What do we owe to our loved ones? What is the status of these requirements? How do we reconcile them with other requirements? Are we allowed to buy our child an expensive car when that money could save countless strangers overseas? What exactly does morality demand of us? / My thesis defends an account of partiality justified in terms of relationships. I develop the view that relationships are inextricably linked to wellbeing, and I defend the idea that morality must be concerned with our wellbeing. I try to make sense of this account of partiality with the idea that morality carries a requirement of impartiality. If wellbeing is an important part of morally right actions, and if acting in accordance with reasons of partiality (qua relationships) sometimes promotes wellbeing better than impartiality, then some reasons of partiality lead to morally right actions. Minimally, I argue that for why a strictly impartial (or, on the other extreme, a strictly partial) theory does not work. Both reasons (of partiality and impartiality) must be taken into account and carefully calibrated. More ambitiously, I argue for why partiality deserves its own place at the table in normative ethical theorizing. This is not to say that partiality always leads to right action, rather the suggestion is that there are some forms of partiality (found within relationships) which morality requires. / Thesis / Candidate in Philosophy / Some forms of partiality seem clearly wrong, like racial bias or nepotism; in such cases, it is better to consider our reasons to be impartial, which seem to lead to more fairness or equality. Still, there seem to be other forms of partiality which are clearly right, like the love and care a parent has for their child; in these cases, considering our reasons to be impartial seem like (to quote Bernard Williams), “one thought too many.” This thesis tries fit reasons of partiality and reasons of impartiality together, and argues for a view of (moral) partiality grounded in relationships.

An individual’s health is influenced by more than just the health care system, but also in large part by the social determinants of health. People exist within broader social, cultural, and ecological systems which influence their health outcomes through the social determinants of health. This doctoral dissertation examines social, cultural, and ecological systems to understand several factors that support and hinder community health and wellbeing to inform future policy. This dissertation incorporates a mix of methodological approaches across four interrelated research studies to better understand direct and indirect factors influencing community health and wellbeing. In doing so, this thesis is divided into four research chapters. Study 1 consists of a community-based research project that examines how food security, cultural continuity, and community health and wellbeing are connected through the sharing of harvested country food in Chesterfield Inlet, Nunavut, Canada. Based on this understanding we can demonstrate how climate change and increased shipping along the inlet affects the community as a result of changes in marine mammals and harvesting activities. Study 2 presents a logistic regression that models how cultural continuity variables impact self-rated health for participants living in Inuit Nunangat in Canada. This model uses the Arctic Supplement questions of the Aboriginal Peoples Survey to compare measures of cultural continuity to traditional measures based on government services. This study demonstrates an important link between cultural continuity and self-rated health for Inuit living in Inuit Nunangat. iv Study 3 contains a case study of different implementation successes and challenges of Locally Managed Marine Areas globally. These cases are used to understand how community member involvement as stakeholders in marine resource decision-making not only aligns with existing local and Indigenous ways of management, but also can enhance biodiversity as well as local livelihoods. Finally, Study 4 uses ontology engineering methods to represent the results from the first three studies. This study demonstrates how this novel method can be used to illustrate the interconnectedness of results from different disciplines using diverse data sources and through the creation of different scenarios. Taken together, these studies provide timely insights regarding the ways policy can support or hinder efforts to improve community health and wellbeing and adapt to climate changes. / Thesis / Doctor of Philosophy (PhD) / The goal of this doctoral dissertation was to develop a better understanding of how social, cultural, and ecological systems impact community health and wellbeing in various contexts. Findings indicate climate and shipping changes impact Chesterfield Inlet, Nunavut through the relationship between food security, cultural continuity, and community health and wellbeing. Relatedly, harvesting activities, access to country food, satisfaction in Inuit governance, and community involvement all increase the probability that an Inuk living in the Arctic has good or great self-rated health. Additionally, Locally Managed Marine Areas, an approach to marine resources management that includes community members as key stakeholders, not only aligns with existing local and Indigenous management practices, but can also support biodiversity and increased catch of various species. Finally, by representing these research results in a single model called an ontology, we can make educated guesses about how these different studies are interconnected. The insights gained from this work can be adopted by decision- makers to create supports for and remove barriers to improved community health and wellbeing and community efforts to adapt to changes.

