Asthma is a complex, chronic disorder of the airways that is characterized by underlying inflammation, airflow obstruction, and bronchial hyperresponsiveness. Asthma symptoms can be frightening and can have an effect on the emotional functioning Quality of Life (QOL) of school-aged children who have asthma. The purpose of this exploratory, descriptive, cross-sectional, correlational study was to explore the influence of factors identified in the literature on school-aged children’s emotional responses to asthma. Guiding this study was a theoretical model that proposed that the impact of chronic illness severity on QOL is potentially mediated by both resource and barrier factors. The population of interest was 85 school-aged children (ages 6-12) and parents of children who have asthma that were recruited from participants already enrolled in year 4 of the Asthma in Central Texas (ACT) study (R01NR007770, Sharon D. Horner, P.I.) at The University of Texas at Austin. Significant inverse correlations were found between asthma related child emotional functioning QOL and each of the following variables: asthma severity, r = -.30, p < .01; child internalizing behaviors, r = -.26, p < .05, and child externalizing behaviors, r = -.43, p < .001. Significant inverse relationships were found between caregiver emotional functioning QOL and each of the following variables: asthma severity, r = -.39, p < .001; child internalizing behaviors, r = -.22, p < .05 and child externalizing behaviors, r = -.25, p < .05. Multiple regression analysis revealed that asthma severity and child externalizing problems accounted for 26% of the variance in child emotional functioning QOL. No moderators or mediators were identified. Findings from this study imply that externalizing problem behaviors of school-aged children may be a predictor of their negative feelings about their asthma. Nursing educators should consider including the emotional impact of asthma on children in nursing curriculums as this may ultimately influence health care providers to more skillfully address this important issue in both assessment and intervention settings. / text

National health expenditures will continue to grow faster than nominal gross domestic product (GDP) in the early 21st century (Heffler et al., 2002; Heffler et al., 2005). Increased Medicaid costs have spurred research to find reliable cost-saving methodologies (Kronick et al., 1996). The Medicaid administrations of some states have chosen risk adjustment as a methodology for savings (Tollen et al., 1998; Weiner et al., 1998), since it can reduce the financial burden of health care providers and distribute medical resources more efficiently. This dissertation presents a risk-adjustment model based on two types of health condition adjusters: diagnosis-based HCC adjusters and pharmacy-based RxRisk adjusters. HCC adjusters were developed from different diagnostic categories from inpatient, outpatient and long-term care data. RxRisk adjusters included diseases inferable from prescription drug usage. The underlying assumption is that using both types of health condition adjusters, rather than relying on either diagnosis-based adjusters or pharmacy-based adjusters alone can help increase predictive power and lower Medicaid's risk of reimbursing inflated medical costs for its beneficiaries. The population in this study consisted of all disabled and aged Florida adults who were eligible for Florida's Medicaid program in state fiscal year (SFY) 2002-03 and state fiscal year 2003-04. The population was broken down into two subpopulations: disabled Medicaid beneficiaries aged 64 and under and beneficiaries aged 65 or over.The proposed regression model includes diagnostic and pharmacy-based adjusters, and this dissertation compares the proposed model with models based solely on pharmacy- or diagnosis-based adjusters.The results presented in this dissertation demonstrate the proposed model has higher predictive power than the diagnosis-based HCC model and the pharmacy-based RxRisk model for the overall population and the subpopulations in this study. Risk-adjustment models using diagnostic and prescription drug information have higher predictive power and decrease the possibility of inappropriate gaming of the Medicaid capitation payment system.

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Menopause is a period of biological transition in middle-aged women, when oestrogen levels gradually drop. After menopause women no longer can give birth to children. However, menopause is more than biology; it is also an example of a bio-psycho-social process, where psychosocial and cultural involvement can influence experiences of the biological transformation. Furthermore, many myths and meanings surrounds menopause, and the purpose of this study drawing on a Foucauldian perspective, is to examine discourses in contemporary society that affect the understanding of what menopause is. The methodological approach consists of an analysis of media articles and interviews with middleaged women to explore different conceptions of menopause. The analysis of articles in two leading Swedish newspapers during a period of five years (Dagens Nyheter and Svenska Dagbladet, 2007- 2011) reveals that the media present menopause as a substantial risk factor that increases the possibilities of many diseases, irrespective of genes and lifestyle, and that menopause appears to cause reduced quality of life and degraded body. This female period of life is portrayed as “the beginning of the end”, filled with dichotomies concerning whether menopause is natural or pathological, but with an emphasis on the pathological. The newspaper articles present different strategies for women on how to deal with this transformation, such as hormone replacement therapy, fitness, and different diets that can "calm" women’s experience of menopause. Media thus present menopause as both problematic and challenging. However, interviews with six middle-aged women show that women themselves view this differently. Women define menopause as the border between being young and old, and this makes menopause in conflict with today's youth-obsessed society, where health and appearance are essential components of personal identity, particularly for women. Women talk about menopause as a confirmation of age, and also indirectly as the beginning of deteriorating health. In contrast, the majority of women experience menopause positive in terms of what they had expected. Due to the confusion surrounding menopause women call attention to the lack of information and knowledge on the subject of menopause. Information that can increase women’s knowledge, and thus give women more control over their own bodies. These different images of menopause are problematized both in terms of the gendered body, as well as in terms of knowledge and power.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

No description available.

