In 2019, diabetes affected approximately 283,000 individuals, aged 20 years or younger, in the U.S. Due to illness symptoms (e.g., hypo/hyperglycemia) and disease-related complications (e.g., nephropathy), individuals report poor health-related quality of life. However, individual-level, family-oriented, and health care system factors may affect perceptions of a child’s overall health status. For example, beliefs of having spent enough time with the doctor may predict proactive health behaviors and perceptions of health. Overall health status may also be indirectly related to time spent in medical conversations. For instance, perceptions of shared decision-making (e.g., exploring pros and cons of treatments together) between families and providers may, in turn, foster family empowerment and resiliency (i.e., ability to adapt, cope, and overcome challenges) in the context of caring for a child with a chronic illness, with positive implications for perceived health status of their child. This study aims to examine the relationships of these variables. At the bivariate level, it was hypothesized that time spent in visits, shared decision making, family resilience, and perceived health status of the child would all be positively related. At the multivariate level, it was hypothesized that doctors working collaboratively with parents and family resilience would serially mediate the relation between time spent in medical visits and perceived health, such that more time spent with the doctor would be associated with perception of collaborative decision making and, in turn, higher levels of resiliency and better overall health status from parents’ perspectives. Utilizing data from the National Survey of Child and Adolescent Health from 2020-2021, this study examined survey responses from 369 parents of children with a reported diabetes diagnosis. Responses were extracted from a larger survey for questions related to time spent with providers in prevention focused visits, collaborative decision-making, family resilience, and health status of the child. Bivariate correlations and serial mediation analyses, per Hayes (2013), were conducted, covarying age, sex, ethnicity of child, health insurance, family structure, income, and education level of parents. Bivariate analyses showed some variables were significantly related in hypothesized directions (p < .05). In serial mediation analyses (10,000 bootstrapped samples), the total effect of time spent with the doctor on overall health status was nonsignificant (t = 0.7767, p = 0.4383), and the direct effect was also nonsignificant when mediators (i.e., collaborative decision making, family resilience) were added (t = 0.805 CI= -0.0044, 0.0122), indicating no serial mediation. Controlling for the effects of the other mediator, a significant indirect effect was found through collaborative decision making (t= 1.9181 CI = 0.0015-0.0940) but not family resilience (t = 0.9565 CI=-0.0059-0.478). This study demonstrates that collaborative decision making with parents mediates the relationship between time spent in preventative health care visits and overall health status. Changes such as policies that incentivize quality of care rather than number of billable visits, or establishment of patient centered medical homes, could support appointments of sufficient length that would allow for collaboration and, in turn, better perceived health status for those affected by diabetes.

Kurs: Examensarbete i logistik för Civilekonomprogrammet, 4FE19E, VT17 Författare: Martin Norén och Kristoffer Nählstedt Handledare: Hana Hulthén Examinator: Helena Forslund Titel: Hemtjänsten i Växjö kommun - En fallstudie om personal- och ruttplanering Bakgrund: Boendeformen särskilt boende har minskat påtagligt de senaste åren och förväntas minska ytterligare i framtiden. Samtidigt ökar andelen äldre som är i behov av vård och omsorg. Ett sätt att lösa detta är att förlägga omsorgsvården på hemtjänsten. För att klara sitt uppdrag använder hemtjänstenheter idag sig av olika planeringsverktyg som är tänkt att säkerställa att en kostnadseffektiv hemtjänst kan bedrivas samtidigt som den inte ska ge avkall på kvalitén av omsorg. Det ökade trycket på hemtjänsten kräver dock mycket resurser och det är idag svårt