Background: The role of community matron (CM) was introduced to provide a single point of access to patients living with co-morbid long-term conditions who had, or were at risk of, frequent emergency admissions to hospital. CMs utilised case management as a means of managing this growing population of patients with fragile health. Since its inception, many changes in service delivery have impacted on the role. Aim: The aim was to undertake a mixed methodology study of the factors that have affected embedding of the community matron role in 3 geographical areas. Methodology: A pragmatic mixed methods approach (QUAL quan) was utilised. Settings and participants: The studies were based in health services within 2 cities and a rural area in central England. Participants for the qualitative components of the study were purposefully sampled. The sample comprised professionals: community matrons (n=21), managers (n=4), former commissioners (n=2) and GPs (n=3); and patients (n=10) and their family carers (n=5). Quantitative data for 212 people with long-term conditions were derived from the anonymised Patients at Risk of Rehospitalisation database (PARR data) held by area 1. Methods: Qualitative data were collected from participants using semi-structured interviews and audio diaries. For the quantitative component using PARR, some patient journeys within area 1 were explored. In addition, a sample of patients who were case managed by a CM (n=106) were matched with a set of patients who were not (n=106) and the data was examined. Findings: Participants were largely positive about the role of CM. However, difficulties with role setup had led to numerous changes which affected how the role has embedded. Additionally, this impacted understanding of the role by health care professionals, and caused practical and emotional difficulties for some CMs as they perceived the role to be eroded. The quantitative findings showed that CMs did not make a significant difference to hospital bed days used by patients on their caseload. Evaluating the role and finding an effective means of showing the work undertaken by CMs, which is often invisible, proved difficult. Conclusion: Embedding of the CM role has been affected by numerous changes in service delivery. Invisibility of community nursing rather than autonomy of the community matron role seems to be a key factor in the challenges of embedding the role. The significance of these findings is that using a mixed method approach and Liaschenko and Fisher’s adapted model may help CMs to improve the visibility of their role, and so helping the role to be less prone to the challenges of service redesign.

Self-management interventions enhance the health self-management techniques and physical and psychological health outcomes among people with long-term health conditions (LTHCs). Few individuals from South Asian backgrounds attended the pilot phase of one such intervention: the Expert Patients Programme (EPP), a community-based self-management course. This raised concerns about exacerbating health inequalities. South Asian people have increased prevalence and severity of certain musculoskeletal conditions, yet little is known about their experiences of living with and self-managing these. This research aimed to rectify these omissions, by describing Punjabi Sikh women's experiences of living with and self-managing arthritis, and identifying barriers and facilitators to EPP. Three studies explored White and Punjabi Sikh EPP tutors‟ experiences of delivering EPP to South Asian attendees, and Punjabi Sikh women's experiences of living with and self-managing arthritis, both before and after they attended a Punjabi-language EPP. White and Punjabi Sikh tutors' sometimes dichotomous experiences of delivering EPP to South Asians, captured barriers to South Asian people's attendance, engagement and self-management. Facilitators identified included the need for sensitive tailoring of the Course, involving the Punjabi Sikh community. The Punjabi Sikh women's vibrant experiential accounts revealed the detrimental psychological and physical consequences that arthritis had upon their lives. Highly versatile in their proactive arthritis self-management prior to attending EPP, participants' refined techniques encompassed combinations of medication and Indian remedies, empowered by their religious and spiritual values. Following EPP attendance, the participants reported psychological and physical improvements in their arthritis. Thus, this Study established Punjabi Sikh 4 Abstract women's inherent acceptance of the concept of self-management, and, notwithstanding its current limitations, the likely appropriateness of EPP. Every Study represents a novel contribution to knowledge. Meaningful engagement with Punjabi Sikh community-members may produce a culturally-competent intervention that could better improve this group's physical and psychological outcomes, thus addressing one small area of health inequalities.

