Cloud computing has gained popularity due to its ability to simplify IT infrastructure, reduce costs, and provide remote access. Among EU countries and company sizes, Sweden stands out with the highest rate of cloud computing adoption. However, there is a lack of concrete research in the literature focusing on the determinants of cloud computing adoption specifically by large companies in Sweden. Previous studies have examined cloud adoption from various perspectives, with a particular emphasis on small and medium-sized enterprises (SMEs) rather than large companies. Additionally, technology-related determinants have received more attention compared to those related to business, conceptualization, and application domains. To address this knowledge gap, this research aims to investigate the determinants of CC adoption in large companies in Sweden. The research question was formulated as follows: What are the determinants of cloud computing adoption in large companies in Sweden? Case study was selected as the research strategy, and the data was collected through semi-structured interviews and analyzed through thematic analysis. Semi-structured interviews were conducted with employees working at a large company in Sweden, who have experience in the IT and cloud computing field. The TOE framework was used to categorize the determinants as sub-themes into three themes: technology context, organization context, and environment context. In Company X, 30 determinants were found, with 20 aligning with previous literature. These included factors such as security, compatibility, scalability, top management support, and competitive pressure. Additionally, 10 new determinants were identified, including robustness, perceived usefulness, innovativeness, knowledge and training, and geographical locations/data centers. The experience and lessons learned from Company X could assist other companies to have better preparation for cloud adoption by understanding the significance of various potential determinants and underlying problems.

The psychosocial implications of chronic illnesses (CIs) are an apparent issue as exemplified through the extensive literature put forth on the matter. However, the primary focus of this literature is typically the aging population, and researchers have given less consideration to the experiences of youth. At this point in their life, young adults are already experiencing self-discovery, pursuing anticipated milestones, and defining one’s worth/purpose, therefore, being diagnosed and living with a CI only complicates these matters. Investigating how CIs impact young adults’ mental health (MH) is imperative when trying to understand the various intersecting forces that influence one’s ability to achieve optimal health and well being. This research explores the psychosocial effect of receiving a CI diagnosis using a qualitative, interpretive phenomenological approach ( Van Menen’s viewpoint) in which 12 semi-structured interviews were conducted with university students. Interviews were recorded and transcribed for thematic analysis. Findings indicate that the onset of CIs among young adults adds/perpetuates various types of psychosocial distress, ultimately impacting one’s MH based on their exposure towards such stressors and ability to cope. Irrespective of individualized experiences, all participants unilaterally echoed the need for MH support post diagnosis. Such a finding warrants evaluation of the existing treatment and management of CIs, suggesting that interventions ought to be more holistically designed to include greater MH support. / Thesis / Master of Science (MSc)

Child mortality rates do not only reflect the development in a society but also reflect access to basic health interventions and socio-economic conditions. The uneven distribution of child mortality rates is a matter of inequity. Even though there has been a reduction in the child mortality indicator neonatal mortality rate on the global level, the rate is still unacceptably high. Data indicates that it in a few countries, such as Lesotho, the neonatal mortality has an arrested decrease even though being a focus area within the sustainable development goals. This explorative case study aims at finding and explaining the factors behind the arrested decrease in neonatal mortality in Lesotho. Framing this study are the social determinants of health. The results indicate that the combination of HIV and droughts with exacerbated poverty and increased requirements for adequate care as a result, in combination with the vulnerable situation of women has aggravated the situation for new-borns in Lesotho. In order to improve the survival of new-borns in Lesotho measures cannot solely be aimed at improving health care but also have to be directed beyond the direct cause of death such as measures to improve the factors causing poor health. In order to achieve better prerequisites for new-borns measures have to overcome health inequity. It is a fundamental human rights concern.