Bakgrund: Utmattningssyndrom (UMS) är ett tillstånd som orsakar ihållande trötthet och därav tenderar personerna att undvika aktivitet. UMS har betydande konsekvenser för en individs utförande och deltagande i vardagliga aktiviteter. Syftet med studien var att belysa kvinnor med utmattningssyndroms upplevelser i vardagliga aktiviteter. Metoden var kvalitativ med induktiv ansats. Typiskt urval tillämpades och bearbetning av data utfördes utifrån kvalitativ innehållsanalys med ett induktivt tillvägagångssätt av sju bloggar. Resultatet visade att kvinnor med utmattningssyndrom upplever svårigheter i sina vardagliga aktiviteter. Psykologiska och fysiska besvär uppstod vid fysiska aktiviteter vilket gjorde att kvinnorna undvek ansträngande aktiviteter. Återhämtning var en betydande faktor för att orka med det dagliga livet men sömnstörningarna utgjorde hinder att hantera dessa. Kvinnorna använde sig av strategier för att kunna hantera vardagliga aktiviteter. Slutsatsen var att kvinnor med utmattningssyndrom upplever olika utmaningar i vardagliga aktiviteter och studien bidrar med utökad förståelse för deras upplevelser av vardagliga aktivitet i relation till utmattningssyndrom. Vidare forskning kring personliga upplevelser av utmattningssyndrom anser författarna är relevant. Implikationer: Genom att förstå kvinnornas individuella behov, strategier och resurser kan arbetsterapeuter anpassa sina interventioner. / Background: Chronic fatigue syndrome (CFS) is a condition that causes persistent fatigue and as a result people tend to avoid activity. CFS has significant consequences for an individual's performance and participation in everyday activities. The study aimed to describe how women experience the impact of CFS on everyday activities. The method was qualitative with an inductive approach. Typical sampling was applied, and data processing was performed based on qualitative content analysis with an inductive approach of seven blogs. The results showed that women with CFS experience difficulties in their everyday activities. Psychological and physical distress occurred during physical activities, causing women to avoid strenuous activities. Recovery was an important factor in coping with daily life, but sleep disturbances were barriers to managing these. The women used strategies to cope with everyday activities. The conclusion was that women with CFS experience different challenges in everyday activities and the study contributes to an increased understanding of their experiences of everyday activities with CFS. The authors believe that further research on personal experiences of fatigue syndrome is relevant. Implications: Occupational therapists can adapt interventions by understanding women's individual needs, strategies, and resources. In this way.

Yes / Young people choose energy-dense, nutrient-poor diets, yet understanding of potential determinants is limited. Associations between food choices, mental wellbeing, health-related quality of life (HRQoL) and family affluence were explored to identify targets for intervention to promote dietary health and wellbeing in young people. Adolescents were recruited via post-primary schools in the UK and surveyed at two time-points when aged 13-14 years and 15-16 years. The questionnaire enquired about mental wellbeing using the Short Warwick-Edinburgh Mental Wellbeing Scale, HRQoL using the KIDSCREEN-10, socio-economic status using the Family Affluence Scale and food choice by Food Frequency Questionnaire (FFQ). With missing and anomalous cases excluded, the sample comprised 1208 cases. Factor analysis on the FFQ indicated five food choice factors: ‘Junk Food’; ‘Meat’; ‘Healthy Protein’; ‘Fruit/Vegetables’; ‘Bread/Dairy’. Multivariate regression analysis indicated that frequent consumption of Junk Food was associated with being male and lower mental wellbeing. Frequent Meat intake was associated with being male and with lower HRQoL. Frequent choice of Bread/Dairy foods was more common among males and associated with higher wellbeing and greater affluence. Those who consumed Fruit/Vegetables frequently were more likely to be female, have higher HRQoL, higher mental wellbeing, and greater family affluence. These direct associations endured between time points. The dietary factors were not mutually exclusive. Those who frequently chose Junk Food were less likely to choose Fruit/Vegetables. Frequent choice of Meat was associated with more frequent choice of Junk Food and Healthy Protein. Intervention to improve dietary and psychological health in young people should target males, those in less affluent households, seek to reduce consumption of ‘junk’ food, and increase fruit and vegetable intake. / This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. This ma-terial is based upon work conducted as part of the Wellbeing in Schools (WiSe) study which was financially supported by the Centre of Excel-lence for Public Health (Northern Ireland), and the Centre of Evidence and Social Innovation, at Queens University Belfast.

