Venous disease is a common vascular condition affecting the lower limbs and causes considerable morbidity in affected patients. National Health Service (NHS) treatment costs are substantial and there is a large demand for treatment much of which cannot be met. Roughly half a million people in the United Kingdom contact their general practitioner each year about varicose veins and associated clinical symptoms. In order to assign priorities and target interventions properly, authorities need to know which patients with venous disease will progress. Although many epidemiological studies have investigated the prevalence of venous disease, information on deterioration is scarce. The overall aim of this study is to determine the natural history of venous disease in the population and to identify lifestyle and clinical factors related to deterioration which might aid clinical decision making and health services policy. The specific objectives were to determine which risk factors were associated with deterioration of venous disease and venous reflux, and to ascertain the natural history of asymptomatic venous incompetence in terms of deteriorating to overt trunk varicose veins and chronic venous insufficiency. The study design was a population based cohort in the Edinburgh Vein Study which the survivors of the 1566 individuals aged 18 to 64 randomly sampled years from the general population at baseline underwent a 13-year follow-up examination. Details of the 1566 participants in the baseline study were sent to the Practitioner Services Division (PSD) of the NHS in Scotland who provided updated addresses and general practitioner registration details. Information collected on each subject at a follow-up clinic included lifestyle factors and medical history, height and weight measurement (by means of a questionnaire), clinical examination for classification of venous disease according to the Basle and CEAP systems, and duplex scanning to assess incompetence of venous valves in the deep and superficial systems of ten vein segments in each leg. Of the subjects from the baseline, 880 participated in the follow-up study, and 576 did not participate, providing a response rate of 60.4% of which 490 were female (55.7%) and 390 were male (44.3%). The study subjects were generally older and slightly more affluent than residents of the City of Edinburgh. For trunk varicose veins, the baseline prevalence was higher in males compared to females (p<0.01), but there was no difference in prevalence among subjects at the follow-up stage of the study (p=0.56). The overall rate of deterioration in trunk varicose veins was 3.55% per annum. More females than males deteriorated (p=0.04). Among subjects who showed deterioration in their trunk varicose veins, the commonest deterioration was from Basle Grade I (mild) at baseline to Grade II (moderate) at follow-up in both the right and left leg (28.1% and 32.9% respectively). Subjects older than 55 years of age (OR=1.59, 95% CI 1.01-2.51), who had a positive family history of varicose veins or venous ulcer (OR=1.92, 95% CI 1.20-3.07), and sat down at work for more than half the working day (OR=1.69, 95% CI 1.04-2.73) had increased risk of deteriorating trunk varicose veins. There was no significant difference between males and females in the prevalence of chronic venous insufficiency (CVI) among subjects at both the baseline and follow-up stage of the study (p=0.15 and 0.16 respectively). The rate of deterioration in CVI was 1.76% per annum. Similarly, among subjects who deteriorated, the commonest deterioration was from Grade I (mild) to Grade II (moderate) CEAP classification in both the right and left leg (42.4% and 45.5% respectively). The risk of worsening of CVI among those older than 55 was nearly three times more than those aged less than 55 (OR=2.85, 95% CI 1.18-6.87), and was still significant when adjusted for gender. The prevalence of telangiectasia was higher in females than in males in both the baseline and follow-up stages of the study (both p<0.01). The rate of deterioration in telangiectasia was 1.6% per annum. The commonest deterioration was from grade I (mild) at baseline to grade II (moderate) follow-up in the left and right leg (using the Basle Classification). Females subjects (OR=1.87, 95% CI 1.35-2.64), those older than 55 (OR=1.68, 95% CI 1.19-2.36), with a positive family history of venous disease (OR=1.60 95% CI 1.14-2.24) were associated with an increased risk of deterioration from telangiectasia compared to male subjects under 55 years of age and with no family history of the disease. The risk of telangiectasia deterioration was more than twice as high in subjects with venous reflux in the greater saphenous vein (origin) (OR=2.34, 95% CI 1.53-3.57), the greater saphenous vein (lower third of the thigh) (OR=2.28, 95% CI 1.59-3.27) and in the small saphenous vein (1.89, 95% CI 1.06-3.36) compared to those with no segments affected. The age and gender adjusted risk was also more than twice as high in subjects with venous reflux in two segments of the superficial system compared to subjects with no venous reflux in any segment (OR=2.06, 95% CI 1.23-3.44), and almost four times as high in subjects with reflux in more than three segments of the superficial system (OR=3.97, 95% CI 2.16-7.31) compared to subjects with no segments affected. On duplex scanning, the prevalence of reflux was higher in females than in males in the superficial system at baseline and follow-up stages of the study (p<0.01 respectively). In the deep system, the prevalence was higher in males than females at the baseline stage (p<0.01) with no significant difference at