att klara av att nå upp till de interna målen som ställts på organisationen under denna föränderliga tid. Därför är det viktigare än någonsin med effektiva planeringsprocesser som kan underlätta och stödja hemtjänsten i sina åtaganden. Syfte: Syftet med studien är att effektivisera hemtjänstenheters planeringsprocesser. Avsikten med effektiviseringen är att uppnå en mer kostnadseffektiv hemtjänst som når måluppfyllelsen inom kontinuitet och brukartid. Metod: Studien är en fallstudie som genomförts i Växjö kommuns omsorgsenhet. Med hjälp av semi-strukturerade intervjuer, insamling av kvalitativ och kvantitativ data har studien kunnat inhämta empiriskt material. En processkartläggning genomfördes och författarna identifierade slöserier och presenterade sedan förbättringsförslag med stöd från åtskilliga teorier. Slutsatser: Författarna lyckades lägga fram förbättringsförslag på alla de tre planeringsprocesser som studien lyckades identifiera. Först lades förbättringsförslag av både kvantitativ och kvalitativ karaktär fram med avsikten att säkerställa kompetensförsörjningen i organisationen. I ruttplaneringsprocessen delade författarna upp hemtjänstenheten Vikaholm i två olika grupper baserat på dess geografiska placeringar och lyckades därigenom förbättra både kontinuiteten och brukartiden samtidigt som kostnaden sjönk för organisationen som helhet. Efter observationer och intervjuer på de olika arbetsgrupperna framkom slutligen fler förbättringsförslag på hur hemtjänstenheter skulle kunna arbeta för att effektivisera sin schemaläggningsprocess ytterligare. Nyckelord: Hemtjänst, äldreomsorg, kontinuitet, brukartid, planering, planeringsprocesser, processkartläggning, ruttplanering, prognostisering. / Course: Examensarbete i logistik för Civilekonomprogrammet, 4FE19E, VT17 Authors: Martin Norén and Kristoffer Nählstedt Tutor: Hana Hulthén Examiner: Helena Forslund Title: Home care for the elders in Växjö municipality - A case study about personnel and route planning Background: In Sweden the amount of people living in an assisted living have reduced significantly during the recent years and is predicted to be reduced even more. At the mean time the amount of elders in need of care is increasing. One way of solving this is by the use of home care. To handle its duty home care units use different kinds of planning tools to ensure quality of the care and that the home care is being cost efficient. The increased demand on the home care service requires a lot of resources and it is today very hard to achieve the internal goals which have been set up by the organisation. Therefore it is now more important than ever with efficient planning processes that can ease and support the home care service in its obligations. Purpose: The purpose of the study is to streamline the planning process in elder care units. The streamlined planning process intends to achieve a more cost efficient elder care, that achieves the objectives concerning continuity and time spent with the elders. Method: The study is a case study, which have been carried out in the municipality of Växjö. With the use of semi-structured interviews, gathering of qualitative and quantitative data the study have been able to obtain empirical material. In order to identify waste the authors used process mapping and then later on proposed improvements with support from a number of theories. Conclusions: The authors managed to propose improvements on all of three identified planning processes. Firstly, the study presented the proposed improvements on the process of ensuring competent personnel with the use of both qualitative and quantitative data. In the route planning process the authors split the home care unit of Vikaholm into two units, based on the locations of the elders. Thereby the authors managed to improve all of the three main goals of the home care unit; continuity, economy and the amount of time the care takers spend with the elders. Observations and interviews on the different units lead to the conclusion of potential improvements on how home care units could work to be more efficient in their scheduling processes.  Keywords: Home care, elder care, time spent with the elder, planning, process planning, process mapping, route planning, forecasting.