Yes / Wellbeing declines during adolescence, for which the reasons are unclear. This analysis explored associations between wellbeing and multiple lifestyle, socioeconomic and school-level factors in young people. Data were collected as part of the Wellbeing in School (WiSe) survey of adolescent school children in Northern Ireland at age 13-14 years (N=1618; 49% female) and 15-16 years (N=1558; 50.5% female). Wellbeing was assessed using the short-form Warwick-Edinburgh Mental Wellbeing Scale (sWEMWBS), where scores declined between time one (13-14 years) and time two (15-16 years) in both sexes and were significantly lower in females at both timepoints. Multilevel, multivariate modelling was therefore undertaken separately for males and females with sWEMWBS scores as the dependent variable. Physical activity, family affluence, fruit and vegetable intake, social media use, sleep duration, school factors (size and type) and religion were independent variables. More frequent physical activity in both sexes at both timepoints was associated with higher sWEMWBS scores. In females, higher sWEMWBS scores were associated with less social media use at time one (and marginally at time two), greater family affluence at time two, and being Catholic at both timepoints. In males, higher sWEMWBS scores were associated with more frequent fruit and vegetable intake at time one. Mental wellbeing was unrelated to sleep duration or school factors in either sex, at both time points. Efforts to maximize mental wellbeing in adolescents should promote engagement in physical activity and implement sex-specific interventions. / This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. This material is based upon work conducted as part of the Wellbeing in Schools (WiSe) study which was financially supported by the Centre of Excellence for Public Health (Northern Ireland), and the Centre of Evidence and Social Innovation, at Queens University Belfast.

Yes / and methods This report is derived from a review of the research evidence on physical activity interventions and initiatives, interventions to support self-management/ self-care of long-term conditions and digitally enabled care services and technologies. The aim was to use existing evidence to envision future services and associated infrastructure. The Evidence Review involved scoping the literature for topics researched and to determine the nature of that research. Rapid-scoping review methods were applied to trusted sources, and searches for specific key texts were conducted. A separate search was conducted to identify literature relevant to each domain. A narrative was then produced from the review findings. Review findings The evidence base for physical activity interventions is growing. There has been significant recent investment in the development and evaluation of interventions to promote activity and reduce sedentary behaviour at the individual, community and population levels. The evidence to link higher levels of physical activity to positive health outcomes and disease prevention is convincing, both in ‘well’ populations and in those with long-term health conditions. Self-management interventions are heterogeneous in nature but common elements exist across the majority of them. The consensus in the literature is that self-management will become increasingly important due to unsustainable demands upon services. Evaluation of selfmanagement interventions reveals a small but varying effect across a wide range of outcomes. However, little is known about the mechanisms by which these interventions work and how these might vary across differing conditions and populations. Technology is being increasingly used to support service delivery in a wide range of contexts, and for the delivery of a variety of interventions including fitness and self-management. There is strong evidence supporting the use of technology for remote monitoring of people with longterm conditions, but further research is required. Implications Digital applications are already altering established patterns of service delivery. The findings presented here reveal varying results of efficacy which do not accord with the optimistic future described in various envisaging reports. Research has yet to consider unwanted and unforeseen effects of moving towards technology-enabled services. It is also important to consider how to effectively harness new health data emerging from the use of eHealth systems, technology-enabled services and health-tracking devices. There is an ongoing requirement to evaluate new technologies and technology-enabled services in ways that provide both timely and robust answers, particularly as technology development is a continually moving target. These considerations are discussed in this report. / The evidence review was commissioned as part of the Foresight future of an ageing population project