The concurrent experience of multiple health conditions (often termed multimorbidity) has become an important issue in recent years. Most research on this topic uses clinical data (e.g. GP or hospital records) that lack important socio-contextual information about the lives of people with multiple conditions. Population health surveys can help to overcome these limitations, but identifying people who have multiple conditions is problematic. Decisions need to be taken regarding what is meant by a condition, which ones should be included, and how multiple should be defined. These decisions tend to be based on what data are available, rather than on any universal inclusion criteria or theoretical underpinnings. This thesis used an approach informed by sociological theory and principles drawn from critical realist philosophy to estimate the prevalence of multiple conditions among adults (16+) in the general population, using data from the 1998 and 2008- 2011 Scottish Health Surveys. It explicitly acknowledged the multiple, contested and constructed nature of health, illness and diagnosis; the limits of empirical enquiry; and the need to approach concepts such as multiple conditions critically. To support the decision-making process, longitudinal analyses of mortality were used to examine the impact of including various contested conditions on people’s long-term chance of survival (if there was no evidence of impact then the definition was rejected). The final measure of multiple conditions arrived at suggested that 24.9% of adults had multiple conditions (compared with 17.2% using the survey’s original, unadjusted, measure). This measure was then used to explore how this status related to people’s wellbeing, which helped to highlight importance differences in experiences. Among adults with multiple conditions, 33.5% of those in the most deprived areas had low wellbeing compared with 13.5% of those in the least deprived areas. Low wellbeing was also higher among people with multiple conditions aged under 65 than those aged 65 and over, especially for those living in areas of high deprivation. There was some evidence that having multiple conditions and additional vulnerabilities (e.g. psychological distress, living in a deprived area, having activity limitations) before the age of 55 increased people’s risk of mortality, which might result in older populations appearing to have better wellbeing due to less healthy people not reaching old age. Working-age people with multiple conditions were also more likely than people of the same age with no conditions to be economically inactive, to not live in an owner-occupied property, and not have a co-resident partner. All of which suggest that poor health at younger ages limits access to the social and economic norms enjoyed by most people. The approach adopted arguably helped to avoid over-classifying largely healthy people as having multiple conditions, while still ensuring that people’s own perspectives on their health were not under-privileged with respect to more traditional biomedically-focused approaches. However, it was also clear that the experiences of adults with multiple conditions are highly varied, and in particular, socially stratified. This heterogeneity has implications for research in this field, as well as clinical practice and public health policy. Recommendations for better reflecting this diversity in future studies included collecting more measures of functional capacity, aspirations, illness experiences, and social stressors (such as financial insecurity).

Adolescents spend a large proportion of their everyday life in school, and schooling is vital for future success and well-being. One group that are in risk for reduced school success are children with disabilities or long-term illnesses. The aim of this study is to investigate whether the factors age, gender, self-perceived relationship with teachers, self-perceived relationship with peers and parental bonding can predict school engagement of students with self-reported long term health conditions and impairment. School engagement is defined as having three aspects, behavioral, emotional and cognitive. HBSC (Health behaviors in School Children) data from Sweden is used. The result shows that self-perceived relationship with teachers and age are related to all three components of school engagement, behavioral, emotional and cognitive in this study.  Self-perceived relationship with peers is related to emotional school engagement only. Gender is related to cognitive engagement. Parent bonding cannot predict any of the three aspects of school engagement. This study demonstrated that school environment, especially teachers, is important for the school engagement of students with long-term health condition and impairment. Dispite the inconsistent results with previous reseach which focus on typical functioning students, School and educators should focus on how to maintain and improve and promote school engagement of students with long-term health condition and impairment in mainstream school setting.

