Sammanfattning  Bakgrund Malnutrition är vanligt förekommande bland äldre och speciellt hos sjuka äldre. Rekommendationerna kring hälsosamt kroppsmasseindex (BMI) är högre för äldre personer. Faktorer som påverkar matintaget hos äldre är aptit, sjukdom och måltidssituation.  Syfte Att studera olika aspekter av måltidssituationen på ett kommunalt äldreboende Dorotea kommun.  Metod En vägd kostregistrering på gruppnivå genomfördes under en femdagarsperiod. Maten som intogs energi- och näringsberäknades med hjälp av Dietist XP, jämförande statistik analyserades i SPSS. Halvstrukturerade intervjuer utfördes med personal. Intervjuerna spelades in, transkriberades och analyserades med kvalitativ innehållsanalys enligt Graneheim och Lundman. Även måltidshantering och måltidssituation observerades.  Resultat Maten som vägdes intogs av 26 boende i den kvantitativa undersökningen. Intaget av protein, kostfiber och vitamin D låg signifikant lägre än rekommendationerna. Intaget av energi, kolhydrater, fett och kalcium nådde rekommendationerna. Personalen uppgav att utseende, smak och mängd på tallriken påverkade matintaget. Fokus låg på trivseln för de boende. För förbättrad måltidssituation föreslog intervjuad personal större avdelningsmatsal, förändrad måltidsordning för minskad nattfasta, fler tillfällen för önskemåltider samt mer matlagning från grunden.  Slutsats Intaget av protein, kostfiber och vitamin D var betydligt lägre än rekommenderat samtidigt som det totala intaget av energi, kolhydrater, fett och kalcium nådde rekommendationerna. Ett kostdataprogram skulle därför vara ett behjälpligt verktyg för att bättre kunna anpassa energi- och näringsinnehållet till de boendes behov. Utifrån personalens erfarenheter uppskattades måltiderna av äldreboendets bofasta. Måltidsmiljön på de undersökta avdelningarna kan förbättras med exempelvis en utbyggnad av matsal samt genom förbättrad belysning.

The occurrence of pre-existing type 1 and type 2 diabetes in pregnancy has been on the rise, parallel with the current “diabetes pandemic” (Albrecht et al., 2010; Coton et al., 2016; Feig et al., 2014; The Lancet, 2011). Currently, pre-existing diabetes affects up to 2.4% of pregnancies around the world (Deputy et al., 2018; Fadl & Simmons, 2016; Lopez-de-Andres et al., 2020; Tutino et al., 2014; Wahabi et al., 2017). Importantly, women with type 1 and type 2 diabetes are at a high risk of experiencing perinatal complications. Perinatal complications range from neonatal hypoglycemia to fetal and infant death (Feig et al., 2014; Kishida et al., 1989). The risk of complications is related to maternal glycemia; maintaining tight glycemic control within the recommended ranges for pregnancy is associated with a reduced risk of adverse outcomes (Feig et al., 2018; Inkster et al., 2006; Tennant et al., 2014). To achieve this, women experience a heavy burden of diabetes self-management during pregnancy. Little is known regarding the predictors of glycemic control during pregnancies complicated by type 1 and type 2 diabetes and their relationship with self-management factors, such as self-efficacy. Furthermore, the impact of these factors in combination with women’s pregnancy experiences has not been explored. The objective of this thesis was to explore how self-management and support experiences help explain glycemic control among women with pre-existing diabetes in pregnancy. There were four overarching questions: (a) What are the predictors of glycemic control during pregnancy among women with pre-existing diabetes? (b) What is the experience of managing diabetes during pregnancy? (c) What are the diabetes self-management education and support needs during pregnancy among women with pre-existing diabetes? (d) How do the self-management and support experiences of women with pre-existing diabetes in pregnancy help explain their glycemic control? The results of this sandwich thesis aim to answer these questions. The findings showed that women achieved tight glycemic control during pregnancy as they were motivated by the worry of complications for their unborn child. Fear related to complications, feeling unsupported by the healthcare team and a lack of connection with other mothers with diabetes contributed to compromised mental health. Future research should explore the development, implementation and evaluation of interventions to increase mental health support, peer support and support from the healthcare team for this vulnerable population. / Thesis / Doctor of Philosophy (PhD) / Expectant mothers with type 1 and type 2 diabetes have a high risk of complications related to their glucose levels during pregnancy. The relationship between glucose control, mothers’ self-confidence in managing diabetes and their experiences during pregnancy is not well understood. This study explored the factors that affect glucose control and their relationship with the support needs during pregnancy of mothers with type 1 and type 2 diabetes.