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By 2034 there is predicted to be a shortage of between 17,800 and 48,000 physicians in primary care, (Association of American Medical Colleges, 2021). Nurse practitioners have proven to be a versatile tool in helping to bridge this gap in health care. As the need for family nurse practitioners grows so also the need for quality educational experiences for these providers must continue to expand. Currently, employment turnover rates for family nurse practitioners are twice those of physicians, (Barnes, 2015). Formal transitions into advanced practice, such as residency programming have been found to ease new family nurse practitioners into practice. However, few residency programs exist to help aid in this transition, (Flinter, 2005, 2012). This project aims to develop a program that provides educational opportunities for post-graduate family nurse practitioners as they transition to advanced practice nursing. The project will develop a nurse practitioner residency program specific to the needs of this region guided by the Social Determinants of Health. The program will provide new graduate family nurse practitioners with an opportunity to take part in a year-long post-graduate residency program. Providing an intense on-the-job training experience from veteran practitioners. This program will then be written into a grant to help fund the project in our region.

Health encompasses our lives in various ways; where we live, how we work, and how we play. These differentiating factors, or “social determinants”, may impact physical and mental health in a prominent manner. Screening for social determinants of health in pediatric primary care may help to identify important areas to intervene with families to address barriers to receiving care and improve health outcomes. East Tennessee State University (ETSU) Pediatrics aimed to find the prevalence of varying social determinants in their patient population through a 6-item screening tool—the Team Care screener. A Team Care screener was administered to the caregiver(s) of every child that came into the clinic for a newborn appointment, six month appointment, or one year well child examination. Caregivers responded with Yes or No to the screener's six items concerning the following: (1) ability to understand written and spoken English; (2) experiencing financial stress related to housing, food, and utilities; (3) stress around substance use; (4) incidents of domestic abuse; (5) feelings of depression and possible suicidal ideation; and (6) if transportation has been a barrier to attending medical appointments. After the screener was collected, if any social determinants were marked as Yes on the screener, a needs assessment was completed with the caregiver(s). The family then received resources to address needs at the appointment or by phone follow up, if applicable. This procedure is ongoing at the clinic. Results indicated that of the 1,009 Team Care screeners administered over a four-month period, 15% (n=153) of patients' caregivers reported a deficit in at least one social determinant. More specifically, 8% (n=79) endorsed experiencing financial stress, 5% (n=49) reported strain from acquiring transportation to appointments, 4% (n=17) expressed concerns related to substance use, 1% (n=14) noted difficulties with comprehending English, and less than 1% (n=6) reported possible incidents of domestic abuse. After discussion with caregivers, the most frequently reported stressors were determined to be access to adequate food, housing, and utilities as well as distress concerning transportation to medical appointments. Overall, our results suggest that a large portion of the patient population demonstrates varying social needs which have the potential to influence health outcomes. The Team Care screener has elucidated which patients are at particular risk, which allows clinic staff to provide more efficient patient-centered care.

The birth of a child can be a stressful time accompanied by an array of emotions including depression. Postpartum depression (PPD) affects approximately 1 out of 7 new mothers. It can affect a new mother’s sleep, appetite, mood, and bond with her baby, as well as impact child development and well-being, if left untreated. Beginning in March, 2013, ETSU Pediatrics deployed an evidence based screening tool, the Edinburgh Postpartum Depression Scale (EPDS), to identify mothers of newborns with PPD. Mothers attending well-visits with their baby from birth to six months of age who score above an eight on the screener are provided with education about PPD, referrals, brief on-site counseling, and phone-call follow- up. Many of these mothers express concerns about resources and social factors that impact their health and mood. An Ecomap is a visual representation of strengths and stressors of a patient’s relationship with their environment, social supports, and resources. The awareness of a patient’s relationships and support within their environment can be useful for assessment of needs and intervention on their behalf. The objective of this study is to pilot the utility of the Ecomap to illuminate common stressors of the social determinants contributing to or exacerbating symptoms of PPD, in order to provide brief solution-focused interventions and referrals to alleviate the stressors. Although Ecomaps have been utilized in clinic settings, there is a lack of research on their effectiveness in identifying social determinants of mothers with PPD. We hypothesized that implementing the Ecomap with mothers that present with an elevated EPDS score will identify a significant number of social determinates that are actionable by social workers on staff. When a mother presented with a score of eight or above on the EPDS administered during a well-child check, the social work staff completed an Ecomap with mothers via a warm handoff. The social determinants identified on the Ecomaps were then categorized and counted to determine biggest social needs of mothers at the ETSU Pediatric clinic from 11/13/2015 through 02/28/2016. The clinic completed 27 ecomaps with mothers who scored 7 or above at well child checks. Transportation and mental health services presented as the most common domains that social work was able to effectively act to rectify. Overall, the utilization of the Ecomap was successful in identifying social determinants contributing to or exacerbating symptoms of PPD. Addressing these stressors through resource allocation and brief solution-focused therapies may contribute to a reduction of PPD symptoms. Future research, therefore, should examine whether addressing these social stressors reduces symptoms of PPD above and beyond targeting depressive symptoms alone in mothers presenting at pediatric clinics.

