Abstract The aim of the study was to search for, analyse and describe the visions of the future of representatives of the baby boom generation in Northern Finland concerning their own ageing, the factors affecting their well-being and their social and health care services. Visions of the future are based on views charted in two phases in accordance with qualitative driven mixed method research methodology. The material consisting of narratives describing future visions (n = 39) was collected using the method of empathy-based stories. Analysis of themes revealed three main themes in the narratives: 1. ageing as a subjective and social experience, 2. factors contributing to well-being from the viewpoint of life control and the environment and 3. social and health care services from the viewpoint of operational environments and resources. The material for the second phase was collected with the aid of a questionnaire drawn up based on the results of phase 1 (n = 405). The material was analysed using multivariate methods: main component analysis, K-means Kluster analysis and correspondence analysis. According to the results, ageing consists of subjective and social experience associated with adaptation, resignation and opening up of new possibilities. An existential experience about life, active self-care and a sense of community based on different networks seemed to have increased. Three future scenarios of the role of senior citizens emerged: seniors as objects of actions, as active, participating actors and as actors in their immediate community. A sense of life control, which was associated with the social, physical and symbolical factors of the environment, was seen as a source of well-being in the future. The operational environments and resources of service and support providers made up three categories: public social services and support from the immediate community, varied service networks and support from the immediate community in a wider sense, as well as public health care services and self-help. It was considered both desirable and likely that future services would comprise pre-emptive, versatile and technology-aided service combinations as well as family- and community-based housing services. The information provided by the study contributes to and expands the social, health-policy and nursing science knowledge base. The information may be utilised as basis for planning, decision-making and operation among professionals, NGOs and political decision-makers working with the elderly. Gerontological nursing science research and practical nursing can obtain information about future clients of elderly care services and the operating environments and resources of nursing. / Tiivistelmä Tutkimuksen tarkoituksena oli etsiä, analysoida ja kuvata millaisia tulevaisuudenkuvia pohjoissuomalaisilla suurten ikäluokkien edustajilla on ikääntymisestään, hyvinvointiinsa vaikuttavista tekijöistä ja sosiaali- ja terveyspalveluistaan. Tulevaisuudenkuvat perustuvat näkemystietoon, jota on kartoitettu laadullisesti ohjautuvan monimenetelmällisen tutkimusperinteen mukaisesti kahdessa vaiheessa. Tulevaisuustarinoista (n = 39) koostuva aineisto kerättiin eläytymismenetelmän avulla. Teemoitteluanalyysi tuotti tarinoista kolme pääteemaa: 1. ikääntyminen subjektiivisena ja sosiaalisena kokemuksena, 2. hyvinvointia tuottavat tekijät elämänhallinnan ja ympäristön näkökulmasta ja 3. sosiaali- ja terveyspalvelut toimintaympäristöjen ja resurssien näkökulmasta. Toisen vaiheen aineisto kerättiin 1. vaiheen tuottamien tulosten pohjalta laaditulla kyselylomakkeella (n = 405). Aineisto analysoitiin monimuuttujamenetelmillä: pääkomponenttianalyysilla, K-means Kluster -analyysilla sekä korrespondenssianalyysilla. Tulosten mukaan ikääntyminen muodostuu subjektiivisesta ja sosiaalisesta kokemuksesta, johon liittyy sopeutumista, luopumista sekä uusien mahdollisuuksien avautumista. Eksistentiaalinen kokemus elämästä, aktiivinen itsestä huolenpito ja erilaisista verkostoista syntynyt yhteisöllisyys näyttivät lisääntyneen. Ikäihmisen roolista muodostui kolme tulevaisuudenkuvaa: ikäihminen toiminnan kohteena, aktiivisena osallistuvana toimijana ja lähiyhteisönsä toimijana. Hyvinvointia tulevaisuudessa tuottivat kokemus elämänhallinnasta, joka oli yhteydessä ympäristön sosiaalisten, fyysisten ja symbolisten tekijöiden kanssa. Palveluiden ja tuen tuottajien toimintaympäristöistä ja resursseista muodostui kolme tyyppiä: yhteiskuntavastuiset palvelut ja suppeiden lähiyhteisöjen tuki, monipuoliset palveluverkostot ja laaja-alaisten lähiyhteisöjen tuki sekä julkiset terveyspalvelut ja oma-apu. Toivottavana ja todennäköisenä pidettiin, että tulevaisuuden palvelut sisältävät ennakoivia, monipuolisia ja teknologia-avusteisia palvelukombinaatioita sekä perhekeskeisiä ja yhteisöllisiä asumispalveluita. Tutkimuksessa tuotetulla tiedolla laajennetaan yhteiskunnallista, terveyspoliittista sekä hoitotieteen gerontologista tietoperustaa. Tietoa voidaan hyödyntää ikääntyvien parissa työskentelevien ammattilaisten, kansalaisjärjestöjen sekä poliittisten päättäjien suunnittelun, päätöksenteon ja toiminnan perustana. Hoitotieteen gerontologiselle tutkimukselle ja hoitotyölle tutkimus tuottaa tietoa tulevaisuuden vanhusasiakkaista ja hoitotyön toimintaympäristöistä ja resursseista.

