Modern research on the shared points of natural and cultural heritage has opened new opportunities for the investigation of the dimensions of this natureculture phenomenon. Theo bjective of this study is to develop this subject by analysing the dialogue between the most critical human geographies and the heritage field. The theories on social space and place, non-places, liminality or phenomenological dwelling help both to find the character of a place and observe threats in the crisis of “loss of place” processes under postmodern conditions. These background phenomena that I name here as the Spatial Turn is linked to the heritage field through the (2008) Québec Declaration on the Preservation of Spirit of Place. This heritage factor in the search for the Spirit of Place is put into practice with the Arctic region as a case study. Analysing the Spirit of Place of the area, we shall also search for some of the threats and prospects for the region that will see the most changes in its natural and cultural heritage in the next years.

This mixed methods thesis provides a cumulative study of bamboo as a natural material and building product through the lenses of architectural and product design, engineering, manufacturing, agriculture, material science, environmental science, history, and culture. All case study work is based in the context of coastal Ecuador. The main goal of the thesis is to explore an identified need for a bamboo relief housing system that has the attributes of longevity and quality, but is also rapidly deployable via pre-fabrication. This exploration is performed with the methodology of an in-country applied product and process design, physical prototyping of elements and joints, mechanical performance testing, a case study house design, and a comparative cost analysis with an alternative bamboo relief home. Results of these methods include a successful on-site fabrication process for cross-laminated floor panels installed into culm-frame structure, adequate floor system bending data for design incorporation, and a cost-effective design proposal compared to bamboo disaster-relief precedence. This thesis has the potential to be built upon to the result of real-world environmental, economic, and social impact. / Master of Science / This thesis addresses the use of bamboo in coastal Ecuador from the perspectives of architectural and product design, engineering, manufacturing, agriculture, material science, environmental science, history, and culture. Specifically focused on is the need for post-disaster bamboo housing that is factory-built, and therefore quickly deployable when needed, but also designed for durability and longevity, providing people with safe and dignified living conditions in times of severe need. It is concluded that the proposed system has merit, but will require further research and testing to prove its exact role in Ecuador and/or elsewhere. Ultimately, this work is important to solving greater global environmental issues such as increasing atmospheric CO2, increasing natural disaster frequency and intensity, and increasing human population and the accompanying housing demand.

In the upcoming years, the proportion of elderly within the population will increase significantly (SCB, Socialstyrelsen). The share of aged is already, and will increasingly be, noticeably higher in municipalities on the countryside compared to in the cities. Accordingly, “a variety of dwellings and form of housing suitable for elderly” is asked for and needed (Socialstyrelsen, Boverket). This thesis is one respond to the situation and an addition to the housing possibilities for elderly; a proposal and a test of one way of dwelling as an elderly on the countryside.  To this background, the thesis is a case study: an interpretation of the obsolescent typology “Undantaget”, a free standing (secondary) structure within the homestead on the countryside which the aged, previous owners often inhabited in preindustrial times. The case study is based on an investigation of the local vernacular building tradition. A contemporary dwelling for an elderly is explored, informed by vernacular tradition and its interwoven principles considering construction and tectonic, approach to/usage of resources as well as (else) economic, social and ecological aspects. A modified “Undantag” is proposed; an investigation of sustainable building and living intertwined.

Denna studie undersöker hur formuläret Organiserad Verksamhet i Renbetesfjäll inom förvaltning i Västra Jämtlandsfjällen förstås och används av människor som arbetar i besöksnäringen och i småföretagande. Med intervjuer som empiriskt material diskuterar studien hur begreppen funktion och struktur är relaterade till dominerande idéer i områdets förvaltning. Som teoretiskt perspektiv används Tim Ingolds dwelling-perspektiv. Studien når fram till att formuläret inte uppfyller de behov aktörerna har för att ha ett tillfredsställande samarbete med varandra och renskötarna. Formuläret för förvaltning är inte anpassat efter en lokal kulturell kontext, den är skapad utifrån idéen om landskapet som multifunktionellt vilket studien formulerar kritik gentemot.

Background: Fear of falling has significant adverse physical and psychological effects for the community-dwelling older adult. Objective: The purpose of this study was to assess fear of falling in community-dwelling older adults and explore participant perceptions of fear of falling assessments and interventions. Methods: A mixed methods case study was utilized to gain an in-depth understanding of older adults' perceptions. It consisted of quantitative data collection by objective measures and qualitative data collection by four individual in-depth interviews. A sample of four community-dwelling adults aged 65 years and older and living in Orlando, Florida, completed the study in their home environment. To combine quantitative and qualitative data for each participant, a case-specific analysis was used, resulting in narratives with a storytelling approach aiming to explore each participant independently. This was followed by a cross-case analysis to gain a more comprehensive understanding of the participants in relation to one another. Results: Four themes emerged: 1) Feedback from an objective measure is valuable; 2) Family experiences with fear of falling drive personal interventions; 3) Fundamental assessments for fear of falling are missing, and 4) Fluctuating definitions of "fear" contribute to difficulty in assessments and interventions. Conclusion: Clear perceptual themes developed to provide a comprehensive understanding of community-dwelling older adults' perceptions of fear of falling assessments and interventions. Future research is needed to determine how to best combine feedback-oriented assessments with established interventions, such as exercise. Standardization of a subjective measure for fear of falling to use in combination with objective measures is also needed. Keywords: assessment, intervention, fear of falling, older adults, community-dwelling, mixed methods

No description available.

No description available.

