of self, future possible selves, and subsequent intimate relationships. The findings highlight participants’ self-descriptions of strength and resilience, as well as accounts of challenges and growth since the relationships ended. The findings have meaningful implications for theory and research on IPV for young women, and for counselling practice. / Graduate / kateborsato@gmail.com

The public’s views on what constitute appropriate reactions to crime, have come to assume an increasingly central position in the crime policy rhetoric of western countries. In Sweden this manifests itself in recurrent referrals to the public’s sense of justice. Any clear definitions of what the public’s sense of justice is, how it is expressed and how it can be read are however absent from these referrals. In this thesis the use of referrals to the public’s sense of justice as a legitimizing ground for penal legislation is problematized from an empirical perspective. Paper I points out the substantial variation found in the public’s view on what constitutes appropriate sentences. According to Paper II society’s reactions to crime are expected to fulfill different, and often contradictory, objectives simultaneously. Paper III also points to the assumption that views on what constitutes appropriate sentences are based on deliberations where different dimensions of society’s reaction are weighed against each other. The public’s sense of justice, thus, consists of diverse, variable and complex opinions. Referrals to it as a legitimizing ground for changes in penal legislation becomes a matter of choice between whose and which opinion it is that should be emphasized. For this choice to be perceived as legitimate it should not be made without at the same time motivating it. If crime policy is to be both knowledge-based and fitted to the public’s sense of justice the public must be given the opportunity to develop an informed and well-grounded sense of justice. Especially since, compared to other political matters, crime policy and its consequences are something that only a small portion of the public comes into direct contact with. The suggestion is that the public criminal policy debate is framed so that it matches the complexity of the public’s sense of justice itself. / <p>At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 2: Accepted. Paper 3: Accepted.</p>

In this thesis I scavenge the history of philosophy for answers to the question ‘How are claims to knowledge justified?’. I argue that Plato’s psychological doctrine of knowledge marks the starting point of a philosophical inquiry motivated by the possibility to discover foundations of knowledge through investigating the nature of mind. At the core of this inquiry lies the hypothesis that if the psychological mechanisms that govern the capacity for knowledge acquisition is fully understood, then answers will follow about why judgements are true or false. The prospective result of the inquiry is a theory of universal epistemic justification which demarcates epistemically warranted beliefs from unwarranted beliefs. I suggest that there is a historically persistent case of cognitive dissonance within the epistemological enterprise — a tension between two of its central theses — which is caused by the persistence of the of the hitherto unsuccessful but ongoing quest for universal epistemic justification, and its inciting promises. The contradicting theses are those of certain justification (that one is justified in believing that p only if p is entailed by evidence) and proportional justification (that one is proportionally justified in believing that p to the extent that evidence makes p credible). I discuss the consequences of giving up one of the respective theses. I conclude that the thesis of certain justification cannot be given up unless an adequate theory of proportional justification is proposed, and that the legacy of searching for universal epistemic justification will continue unless epistemologists are able to construct one.

This thesis examines the everyday experiences of Anglophone communities in three different regions of Quebec – the Gaspésie, Gatineau and Eastern Townships – with the aim to understand their sense of place. Specifically, the focus is on the role of different geographic contexts on everyday access to social services, particularly healthcare, and how these experiences contribute to Anglophones’ place attachment. Data collection involved semi-structured personal interviews with ten participants in each region. Comparative analysis yielded three main findings: (1) issues with accessing healthcare in English reinforces Anglophones’ minority status; (2) in spite of the challenges faced as a linguistic minority, Anglophones demonstrate a strong sense of place to their region; and (3) feelings of home, heritage, and rootedness constitute elements in Anglophones’ place attachment and contribute to their sense of place in Quebec. The study also concludes that age, mobility, and location are important variables in influencing everyday experiences in each of the three regions.

This research explores feelings of obligation to volunteer, which lie at the interface of volunteering as simultaneously individual and collective and challenge traditional understandings of volunteering as leisure. The study examined volunteering within the context of communitarianism, particularly how collective outcomes of volunteering are related to feelings of obligation to volunteer. Phase one of this research focused on scale creation of a measure assessing feelings of obligation in the context of volunteerism. Using exploratory factor analyses of data from a student sample, this first phase yielded two measures: an 18-item Obligation to Volunteer as Commitment measure (OVC), encompassing dimensions of reward, affective attachment, flexibility, and side bets; and a 14-item Obligation to Volunteer as Duty measure (OVD), encompassing the dimensions of expectation, burden, and constraint. In phase two, survey research was conducted with 300 volunteers at ten community organizations. These new measures were used to examine relationships between obligation to volunteer and the value orientations of individualism and collectivism, the experience of volunteering as serious leisure, and the community characteristics of sense of community and social cohesion. Both individualism and collectivism were associated with the commitment but not the duty dimension of feelings of obligation, and both value orientations, but particularly individualism, was linked to serious leisure. Serious leisure very closely aligned with the commitment aspect of obligation as well as sense of community and social cohesion, thus emerging as a possible pathway for nurturing sense of community in a culture of individualism. Correlation and hierarchical regression analyses link the commitment aspect of obligation to sense of community and social cohesion. Feelings of duty to volunteer, in contrast, were inversely related to sense of community. Thus, the nature of feelings of obligation related to volunteering as commitment or duty have significant implications for the collective outcomes of volunteering, particularly sense of community. Also notable are the strong theoretical and empirical relationships between the OVC scale and serious leisure, which suggest that the newly-developed commitment scale could be considered a measure of the agreeable obligation that accompanies serious leisure pursuits.