This dissertation examined health care utilization patterns across conventional health care (CHC), complementary and alternative medicine (CAM), and public health care (PHC) systems among Canadians aged fifty and older. I argued that utilization research is currently limited by a primary focus on discrete use of health care services, largely within the CHC system (i.e., medical doctors, specialists, hospitals). However substantial growth in use of CAM and PHC, particularly among late middle-age cohorts, suggests the need to widen the research lens from discretionary service use within health care systems to include medical pluralism or use across health care systems. To address the lack of research on medical pluralism and the need for a comprehensive overview of service use, I used two different strategies to create discrete patterns of service use and non-use. To frame the predictors of these patterns, a medical pluralism paradigm was proposed, which suggests that there are distinct social location and health characteristics that may explain use across health care systems. Five hypotheses were tested using data pooled from two cycles of the Canadian Community Health Survey (Cycles 2.1 [2003] and 3.1 [2005]) to create an overall sample (n=117,824). Results from the deductive (variable oriented) and inductive (person centred) strategies were compared. Differences in both the number and form of patterns are apparent. Across both strategies, the most common pattern is dual use of CHC (medical visits, specialist visits) and PHC (flu shots, sex-specific screening) but not CAM (chiropractors, other CAM providers). Consistent with the literature, women use more types of services overall than do men. The gender effect is significantly mediated by age: older men are less likely to use services across the three health care systems than older women. Strong evidence for a socioeconomic gradient in medical pluralism is also found. Higher levels of income and education increase the likelihood of using services across the three health care systems compared to low and middle levels of both income and education. The relationship between race and health service use was much less significant. Long-term immigrants demonstrate tri-use patterns close to those of Canadian born individuals; however, service differentials remain even after controlling for health needs, in favour of native-born Canadians. Medical pluralism is also associated with health related-need as support was found for both illness and wellness care. Lastly, regional differences point to a greater likelihood of medical pluralism in western Canada, but not always in urban areas. In future, a longitudinal examination of medical pluralism is necessary and would help establish the sequencing of services and how services are used in relation to the disablement process. Health policy would thus benefit from insight into the extent of service duplication for specific conditions and clarify the role of medical doctors in referral processes. / Graduate

M.Phil. / Although a great deal of research has been conducted on diversity management in South Africa, very little of this research has focused on age diversity within interactive information societies such as libraries in South Africa. This study will focus specifically on academic libraries. It is also clear that most of the research regarding age diversity within Academic Information Services (AIS) has focused on managing the difference in ages between library patrons and library staff members. Very little of the research is devoted to age diversity between co-workers, and even less research has been conducted regarding Cuspers as a generational cohort within the library environment. This study is aimed at investigating age diversity within AIS in South Africa in relation to its effect on work, work performance and co-worker relationships. It is also aimed at encouraging organisations, and specifically AIS, to take cognisance of the current age demographic of their libraries and to develop and implement not only succession planning policies, but also relevant recruitment and retention policies in order to avoid employee and leadership vacuums. The research findings of this study are relevant as they give organisations in general, and specifically AIS within higher education institutions (HEI), a point of reference to guide the formulation of recruitment and employment policies that would appeal to the values and preferences of younger generational cohorts currently under-represented in these organisations. In addition, this study is of value with regard to the formulation of succession policies focused on the planning and training of new middle and top management staff members in order to improve current succession policies and plans.