The aim of this thesis was to explore and describe foodwork and meals for older persons with dementia and their partners in ordinary homes. Descriptive and explorative designs were used in the four papers this thesis is based on. Longitudinal data, including older home-living unlike-sex twins, were analysed using descriptive and analytical statistics. An ethnographic approach was used to describe everyday life for persons with dementia. Interviews with partners and staff were analysed using thematic analysis and qualitative content analysis, respectively. The results revealed that, among home-living older persons, there is an association between a person’s cognitive ability and nutritional status; i.e. low cognitive ability leads to increased risk of malnutrition. For home-living persons with dementia and their partners, foodwork and meals sometimes changed, meaning that shopping, preparing food and eating as well as social interaction become complicated, which seemed to lead to transitions in roles, routines and relations. There was foodwork that the persons with dementia could perform, and participants expressed a desire that abilities and independence be preserved. However, support was sometimes needed, and it was emphasized that this was based on the person’s needs, wishes and problems. In conclusion, there is an association between decreased cognitive ability and increased risk of malnutrition. Furthermore, foodwork and meals affected both persons with dementia and their partners. Therefore, early intervention whereby both partners in a couple get individually adjusted support is of importance. Consequently, a person-centred care approach can be useful in arranging the support.

The health and fitness status of Canadian children has been declining over the past several decades. Children’s health and fitness impacts future health status as many health and fitness indicators track from youth into adulthood and are associated with serious illnesses such as cardiovascular disease (CVD). One potential determining factor of health and fitness may be the level of proficiency exhibited in performing fundamental movement skills (FMS). Failure to master FMS in childhood may decrease the physical activity options available in adulthood because FMS provide a foundation for all forms of physical activity pursuits necessary for health and fitness benefits. Todate, the relationship between health, fitness and proficiency of FMS has not been examined in Canadian children. Therefore, the purpose of the present investigation was to examine the current state of movement skill proficiency in relation to health and fitness in Canadian elementary-aged children. Boys (n = 71) and girls (n = 91 girls) ages 8 to 11 years were recruited from schools participating in the evaluation component of the Action Schools! BC program. Measures of fundamental movement skill proficiency (i.e., running, horizontal jumping, vertical jumping, jumping from a height, hopping, and skipping) and indicators of health and fitness (i.e., blood pressure, arterial compliance, weight status, musculoskeletal and cardiovascular fitness) were assessed. Results indicated low levels of FMS proficiency for both boys and girls. Analysis also revealed significant relationships between EMS and indicators of health and fitness. Correlation analyses found running and hopping to be significantly (p < .01) related to musculoskeletal and cardiorespiratory fitness tests. Significant (p < .01) relationships between vertical jumping and weight status, musculoskeletal and cardiorespiratory fitness were also found by the correlation analyses. Regression analyses were performed to determine the independent relationship between health and fitness indicators. Vertical jump was significantly (p < .01) related to blood pressure (BP) independent of confounding health and fitness variables. Finding significant relationships between FMS proficiencies and health and fitness indicators coupled with the low proficiencies demonstrated by our sample of children suggest the need for a greater emphasis on the development of FMS.

Background: There is little information on how the quality of oral health services in long-term care (LTC) facilities is conceptualized or assessed. Objectives: This study aims to develop a model for assessing the quality of oral healthcare services in LTC facilities. Methods: This study is divided into four main steps. Firstly, I examined literature for existing concepts relating to program evaluation and quality assessment in healthcare to build a theoretical framework appropriate to dental geriatrics. Secondly, I explored as an ethnographic case study a comprehensive oral healthcare program within a single administrative group of 5 LTC facilities in a large metropolis by interviewing 33 participants, including residents and their families, nursing staff, administrators and dental personnel. I also examined policy documents and made site visits to identify other attributes influencing the quality of the program. Thirdly, I drafted the assessment model combining a theoretical framework with empirical information from the case study. And lastly, I tested the feasibility and usability of the model in another dental geriatric program in northern British Columbia. I applied the assessment model by conducting 15 interviews with participants in the program, made site-visits to the 5 facilities, and reviewed documents on the development and operation of the program. Results: A combination of theory-based evaluation and quality assurance provided six sequential and iterative steps for quality assessment of oral health services in LTC. The empirical information supported the theoretical framework that a program of oral healthcare in a LTC context should be assessed for quality from multiple perspectives; it should be comprehensive; and it should include the three main attributes of quality - capacity, performance, and outcomes. Participants revealed 20 quality indicators along with suggested program objectives which encompass eight quality dimensions such as effectiveness, efficiency, and patient-centered. Conclusion: The model provides a unique system for assessing the quality of dental services in LTC facilities that seems to meet the needs of dental and non-dental personnel in LTC.