Made available in DSpace on 2014-06-11T19:32:57Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-02-04Bitstream added on 2014-06-13T19:22:52Z : No. of bitstreams: 1 velosojunior_rr_dr_jabo.pdf: 691663 bytes, checksum: f6b98360dc2bdb01bfaffd1d7739d51e (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A importância dos psitacídeos como animais de estimação, o grande número de espécimes criados e os problemas desencadeados pela falta de informações sobre suas necessidades nutricionais em cativeiro, especialmente os aspectos relacionados à saúde a longo prazo das espécies com longa expectativa de vida, têm estimulado a comunidade científica ao aprofundamento sobre este tema. Os objetivos deste trabalho foram avaliar: os efeitos da inclusão de teores crescentes de fibra de cana (0, 7, 14 e 21%) sobre os coeficientes de digestibilidade aparente dos nutrientes, coeficiente de metabolização da energia bruta, energia metabolizável aparente e matéria seca das excretas; os processos de extrusão e peletização na produção de alimentos para araras; e o efeito das rações extrusadas ou peletizadas, com baixo e alto teor de fibra, sobre a ingestão de alimentos, parâmetros de bioquímica sérica e peso corporal. Foram utilizados 24 casais de Araras-Canindé. O ensaio de digestibilidade teve duração de 24 dias e adotou-se delineamento em blocos, com dois blocos de 24 unidades experimentais cada, em esquema fatorial 2 x 4 (dois tipos de processamento x quatro níveis de inclusão de fibra). O ensaio sobre os parâmetros de bioquímica sérica teve duração de 105 dias e foi utilizado delineamento inteiramente casualizado, num esquema em parcelas subdivididas, sendo as parcelas um fatorial (dois processamentos x dois níveis de inclusão de fibra x sexo das araras) e a subparcela, os resultados para o 25º e 130º dias de consumo das rações. Concluiu-se que a inclusão de fibra às rações e a diminuição da energia metabolizável resultam em redução linear na digestibilidade dos nutrientes, elevação no consumo de matéria seca e água, e redução nos níveis séricos de colesterol. Rações peletizadas demonstraramse melhores que as rações extrusadas, com menor... / The importance of parrots as pets, the growing number of specimens kept as pets and the problems caused by the lack of information about their nutritional needs in captivity, especially the aspects related to long-term health of species have a long life expectancy, has stimulated the scientific community to a depth on this topic. Our objectives were to assess: the effects of adding increasing levels of sugar cane fiber (0, 7, 14 and 21%) on apparent digestibility of nutrients, metabolism coefficient of gross energy, metabolizable energy and dry matter excreta, the processes of extrusion and pelletization to produce food for macaws and the effect of extruded or pelleted diets, with low and high fiber content on food intake, serum biochemical parameters and body weight. We used 24 pairs of blue and yellow macaw. The digestibility trial lasted 24 days and adopted block design with two blocks of 24 experimental units each in a factorial 2 x 4 (two types of processing x four levels of inclusion of fiber). The test on the parameters of serum biochemistry lasted 105 days and was used a randomized design in a split plot scheme, and the plots were a factorial (two processes x two levels of fiber x sex of macaws) and sub-plot, 25 th and 130 th days of consumption of rations. It was concluded that the inclusion of fiber in diets and the metabolizable energy decrease results in linear decrease in digestibility of nutrients, high in dry matter intake and water, and reduction in serum cholesterol. Rations proved to be better than the extruded feeds, less feed wastage and greater reduction in serum glucose and cholesterol. Diets for macaws should be based on metabolizable energy. And the reduction in energy and fat content of diets provides reduction in serum glucose, cholesterol and triglycerides, so excess energy and fat causes metabolic damage to Araras. The energy requirement ... (Complete abstract click electronic access below)