In this thesis I contribute to the growing literature on the structure of covert networks by exploring the organisation and functioning of two new groups. (1) The Right Club, a Right-wing, Pro-German group active in the UK at the outbreak of World War Two, and (2) The leadership group of the Provisional Irish Republican Army (PIRA) between 1969 and 1986. Specifically, I focus upon the formation of these groups, and how, and indeed if, they maintained covertness in practice. Whilst there has been a wealth of research in this area, many studies simply assume covertness and its impact upon structure due to the illegal nature of their case studies. In this thesis I develop a more nuanced concept of covertness, and a more detailed analysis of the myriad factors which affect the structure of a clandestine group. I employ a mixed methods approach combining Social Network Analysis with qualitative inquiry of the environment and processes which influence the functioning of each group. The qualitative analysis, which was guided by factors identified in the existing covert networks literature, in the Social Movements literature, and by dynamics noted in work on the Sociology of Secrecy, is used to explore and explain the sociometric findings. This provides a more in-depth, more sociological understanding of clandestine organisation than that which currently exists in this field of research. However, more and varied case studies analysed in this way are also necessary if we are to improve our understanding of the structure and functioning of covert groups. With this knowledge more sensitive and successful deradicalisation and/or destabilisation techniques can be crafted.

Background: Recognition of the significance of psychological trauma and its impact on individuals, families, communities, and society at large has greatly expanded over the past 20 years, calling for the need to develop both trauma-sensitive and trauma–responsive services. Nurses, as direct care providers who work within a holistic perspective, are positioned to play an integral role in the advancement of ‘trauma-informed care’ within healthcare services. Objectives: The specific objectives of this thesis were: a) to describe the use of social media (Facebook and LinkedIn) in the recruitment of Registered Nurses for an online survey, and b) to explore and describe the understandings and experiences related to trauma and trauma-informed care among nurses that scored the highest on this scale. Method: This was a two-phase study design using mixed methods. Phase One consisted of an online quantitative self-report survey. Participants were recruited via social media with the aim of examining nurses’ attitudes related to trauma-informed care. Phase Two consisted of a qualitative study exploring nurses’ knowledge and experiences related to trauma-informed care. The studies were conducted using a sequential approach; that is, the target sample for Phase Two (qualitative study) was identified based on the results of the survey (Phase One). Findings: From the first phase of this research, I proposed that social media, and specifically Facebook and LinkedIn, offer suitable platforms for recruiting a diverse sample of Registered Nurses to complete an online survey. Associated advantages and challenges as well as specific differences between Facebook and LinkedIn as recruitment platforms should be considered when incorporating these strategies. Four main categories emerged from the second phase of the research: “(Not)Knowing Trauma-Informed Care”, “Conceptualizing Trauma and Trauma- Informed Care”, “Nursing Care in the Context of Trauma”, and “Dynamics of the Nurse-Patient Relationship in the Face of Trauma”. These findings highlight important considerations for trauma including, the complex dynamics of trauma that affect care, the importance of both knowing trauma as a concept, but also knowing how to act in response to trauma knowledge, the need to facilitate trauma-informed care beyond mental healthcare, and the parallels between nursing and trauma-informed care. Conclusion: This Master’s thesis has explored the use of a novel survey recruitment strategy as well as emphasized the need for nurses and organizations to incorporate trauma-informed principles in the services they provide, and in their cultures as a whole. This research reinforces that the discipline of nursing is aptly situated to apply tenets of trauma-informed care and that we must further the progression of trauma-informed care in practice, policy, education, and research.