Magister Curationis - MCur / The study proposed to conduct a descriptive study related to the correlation of infant feeding (EFF or EBF) and occurrence of morbidity diarrhoea and/or respiratory infections, in infants by 14 weeks of age. The study adopted a quantitative epistemological approach in seeking to describe the correlation of infant feeding and the occurrence of diarrhoea or respiratory infections by 14 weeks of age. The researcher embarked on a descriptive survey design and employed the questionnaire method during the data collection process. The Amathole District of the Eastern Cape Province was selected due to the accessibility of the targeted population. The unique demographic profile and rural-urban setting allows for a potentially rich data source whilst simultaneously reducing the potential incidence of bias in the data collection. The study sample was drawn from routine immunization and growth monitoring clinics in the Amathole district. / South Africa

Magister Public Health - MPH / Disclosure of HIV positive status to male partners is well established as a key element in the success of prevention of mother to child transmission of HIV programmes, as it helps improve adherence to ARVs by the women within these programme. However, partner notification rates remain low in the urban areas of Lusaka, Zambia against a high HIV prevalence of 25%. The purpose of this study was to explore the timing of disclosure as part of the process of disclosure amongst women who were part of the PMTCT services at Kaulu health centre in Lusaka. An exploratory descriptive study using qualitative research methods was conducted. 15 women, who were attending the Kaulu health centre PMTCT programme, were requested to participate in a semi-structured interview. The women, who were purposively selected with the aid of the health centre‟s PMTCT focal point nurse, had to have disclosed their HIV positive status to their partner, either before or during the course of their pregnancy or after delivery. To increase rigour, individual interviews were conducted with 5 health workers associated with the PMTCT programme so as to obtain their perspective and experiences on the issue of HIV disclosure amongst their PMTCT patients. Participation in the study was voluntary and all information obtained during the course of the interviews remained confidential and secure. Potential participants were each provided with an explanation of the purpose and process of the study and their informed written consent obtained before the researcher embarked on the interviews. Content analysis of the transcripts was done so as to develop coding categories and identify emerging themes. Disclosure to male partners is an important step in PMTCT and facilitates adherence to HIV care for the family and should be done as early as possible after the woman receives her HIV test result, though there exists a range of alternative times when it can be done. The relationship existing between a couple is very important in determining the timing of when a woman chooses to disclose. PMTCT services need to provide ongoing counselling for HIV positive women during pregnancy and after giving birth that supports, informs and equips them with the necessary skills to make an informed and timely decision about disclosure to a partner. In addition, the PMTCT service providers need to be encouraged to implement couple counselling as a strategy to facilitate disclosure as well as establishment of a peer support network for HIV positive pregnant women. The study findings will be used to contribute to health workers‟ capacity to support women manage the disclosure process to their male partners, thus helping to increase the disclosure rate and also contributing to improving the positive effect of the PMTCT services, in Lusaka, Zambia. / South Africa

Magister Scientiae (Nutrition Management) - MSc(NM) / The Ministry of Health in Malawi promotes exclusive breastfeeding for the first six months of life and continued breastfeeding with appropriate complementary feeding up to two years or beyond. This policy applies to all children unless there are medical indications. Baby Friendly Hospital Initiative (BFHI) is a strategy that contributes to the attainment of this policy. BFHI is a strategy to increase early and exclusive breast feeding rates among mothers. This study is a pilot to evaluate the success of the BFHI initiative in Malawi.Study design. A cross- sectional cohort study of women and their infants, 0-5 months,attending BFHI and non-BFHI accredited health facilities in Blantyre district of Malawi ] between the period from 28th April to 30th September, 2008 was conducted.Data Collection: An in-depth face-to-face interview using an open-ended structured questionnaire was conducted among 202 mothers of infants within the first week of birth.A convenient sample of 102 mothers was selected from prima gravida mothers at a semiurban BFHI accredited facility while the other 100 were from semi-urban non-BFHI accredited facilities. This sample was used for the descriptive component of the study.From the 202 mothers, 30 from the BFHI and 30 from the non-BFHI Accredited health facility(s) were selected randomly as the sample for the longitudinal cohort of the study at 3 and 5 months respectively.Analysis of results: Data was analyzed using SPSS for Windows. Frequencies were tallied for categorical variables and mean standard deviations were computed for continuous variables. Chi-square p-values with health facility type as classification were computed to determine the difference between BFHI and non-BFHI accredited health facility groups for all relevant variables.Results Exclusive breastfeeding rates differed significantly (p- value, 0.0000) within one week after birth (99% for the BFHI versus 68% for the non-BFHI facilities).Thirty percent of the mothers from the BFHI accredited health facility practiced exclusive breastfeeding up to 5 months as compared to none of the mothers in non-BFHI accredited health facilities.All 202 mothers had ever breast feed in both facilities throughout the 5 months study period.Mothers and mothers-in-law were the significant source of complementing breast milk before 6 months of age,[ 25% more influence of mothers and mothers in-law in the non-BFHI accredited facility when compared to BFHI accredited facility].Conclusion:The BFHI strategy has the potential to successfully influence mothers to adhere to global and national recommendations on optimal breastfeeding practices. Special efforts should be made to continue support of and provide information to new mothers during the first week after delivery and unto few months after birth as mothers seem to introduce complementary foods early and prior to the recommended period of 6 months.