Bakgrund: Fall är vanligt förekommande hos äldre personer och har stora konsekvenser för både individen och samhället. Fallförebyggande multifaktoriella interventioner rekommenderas för äldre personer som bor hemma men det saknas stark evidens för vilka kombinationer av fallpreventiva interventioner som är effektiva. För att få en bättre bild av fördelarna med att inkludera andra interventioner tillsammans med träning är det av vikt att undersöka kombinationen av patientutbildning tillsammans med träning hos hemmaboende äldre. Syfte: Att undersöka effekten av patientutbildning i kombination med träning på antalet fall hos hemmaboende äldre samt redovisa innehållet i patientutbildningarna och träningsinterventionerna. Metod: En systematisk litteraturstudie där sökningen genomfördes i PubMed. Åtta RCT-studier valdes ut. Studiernas kvalitet granskades med PEDro-skalan och tillförlitligheten av det sammanvägda resultatet bedömdes utifrån GRADEstud.   Resultat: Åtta studierna inkluderades med totalt 1557 deltagare där den lägsta medelåldern var 71 år. Fem studier sammanvägdes. Alla studier innehöll patientutbildning och träning, dock varierade komponenterna i interventionerna. Kontrollgrupperna innehöll ingen intervention, sedvanlig vård eller icke fallpreventiva interventioner. Jämfört med kontrollgruppen hade interventionsgruppen ingen effekt av patientutbildning i kombination med träning på antalet fall. De fem studier som sammanvägdes hade bra kvalitet (6-8 poäng) enligt PEDro-skalan medan det sammanvägda resultatet hade låg tillförlitlighet enligt GRADEstud. Konklusion: Patientutbildning i kombination med träning visade ingen fallreducerande effekt på hemmaboende äldre och innehållet i interventionerna skilde sig åt i samtliga studier. Fler framtida studier behövs då tillförlitligheten av det sammanvägda resultatet bedömdes vara låg. / Background: Falling is common among older people and has severe consequences for both the individual and the society. Multifactorial interventions are recommended for community-dwelling elderly, although there is a lack of strong evidence for which combinations of fall preventive interventions that are effective. To get a better picture of the benefits of including other interventions together with exercise it is of most importance to investigate the combination of patient education together with exercise for community-dwelling elderly.   Aim: To investigate the effect of patient education in combination with exercise on the number of falls amongst community-dwelling elderly, and to present the content in the patient education and the exercise interventions.  Method: A systematic literature study was carried out in PubMed. Eight RCT-studies were chosen. The quality was assessed using the PEDro-scale and the combined reliability of the studies was assessed using GRADEstud.  Results: Out of the eight studies five of them were combined with a total of 1557 participants and the lowest average age was 71 years. All of the studies contained patient education and exercise, although the components in the interventions varied. The control groups contained; no intervention, usual care or non-fall preventive interventions. No effects of the patient education in combination with exercise was demonstrated on the number of falls in comparison to the control groups. The five studies that were combined had good quality (6-8 points) according to the PEDro-scale while the combined result had low reliability according to GRADEstud.  Conclusion: Patient education in combination with exercise had no fall reducing effect on community-dwelling elderly and the content in the interventions varied in all the studies. More future studies are needed since the reliability in this study was low.

京都大学 / 新制・課程博士 / 博士(人間健康科学) / 甲第24096号 / 人健博第103号 / 新制||人健||7(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 青山 朋樹, 教授 恒藤 暁, 教授 今中 雄一 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

Introduction: More than half a million Canadians are living with dementia and 260,000 of these individuals live at home. As dementia progresses, persons with dementia require more assistance from caregivers to meet their daily needs including stimulation and emotional support. However, caregivers receive little training in this role. Namaste Care is a program originally developed for use in long-term care homes promoting a structured routine, a slow pace of care, and multisensorial activities for persons with advanced dementia. The program has not yet been adapted or evaluated for use by caregivers of community-dwelling older adults with moderate to advanced dementia. The objective of this study is to explore the feasibility, acceptability and preliminary effectiveness of a version of Namaste Care adapted by caregivers. Methods: A multiphase mixed methods design was used. In the adaptation phase, six caregivers participated in workshop sessions to adapt Namaste Care for home use. In the evaluation phase, 12 caregivers received training to use the adapted program. Surveys were used to collect data on caregiver quality of life, perceptions of caregiving, self-efficacy, and burden at baseline and 3-month follow-up. Qualitative interviews at 3-month follow-up were also completed to assess the acceptability of the program and implementation facilitators and barriers. Findings: All caregivers used the program for a minimum of twice a week as planned and used a variety of program activities. The retention rate was 83%. Caregivers perceived that the program improved their relationships with persons with dementia. Implementation facilitators were receiving a Namaste Care Toolbox and written resources about Namaste Care. No statistically significant effects were found with regards to the outcome measures listed above. Conclusions: The adapted Namaste Care program was feasible and acceptable for use by caregivers. There is a need to conduct a larger trial to determine the extent of its effects. / Thesis / Doctor of Philosophy (PhD) / With the growing numbers of family and friend caregivers across Canada supporting people living with dementia at home, there is a need to better prepare caregivers for their role. The aim of this study is to adapt, implement and evaluate a sense-based, skill-building program called Namaste Care delivered by caregivers of older adults living with moderate to advanced dementia. First, workshops for caregivers were held to adapt the Namaste Care program for home use. Afterwards, 12 caregivers received training in using the adapted program and delivered the program for three months. Caregivers used the program at least twice a week as intended and delivered a variety of activities. The program improved relationships with persons with dementia. No significant changes for caregiver quality of life, positive beliefs of caregiving, burden, and confidence were found. Next steps are to further test the effects of the program in a larger trial.