the follow-up stage (p=0.85). The rate of deterioration in venous reflux was 1.28% per annum. Most subjects deteriorated from one to two vein segments affected in the leg, the majority of which had reflux in the greater saphenous vein (thigh) at baseline and developed reflux in the greater saphenous vein (origin) at follow-up. Subjects more than 55 years of age had significantly more deterioration than those aged less than 55 (p<0.01). Obese or overweight subjects (OR=1.59, 95% CI 1.32-3.67), those aged more than 55 (OR=2.20, 95% CI 1.32-3.67), with a family history of varicose veins (among female subjects only, OR=2.55, 95% CI 1.16-5.56), and who sat down at work more than half the working time (among male subjects only) (OR=2.26, 95%CI 0.97-5.23) had increased risk of showing deterioration in reflux in any leg and in any vein segment from baseline to follow-up. Subjects with venous reflux at baseline were over two and half times more likely to show deterioration in trunk varicose veins compared to those with no reflux (OR=2.69, 95%CI 1.44-5.01), and four times more likely to deteriorate in either trunk varicose veins or chronic venous insufficiency (OR=4.20, 95% CI 2.42-7.29). Subjects with venous reflux at baseline were twice as likely to develop new trunk varicose veins (OR=2.08, 95%CI 1.25-3.46), and 1.78 times more likely to develop either trunk varicose veins or chronic venous insufficiency (OR=1.78, 95%CI 1.12-2.80). Age and gender adjusted risk of trunk varicose veins increased more than fourfold among subjects with venous reflux in the greater saphenous veins (OR=4.04, 95% CI 2.36-6.92), and more than threefold in the greater saphenous vein (lower third of the thigh) (OR=3.13, 95% CI 1.85-5.27) and the small saphenous vein (OR=3.17, 95% CI 1.55-6.48). Subjects with venous reflux in two or more than three vein segments in the superficial system were more than five times more likely to deteriorate from trunk varicose veins (OR=5.39, 95% CI 2.64-10.99 and OR=5.96, 95% CI 2.71-13.10 respectively). The Edinburgh Vein Study follow-up identified factors linked to deterioration of trunk varicose veins and CVI. The findings of this follow-up study have important implications in decision making in NHS and a prognostic tool could be produced to assist clinicians in deciding who should receive treatment or maintained under surveillance. Increasing age, and family history will likely lead to worsening of trunk varicose veins and CVI. The findings also confirm the association between asymptomatic and symptomatic venous valvular incompetence with worsening and developing new cases of venous disease. Such information will be essential for policy makers facing difficult decisions over prioritisation of services in the future. Further research might include trials of surgical and non-surgical interventions designed to limit deterioration in high risk individuals and enable surgeons to target interventions appropriately. Larger prognostic studies of many factors, including genotype, might be conducted to link progression of venous disease, and to provide further information on high risk individuals who might benefit from treatment.

Bakgrund: Hypertoni var en av de främsta folkhälsosjukdomarna i Sverige 2015 och 1,8 miljoner människor beräknades vara drabbade. Den främsta behandlingen ur såväl medicinskt som omvårdnadsperspektiv vid diagnostiserad hypertoni är livsstilsförändringar. Dock har följsamheten visats låg och endast 20-30% av personerna med hypertoni uppnår behandlingsmålet med ett blodtryck lägre än 140/90 mmHg. Syfte: Syftet med litteraturöversikten var att undersöka personers upplevelser av vad som främjar till följsamhet av livsstilsförändringar vid hypertoni. Metod: En induktiv ansats av kvalitativa artiklar låg till grund för litteraturöversikten. Sju artiklar inkluderades och analyserades i resultatet. Resultat: De upplevelser som främjade följsamhet till livsstilsförändringar var upplevelser av trygghet relaterat till kunskap, miljö och ekonomi, autonomi relaterat till vanor, rutiner och livsstil, delaktighet relaterat till omvårdnaden samt samhörighet relaterat till kultur, religion och familj. Slutsats: Sjuksköterskan skulle i mötet med personer med hypertoni kunna framhäva och uppmärksamma upplevelser av trygghet, autonomi, delaktighet och samhörighet för att på så vis stötta personen mot följsamhet till livsstilsförändringar. / Background: Hypertension was one of the main public health diseases in Sweden 2015 with approximately 1.8 million people expected to be affected. The primary treatment when diagnosed hypertension, from both a medical and nursing perspective, is lifestyle changes. However, compliance has been shown to be low, only 20-30% of people with hypertension achieve the treatment goal of a blood pressure less than 140/90 mmHg. Purpose: The purpose of the literature review was to examine people's experiences of what promotes the adherence to lifestyle changes in hypertension. Method: An inductive approach of qualitative articles formed the basis for the literature overview. Seven articles were included and analyzed in the results. Result: The experiences that promoted adherence to lifestyle changes were experiences of confidence related to knowledge, environment and economy, autonomy related to habits, routines and lifestyle, participation related to the care and affection related to culture, religion and family. Conclusion: The nurse could, in meeting with people with hypertension, highlight and draw attention to perceptions of safety and confidence, autonomy, participation and belonging, and thus support the person against adherence to lifestyle changes.