Les travaux de recherche présentés dans ce manuscrit ont pour but de développer des procédés industriels pour la production de quatre ingrédients alimentaires infantiles ayant des propriétés hypoallergéniques et des teneurs réduites en phytoestrogènes. Les propriétés nutritionnelles des protéines de riz et de soja en font des sources intéressantes. Néanmoins, plusieurs problématiques liées aux caractéristiques des produits apparaissent aujourd’hui : la présence de phytoestrogènes (isoflavones) dans les isolats protéiques de soja ; la difficulté à solubiliser et isoler les protéines de riz et la forte allergénicité des protéines dans le cas du soja. Ces travaux présentent l’étude du fractionnement des protéines de soja et de riz pour le développement : d’isolat protéique à teneur réduite en isoflavones ; isolat protéique de riz ayant une teneur supérieure à 90% de protéines ; hydrolysats protéiques de soja et de riz dont le profil de poids moléculaire est maitrisé et potentiellement hypoallergénique. Afin d’y parvenir, la réduction de la taille des protéines par des processus enzymatiques puis le contrôle de leur poids moléculaire ont dû être étudiés. Concernant l’élimination des phytoestrogènes (isoflavones), deux méthodes ont permis d’atteindre de hauts rendements d’extractions. En premier lieu, l’étude de l’extraction par éthanol via une optimisation à petite échelle, suivie d’une mise à l’échelle industrielle ont permis de développer un premier produit à teneur résiduelle en isoflavones inférieure à 50 μg/g de produit sec représentant une réduction de près de 98% de la teneur en isoflavones. Le second procédé étudié a été la rétention des isoflavones sur résine d’adsorption à partir d’un hydrolysat protéique de soja préalablement mis au point, et ceci, par l’utilisation de solution aqueuse sans étape préalable d’extraction. Ce procédé a fait l’objet d’une mise à l’échelle industrielle et d’une étude du comportement chromatographique des isoflavones. L’extraction des isoflavones par eau subcritique et CO2 supercritique est aussi présentée dans cette thèse. Elle a permis de mettre en évidence l’influence de la polarité des différents composés et de la teneur en protéines des produits de soja utilisés. Ces travaux de thèse ont aussi permis de définir un nouveau procédé pour la production d’isolat protéique de riz par l’intermédiaire d’enzymes de types cellulolytiques et amylases, à partir de coproduits issus de l’industrie du sirop de glucose. Des études sur des matières moins transformées telles que le son de riz et la farine ont aussi été étudiées pour la concentration des protéines. L’étude de l’hydrolyse des protéines de soja et de riz a été possible par le suivi de différents indicateurs tels que le pH, la solubilité des protéines, le degré d’hydrolyse, le profil de poids moléculaire par électrophorèse et par chromatographie d’exclusion stérique. Ces procédés ont permis la production de quatre nouveaux ingrédients pouvant être testés pour leurs caractéristiques hypoallergéniques avant une éventuelle production industrielle / The objectives of these works were to develop industrial processes for the production of four infant food ingredients with hypoallergenic properties and reduced levels of phytoestrogens. For this purpose, the nutritional properties of the rice and soy protein are promising. However, due to the presence of phytoestrogens (isoflavones) the consumption of soy protein isolates is a big concern for infant food security because the high exposure to these compounds, known to be endocrine disruptors. Consequently, it was first intended to develop a soy protein isolate with reduced content of isoflavones below 50 μg/g following the recommendations of French and European health authorities. Rice protein isolates are either non-existent on the market, or extremely rare. Therefore, the development of rice protein isolate with a minimum content of 90 % protein was another objective. For the sensitive population, such as infants, the aim of this work was also to develop soy and rice protein hydrolysates conferring hypoallergenic properties. To achieve this goal, the reduction of the size of proteins and the control of their molecular weight was studied. Two methods were used to achieve high extractions yields. A study of ethanol extraction ranging from small-scale optimization to industrial scale was used for a final product with a residual content in isoflavones below 50 μg/g. The second method was to retain isoflavones on adsorption resin from a soy protein hydrolysate. This was possible without preliminary extraction step by solvent. This method was also tested in the industrial scale. The chromatographic behavior of different isoflavones was also studied. The extraction of isoflavones with subcritical water and supercritical CO2 is also presented in this thesis even though these methods were not retained. These pressurized extractions showed the influence of the polarity of isoflavones and the protein content of soy products onto the isoflavone extraction. These works also identified a novel process for the production of rice protein isolate by the hydrolysis of polysaccharides with cellulolytic enzymes and amylases from concentrated protein byproducts from the glucose syrup industry. Studies on less processed materials such as rice bran and flour were also studied for protein isolation. The study of the hydrolysis by proteases of soy and rice proteins were monitored by various indicators such as pH, protein solubility, the degree of hydrolysis, the molecular weight profile by electrophoresis, and size exclusion chromatography. These processes are enabled for the production of four new ingredients that will be tested for their hypoallergenic characteristics before a large scale production.