This thesis examines the relationship between childhood exposure to air pollution and long-term health. The research is based on an earlier study (1978-1986) that examined the relationship between exposure to air quality and respiratory health for a cohort of elementary school-aged children (n=3,202). These children resided in four distinct neighbourhoods in Hamilton, Ontario, which exhibited significant gradients in air pollution levels. Informed by the Life Course Health Development model, a survey was developed and administered on a reconstructed cohort (n = 395). The following objectives were addressed: 1) to determine the current health status of the reconstructed cohort; 2) to assess the potential relationship between childhood exposure to air pollution and adult respiratory health; and, 3) to explore factors mediating this relationship. Data was collected for a range of variables including residential and occupational histories, socio-demographic variables, and health outcomes. The dataset was merged with data from childhood on respiratory health, exposure to air pollution, and socio-demographic variables. Results indicate that a relatively high percentage of respondents had asthma in childhood (11%) compared to the original cohort (5.5%). In addition, prevalence rates of most health outcomes were higher than those of the Canadian population. Despite the gradient in air pollution levels, there were no significant differences in health status across neighborhoods. However, results of bi-variate and multi-variate analysis indicate possible significant associations between childhood exposure to S02 and hospital visits for asthma, asthma incidence in adulthood, and ever being diagnosed with asthma for females. For males, results suggest that childhood exposure to S02 is not linked to respiratory health. Factors related to the macro and micro environments also play significant roles in long-term health. This thesis made significant contributions to knowledge by suggesting that childhood exposure to S02 may impact long-term respiratory health for females, and may be linked to inflammatory diseases. / Thesis / Doctor of Philosophy (PhD)

Resumo: A importância dos psitacídeos como animais de estimação, o grande número de espécimes criados e os problemas desencadeados pela falta de informações sobre suas necessidades nutricionais em cativeiro, especialmente os aspectos relacionados à saúde a longo prazo das espécies com longa expectativa de vida, têm estimulado a comunidade científica ao aprofundamento sobre este tema. Os objetivos deste trabalho foram avaliar: os efeitos da inclusão de teores crescentes de fibra de cana (0, 7, 14 e 21%) sobre os coeficientes de digestibilidade aparente dos nutrientes, coeficiente de metabolização da energia bruta, energia metabolizável aparente e matéria seca das excretas; os processos de extrusão e peletização na produção de alimentos para araras; e o efeito das rações extrusadas ou peletizadas, com baixo e alto teor de fibra, sobre a ingestão de alimentos, parâmetros de bioquímica sérica e peso corporal. Foram utilizados 24 casais de Araras-Canindé. O ensaio de digestibilidade teve duração de 24 dias e adotou-se delineamento em blocos, com dois blocos de 24 unidades experimentais cada, em esquema fatorial 2 x 4 (dois tipos de processamento x quatro níveis de inclusão de fibra). O ensaio sobre os parâmetros de bioquímica sérica teve duração de 105 dias e foi utilizado delineamento inteiramente casualizado, num esquema em parcelas subdivididas, sendo as parcelas um fatorial (dois processamentos x dois níveis de inclusão de fibra x sexo das araras) e a subparcela, os resultados para o 25º e 130º dias de consumo das rações. Concluiu-se que a inclusão de fibra às rações e a diminuição da energia metabolizável resultam em redução linear na digestibilidade dos nutrientes, elevação no consumo de matéria seca e água, e redução nos níveis séricos de colesterol. Rações peletizadas demonstraramse melhores que as rações extrusadas, com menor ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The importance of parrots as pets, the growing number of specimens kept as pets and the problems caused by the lack of information about their nutritional needs in captivity, especially the aspects related to long-term health of species have a long life expectancy, has stimulated the scientific community to a depth on this topic. Our objectives were to assess: the effects of adding increasing levels of sugar cane fiber (0, 7, 14 and 21%) on apparent digestibility of nutrients, metabolism coefficient of gross energy, metabolizable energy and dry matter excreta, the processes of extrusion and pelletization to produce food for macaws and the effect of extruded or pelleted diets, with low and high fiber content on food intake, serum biochemical parameters and body weight. We used 24 pairs of blue and yellow macaw. The digestibility trial lasted 24 days and adopted block design with two blocks of 24 experimental units each in a factorial 2 x 4 (two types of processing x four levels of inclusion of fiber). The test on the parameters of serum biochemistry lasted 105 days and was used a randomized design in a split plot scheme, and the plots were a factorial (two processes