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.

This thesis in an invistigation into the concept of "harm" and its moral relevance. A common view is that an analysis of harm should include a counterfactual condition: an act harms a person iff it makes that person worse off. A common objection to the moral relevance of harm, thus understood, is the non-identity problem. This thesis criticises the counterfactual condition, argues for an alternative analysis and that harm plays two important normative roles. The main ground for rejecting the counterfactual condition is that it has unacceptable consequences in cases of overdetermination and pre-emption. Several modifications to the condition are considered but all fail to solve this problem. According to the alternative analysis to do harm is to perform an act which (1) is responsible for the obtaining of a state of affairs which (2) makes a person’s life go worse. It is argued that (1) should be understood in terms of counterfactual dependence. This claim is defended against counterexamples based on redundant causation. An analysis of (2) is also provided using the notion of a well-being function. It is argued that by introducing this notion it is possible to analyse contributive value without making use of counterfactual comparisons and to solve the non-identity problem. Regarding the normative importance of harm, a popular intuition is that there is an asymmetry in our obligations to future people: that a person would have a life worth living were she to exist is not a reason in favour of creating that person while that a person would have a life not worth living is a reason against creating that person. It is argued that the asymmetry can be classified as a moral option grounded in autonomy. Central to this defence is the suggestion that harm is relevant to understanding autonomy. Autonomy involves partly the freedom to pursue one’s own aims as long as one does no harm.

Syfte och frågeställningar Det övergripande syftet med denna studie är att undersöka hälsan hos unga religiösa kristna och muslimska kvinnor. Syftet kommer undersökas utifrån följande frågeställningar: Hur ser unga religiösa kristna och muslimska kvinnors hälsa ut kopplad till rekommendation för fysisk aktivitet och definitioner för social och psykisk hälsa? Hur upplever unga religiösa kristna och muslimska kvinnor att religionerna påverkar deras hälsa?  Vilka likheter och skillnader finns det mellan unga religiösa kristna och muslimska kvinnor då det gäller hälsan och den upplevda påverkan av religionerna? Metod Studien är en kvalitativ jämförande studie som är baserad på sex halvstrukturerade intervjuer. Respondenterna var tre religiösa kristna kvinnor och tre religiösa muslimska kvinnor mellan 22 och 28 år och boende Stockholm. Intervjuerna var djupgående och mellan 30 och 60 minuter långa. De spelades in och transkriberades ordagrant för att sedan noggrant analyseras. Resultat Samtliga respondenter levde upp till definitionerna för social och psykisk hälsa. Dock levde endast en av muslimerna men samtliga kristna upp till rekommendationen för fysisk aktivitet. Båda religionerna upplevdes påverka hälsan övervägande positivt. Den sociala hälsan påverkades av gemenskap, den fysiska hälsan genom uppmuntran till att sköta om sin kropp och den psykiska hälsan genom att respondenterna upplevde meningsfullhet, trygghet samt hjälp och stöd. Endast små skillnader kunde ses i hur religionerna upplevdes påverka hälsan. Slutsats Denna studie visar på att kristendom och islam erbjuder samma positiva påverkan av hälsan. Om man endast såg till sätten religionerna främjade hälsa på skulle det vara svårt att avgöra vilken religion som var vilken. / Aim The overall purpose of this study is to examine the health of religious young Christian and Muslim women. The aim is explicated through the following questions: What is the state of young religious Christian and Muslim women's health linked to recommendation for physical activity and definitions for social and mental health? How do young religious Christian and Muslim women perceive that the religions affect their health? What similarities and differences are there between young religious Christian and Muslim women regarding health and the perceived affects from the religions? Method The study is a qualitative comparative study based on six semi-structured interviews. The group of respondents consisted of three religious Christian women and three religious Muslim women, all between 22 and 28 years and living in Stockholm. The interviews were profound and between 30 and 60 minutes. They were recorded and went through verbatim transcription as well as careful analysis. Results All respondents lived up to the definitions of social and mental health, however, only one of the Muslims but all Christians lived up to the recommendation for physical activity. The perceived influence both religions had on their health were, all in all, positive. The social health was influenced by solidarity, the physical health through encouragement to take care of the body and the mental health by receiving meaningfulness, safety and help and support. Only small differences could be found in how the religions perceived to influence their health. Conclusions This study indicates that Islam and Christianity offer the same positive health effects. If one only were to see the ways the religions promoted health, it would be hard to tell the difference.

Munnen är en viktig del av kroppen, men trots det så blir den lätt skild från övriga kroppen och placerad i en egen kategori. Komplikationer kan uppstå om inte munvården sköts och därför är det viktigt att sjuksköterskan har kunskap om munhälsa. Hur människor uppfattar sin munhälsa är individuellt och kan ge bra underlag i omvårdnadsarbetet. Syftet var att beskriva sjuksköterskans och patientens syn på munhälsa och dess påverkan på välbefinnandet. Arbetet genomfördes som en litteraturstudie och 13 artiklar användes till resultatet. Resultatet visade att munvård ofta blev bortprioriterat i omvårdnadsarbetet då andra arbetsuppgifter ansågs som viktigare. Patienter uppfattade sin munhälsa på olika sätt, munproblem påverkade välbefinnandet negativt. Vårdpersonalen och patienterna utvärderade munhälsan olika och om patienten inte hade några uppenbara problem så uppmärksammades den inte. Det behövs mer utbildning för vårdpersonal inom munhälsa. Även mer forskning om munhälsa och munvård behövs för att fördjupa sjuksköterskans omvårdnadsarbete och sjuksköterskor bör vara medvetna om att munnen är ett bortglömt område som behöver lyftas fram.

