Purpose: The purpose of this dissertation was to examine the determinants of unplanned emergency department (ED) use by home care clients, the profile of older ED patients, their transitions from the ED, as well as the determinants of post discharge outcomes among older ED patients. The goal of this dissertation was to create theoretically driven, evidence-based, and practical risk identification methods for home care and the ED. Methods: First, a multi-year, census-level cohort study was conducted on home care clients in two Canadian provinces (N=617,035). Census-level data from RAI-HC assessments were linked to census-level ED records. A needs-based decision tree model – the ED Model – informed by the Andersen Behavioural Model, was created using decision tree analyses. The final model was validated on a separate data partition and compared to the ERA Index and the CARS. Multilevel analyses were conducted to test regional variation in model performance. Disease stratified analyses were also conducted to test model generalizability across common disease classes. Regression analyses determined the effect of predisposing and enabling factors within ED Model strata. Second, a multi-site, multi-province prospective cohort study was conducted, termed the Management of Older Persons in Emergency Departments (MOPED) Study, using a clinically representative sample of 2,101 older ED patients. The interRAI ED-CA was used to assess older ED patients, and a 90-day disposition was collected. The profile of older ED patents was examined. Best-subset regression analyses identified person-level determinants of acute inpatient admission. Two needs-based decision tree models – the ALC/LTC and ED Revisit Models – were created using decision tree analyses to determine the risk of ALC designation or LTC placement, and unplanned repeat ED visits, respectively. Both models were validated on separate data partitions. Multilevel analyses were conducted to test site-level variation in the models’ performance. Results: Overall, 41.2% of home care clients had at least one unplanned emergency department visit within 6 months of an assessment. Previous ED use, cardio-respiratory symptoms, cardiac conditions, and mood symptoms featured heavily in the ED Model. The ED Model provided moderate risk differentiation and clinical utility. It achieved an area under the curve of 0.62 (95% CI: 0.61-0.62) and showed clear differentiation in Kaplan-Meier plots using validation data. Multi-level analyses showed no regional variation. The ED Model significantly outperformed the similar tools specific to primary care with respect to overall accuracy and perceived clinical utility. Predisposing and enabling characteristics provided little added differentiation beyond evaluated need. The majority of older ED patients were dependent on others for basic tasks of daily living, and many had fragile informal care or lived alone. Triage acuity generally did not differentiate chronic geriatric disabilities and conditions. Previous ED or hospital use was associated with chronic geriatric disabilities and conditions as well as informal caregiver distress. The Admission Model found that multiple factors were associated with admission to inpatient acute care, including: acuity, instability, changes in ADL function, cognition, nutrition, and anhedonia. Overall, 20.7% of older ED patients admitted to acute care were designated ALC or discharged to LTC; whereas 39.5% of older ED patients discharged home had one or more repeat ED visits within 90 days. Cognitive, functional, and informal care indicators were predictive of ALC/LTC; whereas functional status and symptoms were predictive of repeat ED use. The ALC/LTC and ED Revisit Models provided good risk differentiation, achieving AUC’s of 0.74 (95% CI: 0.69-0.79) and 0.69 (95% CI: 0.63-0.74), respectively. The ALC/LTC and ED Revisit Models showed clear differentiation in Kaplan-Meier plots. Multi-level analyses showed no site-level variation in each models’ performance. Conclusions: This dissertation produced tangible and empirically-based risk assessment models for clinical practice in home care and the ED. The models developed in this dissertation can support the targeting of preventative services as well as better communication strategies between the ED and community supportive care, primary care, and inpatient acute care. Key questions related to the prevention of the risk pathways identified in each risk assessment model remain unanswered, and should be a focus of future research.

The education level has proven to be a good predictor of a range of important outcomes. However, despite substantial research, there are still areas to further explore and as far as the author is aware of, a study comparing education effects between different regions has not been conducted. The aim of this paper is to link previous theory and research and use it to examine effects of the education level on four different areas; politics, health and well-being, social trust and nationalism and immigration. Specifically, focus is on exploring potential differences regarding education effects between the Nordic countries and other countries in Europe. The study was conducted using a quantitative method by analyzing data from European Social Survey covering the period 2012–2016. By adding interaction terms to the regression models this study indicated that the education effects were robust, with higher education levels being associated with higher trust and political interest, better health and well-being, and with less political cynicism and less negative attitudes towards immigration. The study also identified that the education effects differ between the Nordics compared to other European countries. Analysis of the data showed that the education effects related to politics and nationalism and immigration were stronger in the Nordic countries compared to other countries in Europe. In contrast, education effects related to health and well-being and social trust were stronger in other countries in Europe compared to the Nordics.

As the face of aging in our society changes, there is an increasing need for healthy interventions for the elderly. Spirituality and religion are powerful cultural influences for many African Americans and are used as resources to overcome personal, physical and health crises. Churches and other faith-based organizations have become increasingly popular settings to conduct health promotion and research studies, particularly in the African American community. The proposed study is to contextualize the spiritual life and eating behaviors of older adults (63 years and older) using the H.E.A.L. Congregation study. This survey was developed by the research team and utilized a mixed methods approach to assess the role of the church on their health and well-being and administered via Qualtrics to over 300 African Americans across the US. Preliminary analyses identified nearly 75% of participants recognized the church having a role in their spiritual and physical growth.