x two levels of fiber x sex of macaws) and sub-plot, 25 th and 130 th days of consumption of rations. It was concluded that the inclusion of fiber in diets and the metabolizable energy decrease results in linear decrease in digestibility of nutrients, high in dry matter intake and water, and reduction in serum cholesterol. Rations proved to be better than the extruded feeds, less feed wastage and greater reduction in serum glucose and cholesterol. Diets for macaws should be based on metabolizable energy. And the reduction in energy and fat content of diets provides reduction in serum glucose, cholesterol and triglycerides, so excess energy and fat causes metabolic damage to Araras. The energy requirement ... (Complete abstract click electronic access below) / Orientador: Nilva Kazue Sakomura / Coorientador: Aulus Cavalieri Carciofi / Banca: Carlos Eduardo do Prado Saad / Banca: Manoel Garcia Neto / Banca: Euclides Braga Malheiros / Banca: José Mauricio Barbanti Duarte / Doutor

<p>Syftet med studien är att undersöka huruvida interna och externa variabler påverkar personers friskhet samt utreda hur långtidsfriska skiljer sig från övriga medarbetare. Undersökningen genomfördes med ett frågeformulär bland personal med olika arbetsuppgifter. 150 medarbetare besvarade enkäten. De undersökningsvariabler som ingår i den interna skalan är personlighetsdrag, locus of control, KASAM och optimism. Den externa skalan består av krav, kontroll, stöd, ledarskap samt organisationskultur. Resultatet visar att långtidsfriska är mer optimistiska, stresståliga och självsäkra än övriga. Den interna skalan har ett signifikant samband med långtidsfriskhet och ledarskap är den bästa prediktorn tillsammans med kontroll, optimism och locus of control. En slutsats är att både interna och externa variabler är viktiga för hälsan och för att nå friskhet är det viktigt att arbeta med alla delarna.</p> / <p>The purpose of this study is to investigate whether internal and external variables affect individual’s health and examine how long-term healthy people differ from other co-workers. The examination was carried out with a questionnaire among employees with different work. The internal scale contains variables of personality trait, locus of control, sense of coherence and optimism. The external scale contains demand, control, support, leadership and organizational culture variables. The result shows that long-term healthy people are more optimistic, self-confident and endure stress better than others. The internal scale has a significant relation with long-term health, and leadership is the best predictor for long-term health together with control, optimism and locus of control. One conclusion is that both internal and external variables are important for the health and it is important to work with all parts to achieve health.</p>

Syftet med studien är att undersöka huruvida interna och externa variabler påverkar personers friskhet samt utreda hur långtidsfriska skiljer sig från övriga medarbetare. Undersökningen genomfördes med ett frågeformulär bland personal med olika arbetsuppgifter. 150 medarbetare besvarade enkäten. De undersökningsvariabler som ingår i den interna skalan är personlighetsdrag, locus of control, KASAM och optimism. Den externa skalan består av krav, kontroll, stöd, ledarskap samt organisationskultur. Resultatet visar att långtidsfriska är mer optimistiska, stresståliga och självsäkra än övriga. Den interna skalan har ett signifikant samband med långtidsfriskhet och ledarskap är den bästa prediktorn tillsammans med kontroll, optimism och locus of control. En slutsats är att både interna och externa variabler är viktiga för hälsan och för att nå friskhet är det viktigt att arbeta med alla delarna. / The purpose of this study is to investigate whether internal and external variables affect individual’s health and examine how long-term healthy people differ from other co-workers. The examination was carried out with a questionnaire among employees with different work. The internal scale contains variables of personality trait, locus of control, sense of coherence and optimism. The external scale contains demand, control, support, leadership and organizational culture variables. The result shows that long-term healthy people are more optimistic, self-confident and endure stress better than others. The internal scale has a significant relation with long-term health, and leadership is the best predictor for long-term health together with control, optimism and locus of control. One conclusion is that both internal and external variables are important for the health and it is important to work with all parts to achieve health.