Bakgrund: Typ 2-diabetes är en kronisk sjukdom som står för 90 procent av alla diabetesfall i världen och beräknas öka de kommande åren, på grund av bland annat ohälsosamma levnadsvanor såsom kost och fysisk aktivitet. Egenvård innebär att patienten tar ansvar och för att hantera det behövs kunskap och stöd från vårdpersonalen. Syfte: att beskriva upplevelser av egenvården vid typ 2-diabetes, med fokus på livsstilsförändringar. Metod: En allmän litteraturöversikt baserad på tolv kvalitativa vetenskapliga artiklar genomfördes. Resultat: Det har framkommit olika upplevelser av egenvården och dessa har kategoriserats i teman med subteman: 1) Känsla av kontroll: Olika uppfattningar av betydelsen av typ 2-diabetes, 2) Upplevelser av livsstilsförändringar: Kostomläggning och Fysisk aktivitet och 3) Upplevelser av omvårdnadsåtgärder: Rådgivning, Motiverande samtal, MI och Gruppbaserad patientutbildning. Slutsats: Att ändra på sin livsstil kan upplevas som krävande och omställningen behöver stödjas och anpassas utefter patientens behov. Klinisk betydelse: Patientens upplevelser av egenvård med behov, krav och brister kan fungera som ett kunskapsverktyg för vårdpersonalen vid omvårdnaden av typ 2-diabetes. / Background: Type 2-Diabetes is a chronic disease that accounts for 90 percent of all diabetes cases in the world and is expected to increase in the upcoming years, due to unhealthy habits such as diet and physical activity. Self-management means that the patient takes responsibility and in order to manage it knowledge is needed and support from caregivers. Objective: To describe the experiences of self-management in Type 2-Diabetes, focusing on lifestyle changes. Method: A literature review based on twelve qualitative scientific articles were conducted. Results: It has turned out that there have been different experiences of self-management and these have been categorized into themes with subthemes: 1) Sense of control: Different views of the importance of Type 2-Diabetes, 2) Experiences of lifestyle changes: Change of diet and Physical activity and 3) Experiences of nursing interventions: Counseling, Motivational interviewing, MI and Group-based patient education. Conclusion: To change the lifestyle may be perceived as demanding and conversion needs to be adjusted to the patient's needs. Clinical significance: Patient’s experiences of self-management with needs, demands and deficiencies can serve as a knowledge tool for the care staff in the care of Type 2-Diabetes.

Entrepreneurs are portrayed as salient drivers of regional development and for a number of years nascent entrepreneurs have been studied in a large number of countries as part of the Global Entrepreneurship Monitor project and the Panel Study of Entrepreneurial Dynamics. Scholars have devoted much effort to investigating factors that determine how individuals engage in entrepreneurial activities, with most of the discussion limited to business start-ups. However, since this type of project does not follow identical nascent entrepreneurs over time, limited knowledge exists about their development and whether they stay in this nascent phase for a long time. In practice, it is common for entrepreneurs to run a business and at the same time work in wage work, so-called combining entrepreneurs. In Sweden, almost half of all business owners combine wage work with a business. However, not all combining entrepreneurs will eventually decide to leave the wage work and invest fully in the business. Consequently, much research has focused on the first step of entering entrepreneurship full time, but less has focused on the second step, the transition from the combining phase to full-time self-employment. The aim of this thesis is therefore to contribute to the theory of entrepreneurship by gaining a deeper understanding of combining entrepreneurs and their motives and intentions.   In the context of combining entrepreneurs, the theory of identity, resources and choice overload has been used to examine how entrepreneurs’ age (when starting the business), entrepreneurial tenure (the length of engagement in the side-business), hours spent (weekly involvement in the side-business), involvement in entrepreneurial teams (leading the business with one or more partners) and involvement in networks (business networks) influence their passion for engaging in entrepreneurship while sustaining wage work. Different categories of combining entrepreneurs and their intentions have also been examined.   A survey was administered to 1457 entrepreneurs within the creative sector in two counties in Sweden (Gävleborgs County and Jämtlands County). Since there were no separate mailing lists to only combining entrepreneurs, the survey was sent to all entrepreneurs within the chosen industry and counties. The total response rate was 33.5 percent and of them 57.6 percent combined, yielding 262 combining entrepreneurs who answered the questionnaire. The survey was then followed up with eight focus group interviews and two single interviews to validate the answers from the questionnaire.   The results indicate three types of combining entrepreneurs: nascent – with the intention to leave the combining phase for a transition into full-time self-employment, lifestyle – with the intention to stay in the combining phase, and occasional – with the intention to leave the combining phase for full-time wage work and close down the business. Transitioning fully to self-employment increases with the individual’s age. Also, a positive interactive effect exists with involvement in entrepreneurial networks. The results also indicate that the ability to work with something one is passionate about is the top motive for combining wage work with a side-business. Passion is also more likely to be the main motive behind the combining form among individuals who are older at business start-up, but passion is less likely to be the main motive behind the combining form among individuals who spend more time on the business. The longer the individual has had the side-business, the less likely passion is the main motive behind the combining form, and passion is less likely to be the main motive among those who are part of an entrepreneurial team.