With the increase in frequency of the use of mixed methods, both in research publications and in externally funded grants there are increasing calls for a set of standards to assess the quality of mixed methods research. The purpose of this mixed methods study was to conduct a multi-phase analysis to create a preliminary rubric to evaluate mixed methods research articles. This study included four research questions: 1. What are the common evaluation criteria found in the contemporary methodological literature pertaining to the design of mixed methods research? 2. What evaluation criteria do experts in the field of mixed methods research perceive as the most important when distinguishing top-quality research in mixed methods? 3. What differences are there in the outcome of the rubric for evaluating mixed methods research identified from the literature compared to those advocated most uniformly by a panel of mixed methods research experts? 4. What are disciplinary differences between the use of mixed methods and views about evaluating it, including the role of paradigms in mixed methods research? In the first phase of this multi-phase mixed methods study I used an inductive qualitative process to identify the quality criteria endorsed by 12 methodologists with a long-term involvement in mixed methods research. In the second phase of this study I conducted a quantitative analysis to pilot test a set of criteria identified in the qualitative phases. The sample for both phases of this study was comprised of the same eight males  and four females from multiple nationalities. Respondents to the on-line survey rated all 14 items as being important, with 11 of the 14 items being rated as very important or higher. When considered together, findings from the two phases of this study provide a interesting view of attitudes about the use and application of quality standards to the mixed methods literature. While there was agreement about what elements were important to evaluate, there was not an agreement about the idea that one set of standards could be applied to all mixed methods studies. / Ph. D.

Despite growing interest in maternal oral health, research aimed at this population is scant. To date, no qualitative studies of adolescent maternal oral health exist. Therefore, the purpose of this descriptive, exploratory, concurrent, mixed-methods study was to explore oral health status, beliefs, and practices, and pregnancy and parenting outcomes in this population by triangulating both quantitative and qualitative data. A non-probability, convenience sample of 46 pregnant and parenting adolescents was recruited. Five questionnaires were administered and visual oral examinations were conducted. Twenty-four of these 46 participants also participated in the qualitative component of the study. Adolescents in this study were both pregnant (n = 20; 43.5%) and parenting (n = 26; 56.5%), and primarily of Hispanic decent (n = 38; 83%). Of the 20 adolescents who were pregnant, four had been told by a nurse or physician that they had a pregnancy complication(s). Among the parenting adolescents, the most common past pregnancy complications were self-reported as prematurity (n = 6; 35%) and high blood pressure (n = 3; 18%). Thirty-three (72%) participants reported ever having dental insurance. While 16 (35%) participants had seen a dentist in the past 6 months, another 15 (33%) did not recall their last dental visit. One adolescent reported never having been to a dentist. Associations among visual oral health status and selected contextual variables were non-significant, which may be attributed to the small sample size. However, moderate significant correlations were found between social connectedness and oral-health-related quality of life, as well as between visual oral health status and measures of self-reported dental health. For the qualitative component, six themes related to oral health value and well-being, oral health knowledge, practices, myths, and barriers to accessing oral health services emerged. Triangulation of the quantitative and qualitative data did not produce statistical significance; however, discrepancies were found between the overall objective, visual oral health status, and the subjective perception of oral health status, which supports the overall findings. Future research should focus on larger studies to further explore associations between social connectedness, oral-health-related quality of life, and objective and subjective measures of oral health status and behaviors. / text

This thesis examines the relationships people have with rubbish in everyday life. Focusing on domestic recycling policy and practice, environmental concern and action is explored as a sociological problem in a way that moves beyond the individualising paradigms that dominate environmental discourse for behavioural change. In its place, this thesis argues that better explanation may reside in the social context of embedded practices, and how they get enacted in daily life. Beginning with a historical overview and evaluation of current policy, this thesis re-imagines domestic recycling as a complex socio-technical system involving the engagement of different actors. Conducted at the boundaries of sociology, this thesis draws on empirical and theoretical ideas that extend across disciplines. Methodologically the research has been grounded on a principle of mixed methods pragmatism, exploiting the Sequential Explanatory mixed methods research design. Conducted across two phases, Phase One involved the secondary analysis of the Scottish Household Survey and Phase Two the collection and analysis of qualitative data using the Diary- Interview method. The first phase was a macro- analysis of recycling practices in Scotland. The main results of this analysis are presented in Chapter 4, which built a Binary Logistic Regression model, using the Scottish Household Survey, to predict the characteristics of Scottish households likely to engage in recycling behaviour. In addition to identifying the social and structural dimensions of recycling in Scotland, this analysis also enabled a research site to be selected for Phase Two of the study. Chapters 5 and 6 respond to the macro- analysis by accounting for the micro- aspects of recycling practices by looking at the problem inductively. Using qualitative data analysed in Phase Two, these two chapters are based on the idea that how people value the environment is relevant for understanding contemporary recycling practices. Chapter 5 considers the explanatory usefulness of environmental ethics, values and citizenship for explaining why some households engage in environmental behaviour, but others do not. In Chapter 6 these arguments are developed further with a more detailed discussion about how household recycling practices get enacted in everyday life. Using evidence from the data, this chapter considers why commitment to ‘doing’ recycling varies between people and examines recycling as formed, cultivated and maintained habitual behaviour. Taken together the three data chapters try to show that, rather than be an inconsequential feature of normal domestic life, recycling is a practice deeply-rooted in wider social patterns and structural forces. In the final chapter, all of the micro- and macro- findings are integrated together and concluded, along with some reflections on the multidimensionality of contemporary recycling practices in the home, and what this might mean for policy and future research.