Bakgrund: Att undersöka äldres hälsa och välbefinnande med ett livscykelperspektiv ger insikter i hur tidiga livserfarenheter formar välbefinnandet senare i livet, vilket är det övergripande ramverket för denna empiriska studie. Studien betonar vikten av att förstå de komplexa faktorer som påverkar hälsa och välbefinnande hos äldre över livet från ett folkhälsoperspektiv. Med en ökande åldrande befolkning är det avgörande att adressera dessa faktorer för att främja hälsosamt åldrande. Studien utforskar äldres hälsa och välbefinnande genom ett livscykelperspektiv med en unik ansats, belyser hur samverkan mellan familjen, samhället och vetenskapen kan främja detta, med barnläkares perspektiv som en central komponent för att främja hälsa och välbefinnande under livets olika faser. Syfte: Syftet med denna studie är att undersöka sambanden mellan tidiga livsfaser och hälsa samt välbefinnande i äldre ålder. Genom att utforska hur barnläkares expertis inom pediatrisk utveckling och hälsa kan bidra till förståelsen av långsiktiga hälsoeffekter orsakade av barndomens förhållanden. Metod: För att besvara studiens syfte användes en kvalitativ metod med induktiv ansats. Datainsamlingen genomfördes genom semistrukturerade intervjuer med fem äldre barnläkare i Sverige som har minst två decenniers erfarenhet av klinisk verksamhet. Deltagarna valdes ut genom målinriktat urval. Den insamlade datan analyserades med en kvalitativ innehållsanalys med inslag av Grounded Theory. Resultat: Studien identifierar fyra huvudkategorier: Familjens och samhällets roll i barnets utveckling och hälsa, Reflektion över Barnets Utveckling och Livscykelperspektiv, Betydelsen av Tidiga Insatser och Förändring, samt Vetenskapens Ansvar i Barnets Utveckling och Hälsa. Resultaten av studien visar på barnläkares betydelsefulla insikter om livscykelperspektivet och understryker behovet av en multipel-aktörsansats genom att involvera både familjen, samhället och forskarsamhället i processen. Slutsats: Äldre barnläkares perspektiv på livscykelperspektivet ger en unik inblick i hur de sambandet barnets hälsa och välbefinnande i senare skeden av livet. Det understryks en vidgad förståelse av barns utveckling och hälsa med fokus på familjens generationsöverskridande interaktioner och samverkan. Vidare föreslås att en holistisk och multipel-aktörsansats som involverar familjen, samhället och forskargemenskapen är avgörande för att skapa gynnsamma förhållanden för barn och individer. / Background: Investigating the health and well-being of the elderly through a life cycle perspective provides insights into how early life experiences shape well-being later in life, which is the overarching framework for this empirical study. The study emphasizes the importance of understanding the complex factors affecting the health and well-being of older people over a lifetime from a public health perspective. With an increasing aging population, it is crucial to address these factors to promote healthy aging. The study explores the health and well-being of older people through a life cycle perspective with a unique approach, highlighting how the collaboration between family, society, and science can promote this, with the perspective of pediatricians as a central component for promoting health and well-being throughout the various stages of life. Aim: The purpose of this study is to investigate the connections between early life stages and health and well-being in older age. By exploring how pediatricians’ expertise in pediatric development and health can contribute to understanding the long-term health effects caused by childhood conditions. Method: To answer the study’s purpose, a qualitative method was used with an inductive design. Data collection was collected through semi-structured interviews with five senior pediatricians in Sweden who have at least two decades of clinical experience. Participants were selected through purposeful sampling. A qualitative content analysis, with elements of Grounded Theory was used to analysis the data. Results: The analysis resulted in four main categories: The Role of Family and Society in Child Development and Health, Reflection on Child Development and Life Cycle Perspective, The Importance of Early Interventions and Change, and The Responsibility of Science in Child Development and Health. The results of the study highlight the significant insights of pediatricians on the life cycle perspective and underscore the need for a multi-actor approach by involving both the family, society, and the research community in the process. Conclusion: The perspective of older pediatricians on the life cycle perspective provides a unique insight into how they connect child health and well-being in later stages of life. An extended understanding of child development and health with a focus on intergenerational family interactions and collaboration is emphasized. Furthermore, it is suggested that a holistic and multi-actor approach involving the family, society, and the research community is crucial to create favourable conditions for children and individuals.