Yes / Dementia friendly communities, in which people living with dementia actively participate and those around them are educated about dementia, may improve the wellbeing of those living with dementia and reduce the associated stigma. The Adopt a Care Home scheme aims to contribute towards this by teaching schoolchildren about dementia and linking them with people living with dementia in a local care home. Forty-one children, ten people living with dementia and eight school / care home staff participated in a mixed methods (questionnaires, observations, interviews and focus groups) evaluation to assess the scheme’s feasibility and impact. Data were analysed statistically and thematically. The scheme was successfully implemented, increased children’s dementia awareness and appeared enjoyable for most participants. Findings, therefore, demonstrate the scheme’s potential to contribute towards dementia friendly communities by increasing children’s knowledge and understanding of dementia and engaging people living with dementia in an enjoyable activity, increasing their social inclusion. / University of Sheffield's Faculty of Medicine Dentistry & Health Innovation Fund.

Yes / Research suggests a decline in the mental health and wellbeing of people with dementia (PwD) during the COVID-19 pandemic; however few studies have compared data collected pre-pandemic and during the pandemic. Moreover, none have compared this change with what would be expected due to dementia progression. We explored whether PwD experienced changes in mental health and wellbeing by comparing pre-pandemic and pandemic data, and drew comparisons with another group of PwD questioned on two occasions prior to the pandemic. Methods: Community-dwelling PwD enrolled in the IDEAL programme were split into two groups matched for age group, sex, dementia diagnosis, and time since diagnosis. Although each group was assessed twice, one was assessed prior to and during the pandemic (pandemic group; n = 115) whereas the other was assessed prior to the pandemic (pre-pandemic group; n = 230). PwD completed measures of mood, sense of self, wellbeing, optimism, quality of life, and life satisfaction. Results: Compared to the pre-pandemic group, the pandemic group were less likely to report mood problems, or be pessimistic, but more likely to become dissatisfied with their lives. There were no changes in continuity in sense of self, wellbeing, and quality of life. Discussion: Results suggest the pandemic had little effect on the mental health and wellbeing of PwD, with any changes observed likely to be consistent with expected rates of decline due to dementia. Although personal accounts attest to the challenges experienced, PwD appear to have been resilient to the impact of lockdown and social restrictions during the pandemic. / Identifying and mitigating the individual and dyadic impact of COVID-19 and life under physical distancing on people with dementia and carers (INCLUDE) was funded by the Economic and Social Research Council (ESRC) through grant ES/V004964/1. Investigators: LC, Victor, C., FM, CQ, Hillman, A., AB, LA, RA, AM, RC, and CP. ESRC is part of UK Research and Innovation (UKRI). Improving the experience of Dementia and Enhancing Active Life: living well with dementia. The IDEAL study was funded jointly by the Economic and Social Research Council (ESRC) and the National Institute for Health Research (NIHR) through grant ES/L001853/2. Investigators: LC, I. R. Jones, C. Victor, J. V. Hindle, R. W. Jones, M. Knapp, M. Kopelman, RL, A. Martyr, FM, R. G. Morris, S. M. Nelis, J. A. Pickett, CQ, J. Rusted, and J. Thom. IDEAL data were deposited with the UK data archive in April 2020 and will be available to access from April 2023. Details of how the data can be accessed after that date can be found at: http://reshare.ukdataservice.ac.uk/854293/. Improving the experience of Dementia and Enhancing Active Life: a longitudinal perspective on living well with dementia. The IDEAL-2 study was funded by Alzheimer’s Society, grant number 348, AS-PR2-16-001. Investigators: LC, I. R. Jones, C. Victor, C. Ballard, A. Hillman, J. V. Hindle, J. Hughes, R. W. Jones, M. Knapp, RL, AM, FM, R. G. Morris, S. M. Nelis, CQ, and J. Rusted.