This review is an exploration of evolutionary theories with the aim to investigate emotional states, well-being and ill-being from an evolutionary perspective. Functional evolutionary theories of emotional states, posit that emotions have evolved as behavior modifiers responding to specific situations that provided fitness benefits in our ancestral past. Exploring this theory gradually uncover clues towards practical, hands-on suggestions as to how to increase life satisfaction and quality of life. Specifically, these suggestions include interacting with kin, reaping stress-reducing and health effects from letting nature be a part of your life, developing deep friendships, and not comparing yourself with the best or most successful individuals in the world.

Typ-2-diabetes är en kronisk välfärdssjukdom som är associerad med livsstilsförändringar. Omvårdnaden av typ-2-diabetes har traditionellt förknippats med egenvård och patientinformation. Det finns en stor kunskap om typ-2-diabetes och vilka konsekvenser det medför. Det är viktigt att Hälso- och sjukvårdspersonal även har kunskap om människors personliga upplevelser av hälsa och välbefinnande vid typ-2-diabetes. Det finns annars en risk att hälso- och sjukvårdpersonalen fokuserar för mycket på sjukdomen och missar den unika sjukdomsupplevelsen. Syftet med denna studie är att beskriva människors upplevelser av att leva med typ-2 diabetes. Metoden som valdes hade en kvalitativ ansats där data samlades in genom intervjuer. Intervjuerna transkriberades och analyserades utifrån kvalitativ innehållsanalys. Resultatet utmynnande i ett överordnat tema balans mellan Trygghet – Otrygghet och aktiviteter som krav och möjligheter ger hanterbarhet. Temat beskrivs utifrån två huvudkategorier och beskrivande underkategorier. Studien visar att människor med typ-2-diabetes generellt erfar en god hälsa och ett gott välbefinnande utifrån deras egna förutsättningar. De levda erfarenheterna och de olika kraven för hanteringen av typ-2-diabetes varierar utifrån varje människa. Detta indikerar att hälso- och sjukvården bör vara uppmärksam på hur människor betraktar sin subjektiva upplevelse av hälsa och välbefinnande utifrån typ-2-diabetes. / Type-2-diabetes is a chronic welfare disease that is associated with life-style changes. Traditionally, the caring of type-2-diabetes has been associated with self-care and patient information. There is an extensive knowledge on type-2-diabetes and which consequences it results in. It is also important that health care professionals also have knowledge on people’s unique experiences of health and well-being living with type-2-diabetes. Otherwise there is a risk that the health care professionals focus too much on the disease and miss the subjective illness behind the unique person. The aim of this study is to describe people’s experiences of living with type-2-diabetes. A qualitative method was chosen. Data was collected through interviews. The interviews were transcribed and analyzed using qualitative content analysis. The authors found one theme; Balance between security – insecurity and the experience of activities as demands and possibilities give manageability. This study shows that people with type-2-diabetes generally experience good health and well-being in terms of their own resources. However, the lived experiences and the different demands of handling type-2-diabetes vary among people. This indicates that the health care professionals need to pay attention to the experiences of the unique person.

Det finns fyra hörnpelare för gott åldrande: social gemenskap, meningsfull sysselsättning och delaktighet, fysisk aktivitet samt goda matvanor. Syftet med föreliggande studie var att beskriva vad äldre individer upplever bidrar till den egna hälsan och välbefinnandet. Kvalitativa semistrukturerade intervjuer genomfördes med 15 personer över 75 år. Intervjuerna analyserades med hjälp av kvalitativ innehållsanalys. Tre kategorier framkom under det latenta temat ”känsla av att ha tillgång till och kontroll över resurser som gör det möjligt att leva ett fortsatt aktivt och meningsfullt liv som äldre”: ”leva i en bra fysisk miljö”, ”känsla av meningsfullhet” och ”känsla av oberoende”. Det var viktigt för informanterna att ha en bra bostad och en trivsam närmiljö. Meningsfullhet kom av social gemenskap och tillhörighet, meningsfulla aktiviteter och en positiv attityd och tro. Oberoende bestod av att vara frisk och att anpassa sina aktiviteter samt att ha god ekonomi och tillgång till transportmedel. Tillgång till och kontroll över dessa förutsättningar möjliggjorde att fortsätta leva ett aktivt och meningsfullt liv. Resultatet stämmer väl överens med tidigare forskning inom området. Det är viktigt att hälsofrämjande insatser kring äldres hälsa präglas av en helhetssyn och att samtliga behov hos äldre tillgodoses i största möjliga mån. Framtida forskning kan undersöka ämnet hos äldre med sämre självupplevd hälsa än i föreliggande studie. / There are four main factors contributing to good ageing: social community, meaningful occupation and participation, physical activity and good eating habits. The purpose of this study was to describe what elderly people experience contribute to their own health and well-being. Qualitative semi structured interviews were conducted with 15 people aged 75 or more. The interviews were analyzed with qualitative content analysis. Three main categories emerged under the latent theme of “feeling of having access to and control over resources making it possible to live a continued active and meaningful life as an elderly”: “living in a good physical environment”, “feeling of meaningfulness” and “feeling of independence”. It was important to the informants to have a good home and a nice neighbourhood. Meaningfulness came from social sense of community and belonging, meaningful activities and a positive attitude and faith. Independence consisted of feeling well and healthy and adapting activities as well as having a good economy and access to transportation. Access and control over these conditions made it possible to keep living an active and meaningful life. The result is in accordance to previous research within the area. It is important that health promoting efforts for the elderly has a comprehensive view and that all needs of the elderly are met as far as possible. Future research could investigate the subject in elderly with a lower self-perceived health.