Approximately 300 years ago, French astronomer, Jean Jacques became the first individual to scientifically observe circadian rhythm. Since then, a great deal of study has been conducted, and its findings demonstrate that every human action, including digestion, sleep and waking hours, hormone release, blood pressure, and body temperature, is controlled by a physiological mechanism. More critically, any modification to this clock may have an impact on a person's immune system. The sun's rays are diffused in the sky and contain all the required wavelengths to enable the regular stimulation of the circadian rhythms of humans, animals, and plants. People's health and well-being will be supported if they have adequate access to daylight. However, given the changes in the way of life of modern humans, this is not possible. Additionally, as the human circadian rhythm is greatly influenced by the short wavelengths of the visible light spectrum, the process of LEDification would increase human exposure to LEDs blue light, which might negatively affect their health and well-being. This research involves the development of a new architectural design framework to evaluate and support the process of creating lighting systems that maintain human healthy circadian rhythm. This process develops a model consisting of key decisions made in each stage of the design process and related knowledge domains to successfully integrate dynamic lighting techniques into the building design. The process explains the role of each member, the essential tools, and the flow of the decision-making process. / Doctor of Philosophy / Approximately 300 years ago, French astronomer, Jean Jacques became the first individual to scientifically observe the natural 24-hour cycle in plants. Since then, a great deal of study has been conducted, and its findings demonstrate that every human action, including digestion, sleep and waking hours, hormone release, blood pressure, and body temperature, is controlled by a physiological mechanism. More critically, any modification to this clock may have an impact on a person's immune system. The sunlight provides enough light for the natural stimulation of the human circadian rhythm. However, modern humans spend a lot of their time indoors and under electric light sources. These light sources might have negative impacts on human circadian rhythm and health. This research has developed a new design framework that architects and lighting designers can use to ensure a lighting system that would support occupants' health and well-being.

Tango invites communication and creativity, it offers growth and community, and, in Philadelphia, it draws a unique cohort of dancers. What forces have driven growth of the Philadelphia tango community, who exactly are its members, and why do they dance tango? This qualitative and quantitative study recounts the community's history, reveals the people at its core, and explores what the dance means to them. It is a mixed-method, multi-layered integration of dance history, community profile, and individual narrative. Twenty-six instructors and event organizers provided data on the community's history. More than 100 dancers participated in a survey that gathered descriptive and demographic data, and nine dancers gave interviews on their lived experiences of tango. The community grew steadily from 1991 through 2006. Early local entrepreneurs modeled an ethos that placed a premium on tango's community-building capacity. This ethos remained a central force in the community's growth, drawing a unique cohort of dancers. Compared to Philadelphia census data, tango survey respondents were fifteen years older on average, more likely to be divorced or to have been born outside of the continental United States, better educated with higher incomes, and more likely to work in the arts. Ethnographic, quantitative, and mixed methods analysis reveals how tango may serve these unique cohorts and how many dancers perceive that tango enhances their physical, mental, emotional, spiritual, and social lives. Phenomenological inquiry explores dancers' concepts of spirituality and how some made spiritual meaning from tango experiences. Four central themes that emerged--tango music, tango dance, interactive experience, and internal experience--can be theorized to intertwine in a cycle wherein tango invites human interaction that leads to internal growth, which improves one's capacity to dance tango, thus creating a more satisfying interactive and internal experience. This research represents the first comprehensive study of tango in Philadelphia. It documents the creation of a popular social dance community in a major U.S. city and offers new data and theories on community building. It is also the first study to explore intersections between spirituality and tango and offers new insights into how tango improves adults' health and well being. / Dance

Yes / Community-based peer volunteer interventions are increasingly used with people who are asylum seekers and refugees accessing health services. There is a dearth of evidence evaluating the benefits of volunteering for asylum seeking or refugee volunteers. Volunteers may have poor mental health and feel socially isolated due to their experiences as refugees and asylum seekers and may struggle or be unable to obtain paid employment. Volunteering in other contexts has been found to be beneficial to the health and well-being of the volunteer. This paper reports on an aspect of a wider study evaluating the community-based Health Access for Refugees Project, with the aim of exploring the impact of volunteering on the health and well-being of the peer (asylum seeker or refugee) volunteer. In 2020, we conducted qualitative semistructured interviews by phone with 15 volunteers who were asylum seekers or refugees. The interviews were audio recorded, data were transcribed verbatim and the data set was thematically analysed. We found that the positive relationships which developed and the training received through volunteering boosted volunteers' mental well-being. They felt motivated and confident in helping others, felt a sense of belonging and this reduced their social isolation. They also believed they benefited personally, helping their access to health services, and preparing them for future education, training or a career. In light of the beneficial nature of volunteering identified in this study, establishing more volunteering opportunities for this population and other marginalised groups with poor mental health is recommended. However, more research is needed to assess both the long-term impact of the role in terms of the peer volunteer's health and well-being, and the societal benefit of people moving on, integrating and contributing to society. / Refugee Council