The client for this study, the Entheogenic Research, Integration, and Education (ERIE), was interested in the use of anthropological methods to examine the experiences of people who use psychedelics beyond the clinical setting. Through collaborative discussions with the client, we decided that the central questions guiding this research are to understand the various reasons why people consume psychedelic substances across the United States as well as examine the self-reported influences of psychedelics in various areas of participants' life and identity. Participants were recruited using stratified sampling and were given a confidential, online survey that also provided an option to arrange a semi-structured interview. In total, there were 103 completed survey responses and 25 interviews. The results of this research indicate that the reasons for participants' psychedelic use often change over time from strictly recreational or out of curiosity to intentions based on therapeutic and psychospiritual development. Additionally, the majority of both survey and interview participants believed their psychedelic use to have had a transformative influence on their health and well-being, perception of nature, identity, spirituality, and creative expression of art and music. Another theme uncovered in this research is the impacts of punitive drug laws on psychedelic use such as creating barriers to availability, fear of arrest and incarceration, and lack of social support due to the stigma associated with psychedelic substances.

acase@tulane.edu / This dissertation research brings together disparate bodies of literature on environmental inequality, sociology of space, and feminist theories of intersectionality to bear on the location and distribution of environmental hazards in the form of landfills. Landfills pose a threat to both ecological sustainability as well as present risks to human health through contamination and pollution. While environmental inequality literatures have executed exceptional work into the dynamics of race and class with respect to the distribution of hazardous waste facilities, the literature is noticeably lacking with respect to identifying relationships between gender and environmental inequalities. Furthermore, many quantitative studies have exclusively focused on hazardous waste facilities as a singular measure of environmental inequality. This study advances the field in three major ways. First, through the inclusion of theorizations based on feminist intersectionality theories, this research empirically analyzes hypotheses derived from intersectionality theories to understand dynamics of gender-environment interactions. Second, this study extends analysis to all forms of waste containment—municipal, industrial, construction and demolition, and hazardous—to identify trends across the social fabric of the contiguous United States at the county level of analysis with respect to multiple forms of environmental hazards. Third, utilizing innovative analytic techniques, this research provides three unique and related strategies, geographic information systems, logistic binary regression, and structural equation modeling, to examine socio-environmental disparities. Findings from each analytic strategy inform the subsequent strategy. Findings suggest the importance of including gender indicators to account for the unique effect of gender and environmental inequality. Furthermore, results indicate the importance in applying intersectionality theories to environmental outcomes as well as empirically testing hypotheses derived from the largely theoretical and qualitatively backed field. Future research should focus on specific regional dynamics of identified socio-environmental interactions by including historical and qualitative data to triangulate quantitative findings. / 1 / Clare Cannon

From Policy to Practice: Implementation of Georgia’s Medicaid Family Planning Waiver Program Sarah C. Blake, MA 282 pages Directed by Dr. John Thomas The purpose of this research was to examine the implementation of Georgia’s Medicaid family planning program, known as Planning for Healthy Babies® or P4HB®. This program is the first such program to provide both family planning services and inter-pregnancy care services through a Medicaid expansion to low-income, uninsured women. An evaluative case study design was employed using mixed methods. These methods incorporated process measures to study the implementation of P4HB® and to assess whether P4HB® was implemented as planned We incorporated theory from the policy implementation and health care access literatures to understand what served as facilitators or barriers to successful implementation. Findings suggest that despite precise goals and objectives, formal guidance about the program did not incorporate clear implementation planning. Many stakeholders, including advocates, providers, and representatives from implementing agencies felt left out of the implementation process and did not feel invested in the program. Considerable confusion existed among eligible clients and providers about the nature and scope of the P4HB® program. This lack of awareness and understanding about P4HB® likely contributed to the program’s low enrollment and participation in the first year of its implementation. As many states prepare to expand their Medicaid programs under the Patient Protection and Affordable Care Act (ACA), this study provides important lessons for policy planning and implementation.