No description available.

Leisure typically has been regarded as a positive component in people's lives, and evidence points to its central rather than peripheral role in lifestyle. Further, studies of leisure suggest it is conducive to psychological well-being, to physical health, and to the stability of social groups. The extent to which people are able to reach this potential very much depends on leisure's role in lifestyle, the experience of leisure, and whether conditions in a consumption-oriented society facilitate such positive outcomes. For many, leisure in consumption-oriented lifestyles holds symbolic meaning. Important aspects of personal identity and meaning are found in leisure-related possessions and through leisure activities pursued. For others, leisure represents an internal, inner-directed process through which activities or behaviours are intrinsically motivated, freely chosen, and ultimately satisfying. In this study, lifestyle was conceptualized and operationalized using a 'voluntary simplicity' value orientation, focussing on four main value dimensions: (1) material simplicity, (2) self-determination, (3) ecological awareness, and (4) personal growth. The purpose of the study was to examine the role that lifestyle plays in the relationship between leisure and psychological well-being. A self-administered questionnaire was completed by adults enrolled in general interest and continuing education leisure courses. Five basic concepts were assessed in the questionnaire: (1) leisure participation, (2) importance of leisure activity to lifestyle, (3) leisure experience, (4) psychological well-being, and (5) lifestyle. The highest frequencies of leisure participation per month included reading books, magazines and newspapers, listening to music, and watching television and videos. Leisure experience was characterized by higher challenge and awareness, and lower boredom and anxiety. There was general support for voluntary simplicity values in lifestyle with personal growth, self-determination, and ecological awareness dimensions being higher and material simplicity values being the lowest. Lifestyles that more strongly embraced voluntary simplicity were associated with higher levels of challenge and awareness, and lower levels of anxiety and boredom in the experience of leisure. The self-determination, ecological awareness, and personal growth dimensions of a voluntary simplicity lifestyle contributed to heightened positive affect within psychological well-being, while lower levels of material simplicity increased negative affect (decreased psychological well-being). When all factors are taken together, a significant proportion of variance in psychological well-being is explained by the <I><b>experience</b></I> of leisure, especially <I><b>high challenge</b></I>, and <b><I>not</b></I> by <I><b>leisure participation</b></I>, and by a <I><b>voluntary simplicity lifestyle</b></I> characterized by self-determination, ecological awareness and personal growth values in the <I><b>positive affect</b></I> dimension, and material simplicity values in the <I><b>negative affect</b></I> dimension of psychological well-being. These results suggest that regardless of the type and intensity of leisure involvement, if through heightened awareness, higher challenge and lower anxiety are sought in leisure, especially as expressed within a voluntary simplicity lifestyle, then higher levels of psychological well-being may be achieved. Indeed, by reducing lifestyle complexity and lessening the focus on consumerism, the inherent value of leisure to well-being might well emerge to a greater degree.

The documentation of Recreation Therapy and Leisure Opportunities in Long-term Care The Recreation Therapy discipline at Sunnybrook Health Sciences Centre (SHSC) has undergone a series of research initiatives to ensure a patient focused philosophy is integrated into their practice. The purpose of the study is the development of documentation procedures that will enable the recreation therapy practitioners to engage in authentic and professional documentation of the residents’ experiences in recreation therapy and leisure opportunities based on a patient focused philosophy. This research project followed an action research methodology and was guided by a hermeneutic framework adapted from Karkainen and Eriksson (2004). The recreation therapists at SHSC were involved in all aspects of the project as co-research participants. This project employed a variety data collection techniques including focus groups, a hermeneutic dialogue, self-reflective activities and active application sessions. The information collected through the various data collection phases in this project led to the creation of a new documentation framework and associated sample documentation, which allow for a more patient focused documentation process. A series of quality indicators were also developed in this project to help authentically express the experiences in leisure and recreation of the residents living at SHSC. This research project has added to the growing base of knowledge focused on the integration of a patient focused care philosophy into the recreation therapy practice at SHSC.