Purpose: Rural communities often experience higher rates of mortality than their urban counterparts, with gaps widening in the foreseeable future. However, the underlying level of socioeconomic vulnerability (area deprivation) among rural communities can vary widely. This study examines rural‐urban differences in mortality‐related outcomes within comparable levels of deprivation. Methods: Rural‐urban differences in Years of Potential Life Lost (YPLL), derived from the County Health Rankings, were examined across comparable levels of area deprivation using a quantile regression approach. Rural‐urban differences in YPLL were estimated at the 10th, 25th, 50th, 75th, and 90th percentiles across levels of deprivation. Findings: Compared to the reference population (urban counties/least deprived) a clear increase in YPLL among both rural and urban counties was noted across levels of deprivation, with the highest level of YPLL occurring in counties with the most deprivation. While YPLL increased across levels of deprivation, the magnitude of these differences was markedly higher in rural counties compared to urban, particularly among the most deprived counties. Rural counties experienced an advantage at the lowest percentiles and levels of deprivation. However, this advantage quickly deteriorated, revealing significant rural disparities at the highest level of deprivation. Conclusions: This study noted a differential effect in mortality‐related outcomes among rural counties within comparable levels of community deprivation. Findings contribute to evidence that many, but not all rural communities face a double disadvantage. This underscores the need for a continued focus on the development and implementation of multiple policies aimed at reducing differences in poverty, education, and access to care.

The impetus for the recognition of the need for legal partners in healthcare came from Boston City Hospital in 1993. The hospital provided care to the largest uninsured and underinsured population in the New England states. The pediatric patients were noted by Dr. Barry Zuckerman to have difficulty in recovering from medical illnesses. He linked their inability to improve their health to poor housing, food insecurity, and basic social determinants of health. His hiring of a part-time lawyer led to a national movement for the development of medical-legal partnerships. The American Bar Association, the National Center for Medical-Legal Partnerships at George Washington University in Washington, DC and the American Academy of Pediatrics formed the first national medical-legal partnership in 2007. Joint resolutions were passed for members to become partners with the other professional colleagues to “address the legal and social issues affecting patient health and well-being.” The American Bar Association resolution led to the creation of the Medical-Legal Partnership Pro Bono Project. In 2015, the East Tennessee State University College of Nursing nurse-led community health center was awarded a small grant from the National Nurse Centers Consortium to participate in the development of a medical-legal partnership. The health center is staffed by Nurse Practitioners who provide health care for the underserved in northeast Tennessee. The patients are diverse and include homeless, migrants, residents of public housing, uninsured, and underinsured. Partnering with the Tennessee Justice Center in Nashville, Tennessee, the nurse-led medical legal partnership improved lives of pediatric patients, adults, pregnant women across the state, and advocacy rights for those who cannot speak for themselves.

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