Bakgrund: Metakognition kan beskrivas som tankemönster. Det har påverkan på människans utveckling, problemlösning och inlärningsförmåga. Skolsköterskans roll är bland annat att stödja barn och ungdomar i sin utveckling utifrån både hälsofrämjande och livsbejakande perspektiv. Statistik visar att elever i skolan har svårt att nå sina studiemål och saknar framtidstro. Vetenskaplig kunskap om ämnet metakognition i förhållande till barn och ungdomar kan vara värdefull för professioner inom skolan. Syfte: Syftet är att belysa metakognition hos barn och ungdomar. Metod: Examensarbetet är baserat på en systematisk litteraturstudie. Vetenskapliga artiklar söktes i relevanta databaser. Det resulterade slutligen i tio artiklar. Dessa analyserades med tematisk analys. Resultat: Teman som framkom utifrån analys kring den metakognitiva aspekten hos barn och ungdomar var självuppfattning och utveckling, metakognition och agerande samt metakognition som resurs för måluppfyllelse. Resultatet belyser hur den metakognitiva förmågan inverkar på barn och ungdomars utveckling. Konklusion: Metakognition har inverkan hos barn och ungdomar utifrån personlig utveckling och hälsa. Genom utveckling av metakognition kan möjligtvis hälsa, välbefinnande och skolframgång hos barn och ungdomar öka. Skolsköterskan har förutsättningar genom sitt arbete att stödja elever i utvecklingen av deras metakognitiva förmåga / Background: Metacognition can be described as thought patterns. It has an impact on human development, problem solving and learning ability. The school nurse role is to support children and adolescence in their development including health. Several students find difficulties in achieving study goals and lack faith in the future. Hence, in-depth scientific knowledge of the subject is valuable. Aim: Is to shed light on metacognition in children and adolescence. Method: The thesis was based on a systematic literature study. This resulted in ten articles, which were reviewed and analyzed. Findings: The themes that emerged from analysis of the metacognitive aspect of children and young people were self-concept and development, metacognition and acting and metacognition as a resource for goal achievement. Furthermore, an interpretation is presented regarding how the metacognitive ability affects the development of children and adolescence. Conclusion: Metacognition has an impact on children and adolescence based on personal development and health. Through the development of metacognition, the health, well-being and school attendance of children and adolescence can possibly increase. The school nurse has the conditions through her work to support students in the development of their metacognitive ability.

Extant psychological research has consistently demonstrated that insecure attachment is negatively associated with psychological outcomes and positively correlated with the utilization of maladaptive coping strategies. However, no empirical studies could be located that examined the indirect effect of insecure attachment on wellbeing variables via coping focused on Latine populations. This study explored the direct and indirect effects of insecure attachment on psychological wellbeing indicators via culturally coherent coping strategies. Further, the present study examined the potential moderating effect of familism on the indirect effect models. Findings indicated that (1) anxious attachment, but not avoidant attachment, predicted psychological wellbeing; (2) positive reinterpretation significantly mediated the relations between insecure attachment and psychological wellbeing; (3) seeking emotional social support significantly mediated the relations between insecure attachment variables and general self-efficacy but not psychological distress; (4) religious coping significantly mediated the relations between insecure attachment and psychological distress but not general self-efficacy; and (5) familism was positively associated with psychological wellbeing but no significant moderator effect was found. Findings from our study contribute to the paucity of literature on attachment and culturally coherent coping within the Latine community. The limitations of the study, future research directions, and relevant clinical implications are reviewed.