Canada’s aging population is expected to have an impact on all public institutions; for public libraries, the emergence of a large, multi-generational user group of older adults challenges the current paradigm of services to seniors. This thesis examines a subset of this user group: baby boomer library patrons who are in a caring relationship with elders. It investigates how these patrons interact with the public library both for themselves, and as carers, in order to reveal library-related issues particular to this growing segment of the population. The study takes place within a conceptual framework derived from the ethic of care, and from emerging theories of library-as-place rooted in the fields of human geography and sociology. Using a qualitative instrumental case study method, long form interviews were conducted with respondents recruited through theoretical sampling extended by snowball sampling. While not generalizable, findings suggest that while these baby boomer respondents value their libraries deeply, there is potential to create services and practices more attuned to the needs of older adults who are in relationships with elders.

The principal goal of the master thesis is to explore the similarities and possible differences among customers of infant milks. Based on those findings, the customers are clustered into various segments, which are extremely homogenous within each one, but significantly heterogeneous outside each of them. The second goal of the thesis is to suggest the best marketing solutions for each revealed segment. The work is divided into two parts, theoretical and practical. The theoretical part describes the process of market segmentation. The characteristics of the infant milk market and the description of infant milk types are described in the practical part. The customers' segmentation is designed according to primary and secondary research. Secondary data is based on data from project MML-TGI and content analysis. The data from my own primary research are processed by IBM SPSS statistics version 20. Among the main finding of the thesis was defining 5 segments of the infant milk customers. The work characterizes all of them and special term is chosen for each of the segment. Finally, the relevant marketing solutions are suggested for each of the segment.

This Master's thesis deals with the topic of impaired communication skills in premature infants. The thesis is divided into theoretical and practical parts. The theoretical part consists of three main chapters devoted to the development of children's speech, premature babies and care for premature babies. The first chapter describes speech and language, the ontogenetic development of speech, language levels in the ontogenesis of speech and impairment of communication skills in childhood. The second chapter defines a premature baby and discusses the most common postpartum complications. The third chapter is devoted to the care of premature babies in the Czech Republic, describes the logopaedic care regarding such children and their prognosis. The practical part is based on the methods of qualitative research. A triangulation of research methods was chosen - document analysis, observation and interview. The main goal was to describe how impaired communication skills are manifested in premature infants. The partial goal was to find out what postpartum complications occur in premature infants. To achieve the goals of the research, five research questions were formulated. Five respondents were included in the survey, namely four boys and one girl. Based on the obtained data, case studies of individual...