Bakgrund: HPV är den vanligaste sexuellt överförda infektionen i världen. Över en halv miljon kvinnor världen över drabbas av cervixcancer varje år där HPV är den primära orsaken. Föräldrars attityder kring faktorer rörande HPV-vaccin till deras barn spelade en avgörande roll för hur många som erhöll vaccinet. Föräldrar valde att inte vaccinera sina barn på grund av attityder och stigman som kom från omgivningen och samhället. Syfte: Att undersöka faktorer som påverkar attityder hos föräldrar kring HPV-vaccin till deras barn. Metod: Arbetet var en litteraturöversikt för att kartlägga det valda området, med analys av valda artiklarna. Artiklarna var vetenskapliga, skrivna på engelska och med kvalitativ grund. Resultat: Rätt information från sjuksköterskor till föräldrar ledde till positiva attityder, däremot var avsaknad av information angående vaccinets säkerhet och effekt en bidragande orsak till tvekan hos många föräldrar. Ekonomi, medias attityder, synen på sex samt rädsla för biverkningar påverkade föräldrars val att vaccinera sina barn. Åsikter kring lämplig ålder hos barnet vid erhållandet av vaccinet gick isär.Slutsats: Föräldrars attityder påverkade i stor grad andelen barn som vaccinerades. Ökad kunskap till föräldrar angående HPV och vaccinets verkan skulle leda till ett högre vaccinationstal och således förbättrad hälsa globalt. / Background: HPV is the most common sexually transmitted infection in the world. Over half a million women in the world suffer from cervical cancer each year were HPV-virus is the primary reason. Parents attitudes towards HPV vaccine for their children played a crucial part in how many actually got provided with the HPV-vaccine. Parents chose not to vaccinate their children because of attitudes and stigma that was founded in environments and communities. Aim: To examine factors that affect parents attitudes about HPV vaccine to their children. Methods: The chosen method was a literature review as topic, to explore the chosen subject and analyzing suitable articles. The articles have been scientific, in English and with qualitative reasons. Results: The right information from nurses to parents led to positive attitudes, however, the lack of information regarding the safety and efficacy of the vaccine was a contributing cause of doubt among many parents. Economics, media attitudes, views on sex and fear of side effects affected the parents' choice to vaccinate their children. Opinions about the appropriate age of the child when obtaining the vaccine went apart. Conclusions: Parents' attitudes largely affected the percentage of children who were vaccinated. Increased parents’ knowledge regarding HPV and the effect of the vaccine would lead to a higher vaccination rate and thus improved health globally

Thesis (M.Ed.)--North-West University, Potchefstroom Campus, 2008.

Creativity and innovation are attributes that are important in business and leadership today, perhaps more than ever. The recent economic crisis has shown that relying on pre-established business patterns is not enough anymore. Art has always been visionary and creativity is one of its major characteristics.   This thesis looks into the possible impact the arts can have on leadership. We ask ourselves what it is that we can learn from the arts, what they can teach us that is relevant for leaders and leadership. We have used the grounded theory and the methods suggested by Corbin and Strauss. We have conducted conversations with 12 leaders coming from different occupations who share at least one characteristic; they are all engaged in the arts. Through their experience, and through secondary data we used from studies concerning the impact the arts have on communities, we have constructed a theory. This shows that through their interaction with art, people are affected in their well-being, their personal development and their cognition. This phenomenon we have identified as the leader's catharsis.   We conclude our work by showing a map to show where in leadership research our substantive theory is useful. Further we also discuss how our findings can contribute to future leadership research. Our thesis might contribute to the discussions of aesthetics and leadership, the influence art has on the well-being of followers and how leaders can effectively form frames. Further, we suggest that the arts can be seen as a school for leadership development.

A qualitative study was conducted to identify perceptions of high-risk pregnant Aboriginal women during pregnancy. Five women were interviewed by the researcher who is also Aboriginal. Each woman was a client of the Healthy Mother Healthy Baby pregnancy outreach program in Saskatoon, and was considered to be at high-risk for poor pregnancy outcomes. Interviews were conducted utilizing a phenomenologically-based model of research, from which emerged themes or commonalities of thought between each woman during this time of their lives. The themes were discussed with Aboriginal women elders who worked with Aboriginal families in Saskatoon, for further insight and discussion of the findings. The themes were collated under one general theme called `hopes and dreams.' Each theme included the interest of these women to `want to' move ahead with their lives in the area of improving their relationships with their offspring, their partners, and within themselves. Though each women talked about these areas as being important, all except one did not manifest them in their lives.<p> The implications for the delivery of health care services include the need for health care workers to gain further understanding of the positive motivational factors of high-risk pregnant Aboriginal women that work towards achieving long-term positive behavioural changes, and thus reduce the risks of poor pregnancy outcomes. Other recommendations from this research for health promotion programs include the development of a partnership with the urban Aboriginal community in delivering culturally-based services and teachings to complement the educative and supportive model of program delivery.