Sociological Research of TV Audience Behaviour Factors Determining The Time Spent Watching TV ABSTRACT The thesis deals with the phenomenon of TV viewing and with TV audience behaviour research. The theoretical part demarcates watching TV within leisure activities and deals with the question of motivation for watching TV as well. It also mentions the approach of people who intentionally try to exclude TV from their life. The text does not omit even the important contemporary determinants of watching TV - Internet and digitization of TV broadcasting. Subsequently, the main methods of TV audience behaviour research in the Czech Republic are introduced. In the empirical part, the main factors that most affect the time spent watching TV are being identified - first through separate elementary analyses and afterwards through searching for a regression model that would best predict the time spent watching TV for individuals and groups based on their socio-demographic and other characteristics. Keywords: television, time spent watching TV, watching TV, ATS, Peoplemeter, TVmeter, TV viewer, TV audience behaviour research

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Heat-related illnesses and deaths are significant public health problems. Extreme heat is the No.1 deadliest form of weather on average in 1990-2019 in the US according to the National Weather Service. Measurements and forecasts made at regional weather stations are a common data source of Heatwave Early Warning Systems. However, regional weather stations provide inaccurate estimates of the heat index that people experience in different microclimates. Introducing a direct measurement of heat index experienced by individuals via wearable sensors will allow more accurate exposure assessment and identification of factors associated with dangerous exposures to extreme heat. The goal of this dissertation is to characterize the individually experienced heat index exposure via wearable sensors in an urban and a rural location in summer in a southern part of the United States. In the first study, 51 outdoor workers in Birmingham, Alabama wore a small thermometer attached to their shoe. Their occupational Wet Bulb Globe Temperatures (WBGT), a comprehensive heat exposure index, was estimated from either temperature from the shoe thermometers or nearby weather stations. In the second and third studies, 88 urban participants and 89 rural participants completed a seven-day intervention where they performed normal activity on Days 1-2 and spent an additional 30 minutes outdoors daily on Days 3-7. Participants wore a small thermometer attached to the shoe and a pedometer at their waist to track steps. Neighborhood hygrometers/thermometers were deployed close to participants' homes to measure neighborhood level heat indexes. In the fourth study, we conducted a phone survey including 101 participants in the same urban and rural locations to examine how their heat-health behaviors changed due to COVID-19 and high profiles of police brutality cases in Summer 2020 compared to previous summers. The results demonstrated that (1) a wearable thermometer on the shoe was a feasible way to measure individually experienced temperatures; (2) among outdoor workers, WBGT from shoe thermometer temperatures estimated more hours in dangerous exposure categories and recommended more protective work-rest schedules compared to WBGT from weather station temperatures; (3) neighborhood level heat indexes improved the prediction of individually experienced heat indexes compared to weather station data alone; (4) rural participants experienced higher heat index exposures than urban participants, after accounting for ambient conditions; (5) spending a small amount of additional time outdoors was a feasible and effective intervention where participants walked more steps and had lower individually experienced heat indexes during the intervention days compared to baseline days; (6) a significantly lower percent of participants reported they would use public cooling centers in Summer 2020 compared to previous summers. Taken together, the results of these studies identified methods for more accurate heat exposure assessment and its application in monitoring heat-safety while promoting physical activity via time spent outdoors in the summer. Future work could incorporate physiological response monitoring linked to simultaneous individually experienced heat exposure to further characterize exposure-response relationships across different populations. Additionally, a longer intervention and more advanced wearable devices such Fitbit, Apple Watches could be used to monitor sustainability of the intervention and intervention benefits beyond short term increases in physical activity, respectively. / Doctor of Philosophy / Extreme high temperatures/humidity can bring dangerous adverse effects in people. Extreme heat is on average the deadliest form of weather in 1990-2019 in the US estimated by National Weather Service. Heatwave Early Warning Systems are introduced to closely monitor extreme heat events, estimate the magnitude of health consequences due to extreme heat, send warning messages to vulnerable populations, and trigger response plans to reduce the dangerous health effects of heat. Heatwave Early Warning Systems generally rely on the measurement and forecasts from regional weather stations. However, the temperature/humidity measurements made at weather stations can be different from the temperature/humidity people experience. People can live far away from weather stations and they move through indoor and outdoor locations, where weather station measurements will not represent temperatures experienced, particularly in climate-controlled indoor settings. Therefore, we recruited participants in an urban and a rural location and had each participant wear a small thermometer clipped to their shoe to directly measure the temperature they experienced as they went about their normal activities. In the first study, 51 outdoor workers wore this small thermometer on their shoe at work. We calculated a comprehensive heat exposure index from either the shoe thermometer temperatures or nearby weather station temperatures. In the second and third studies, 88 urban participants and 89 rural participants completed a seven-day intervention where they performed normal activities on Days 1-2 and spent an additional 30 minutes outdoors daily on Days 3-7. Participants wore the small thermometer clipped to the shoe and a pedometer at their waist to track how many steps they walked. We placed temperature/humidity sensors close to participants' homes to take measurements at a neighborhood level. In the fourth study, we conducted a phone survey including 101 participants in the same urban and rural locations to examine whether they had different cooling methods due to the COVID-19 pandemic and high profiles of police brutality cases in Summer 2020 compared to previous summers. The results demonstrated that (1) a small thermometer clipped on the shoe was a feasible way to measure temperatures at the individual level; (3) among outdoor workers, the comprehensive heat exposure index using temperatures from the shoe thermometers estimated more hours when outdoor workers were at a risk of dangerous exposure to extreme heat, and it recommended more rest time for workers to cool off compared to using weather station temperatures alone; (3) neighborhood level temperature/humidity was more representative of the temperatures recorded from thermometers on the shoe compared to nearby weather stations; (4) rural participants experienced higher temperature/humidity than urban participants, even when their nearby weather station temperature measurements were the same; (5) spending a small amount of additional time outdoors is a feasible and effective intervention where participants walked more steps and experienced lower temperature/humidity during the intervention days compared to baseline days; (6) a smaller number of participants reported they would use public cooling centers/spaces (e.g., air-conditioned library, air-conditioned churches, waterparks) to cool down due to fear of contracting COVID-19 and safety concerns brought by the high profiles of police brutality cases in Summer 2020 compared to previous summers. Taken together, the results of these studies showed that the wearable thermometers clipped on the shoe could provide more accurate assessment of temperatures experienced by participants compared to weather stations. This method could be used in future outdoor time interventions to monitor and ensure participants safely spend time outdoors while minimizing the risk of heat-related illness. In future work, more advanced sensors (e.g., Fitbit, Apple Watch) can be worn by participants to measure physiological responses across different temperatures experienced. Additionally, a longer intervention time can be used to test if participants would continue to spend additional time outdoors.

Background: In many developing countries, maternal deaths occur mainly as a result of unsafe abortions, a situation reflecting the inaccessibility of safe abortion services in such countries. In Ethiopia, unsafe abortion accounts for 32% of maternal deaths and almost 60% of gynaecological admissions, and is one of the top ten causes of general hospital admissions. Purpose: The purpose of this study was to assess the views of women about the accessibility of safe abortion services in governmental health centres. Methods: A quantitative cross-sectional descriptive and non-experimental study using structured questionnaires was conducted. 342 women who had received abortion care services in governmental health centres participated. Findings: 46.8% of the participants do not know about the penal code regarding safe abortion care. 52.9% of the participants viewed safe abortion care as inaccessible because there are various and competing factors which make abortion service to be viewed as accessible or inaccessible and these include distance to nearest health centre, the time it takes to receive the service, the cost of the service, and the lack of appropriate skills in the service providers. Conclusion: An improvement in the accessibility of abortion services will prevent deaths resulting from unsafe abortions / Health Studies / M.A. (Public Health)

Background: In many developing countries, maternal deaths occur mainly as a result of unsafe abortions, a situation reflecting the inaccessibility of safe abortion services in such countries. In Ethiopia, unsafe abortion accounts for 32% of maternal deaths and almost 60% of gynaecological admissions, and is one of the top ten causes of general hospital admissions. Purpose: The purpose of this study was to assess the views of women about the accessibility of safe abortion services in governmental health centres. Methods: A quantitative cross-sectional descriptive and non-experimental study using structured questionnaires was conducted. 342 women who had received abortion care services in governmental health centres participated. Findings: 46.8% of the participants do not know about the penal code regarding safe abortion care. 52.9% of the participants viewed safe abortion care as inaccessible because there are various and competing factors which make abortion service to be viewed as accessible or inaccessible and these include distance to nearest health centre, the time it takes to receive the service, the cost of the service, and the lack of appropriate skills in the service providers. Conclusion: An improvement in the accessibility of abortion services will prevent deaths resulting from unsafe abortions / Health Studies / M.A. (Public Health)