Background: Diabetes type 2 is a chronic disease with rising prevalence worldwide. The implementation of lifestyle changes is an important part of diabetes treatment. Nurses in primary care have a central role to support and guide diabetics for starting and retaining lifestyle changes to prevent later diabetes complications. Aim: The purpose of this study was to describe the primer care nurse’s experiences regarding the type 2 diabetes patients’ compliance to their advice regarding lifestyle changes. The aim was also to describe the primary care nurse’s experiences and reflections of contributing and hindering factors of compliance. Method: A descriptive design with a qualitative approach is used in this study. Eight diabetes nurses from seven health centers were interviewed. Semi-structured interviews conducted and data analyzed by qualitative content analysis method. Results: The emerged theme from the result was that compliance varies and is affected by different influential factors. Factors such as patients’ motivation and understanding of illness, other simultaneous physical and mental disorders, language difficulties and cultural differences have either contributing or hindering effects on compliance. Primary care nurses reported that they used different strategies, such as justifying the small changes at the beginning, establishing of mutual communication and confirmative relationship and give personalized lifestyle advice to improve patient compliance. According to interviews the items that could be improved are arrangements for group therapy sessions, active involvement of the family members in diabetes care, and assigning more resources to approach the desired goals. Conclusion: Compliance to lifestyle advice is a variable affected positively or negatively by various factors such as the individual characteristic, motivation, self-awareness, language difficulties and cultural differences. Diabetes nurses use strategies which improve compliance of diabetics to their lifestyle advice. Group Training, the involvement of the family and access to more resources are areas that need to be developed. / Bakgrund Diabetes typ 2 är en kronisk sjukdom med stigande prevalens i hela världen. Genomförandet av livsstilsförändringar utgör en viktig del av diabetes behandling. Distriktssköterskor i primärvården har en central roll att stödja och vägleda diabetiker genom rådgivning för att kunna etablera livsstilsförändringar samt att upprätthålla för att förhindra diabetes sena komplikationer. Syftet var att beskriva distriktssköterskans erfarenheter och reflektioner av typ 2 diabetespatienters följsamhet till distriktssköterskansråd avseende livsstilsförändringar. Syftet var även att beskriva distriktssköterskans erfarenheter och reflektioner av följsamhetens bidragande och hindrande aspekter. Metod En beskrivande design med kvalitativ ansats användes. Åtta distriktssköterskor från sju hälsocentraler intervjuades. Semistrukturerade intervjuer utfördes som sedan analyserades med kvalitativ innehållsanalys. Resultatet visade att följsamheten varierar och påverkas av olika inflytelserika faktorer. Faktorer såsom patientens motivation och sjukdomsinsikt, andra samtidiga kroppsliga och psykiska sjukdomar, språksvårigheter och kulturella skillnader har antingen bidragande eller hindrande effekter på följsamheten. Distriktssköterskor uppgav att de använde olika strategier som till exempel att motivera till små förändringar i början, etablering av ömsesidig kommunikation och bekräftande relation och att ge individanpassade livsstilsråd, för att förbättra patientens följsamhet. Att genomföra grupputbildningar, involvering av diabetikers familj och tillgång till mer resurser ansågs som områdena som kunde förbättras för att öka följsamheten hos diabetiker. Slutsats: Följsamheten till livsstilsråd var varierande vilket påverkades positivt eller negativt av olika faktorer såsom individens egenskaper, motivation, sjukdomsinsikt, språksvårigheter och kulturella skillnader. Diabetessköterskor använde strategier som gynnade diabetikers följsamhet till livsstilsråd. Grupputbildningar, involvering av familjen och tillgång till mer resurser är områdena som behöver utvecklas.

Lymphangioleiomyomatosis (LAM) is a rare lung disease recognized by abnormal growth of smooth muscle cells proliferating in lungs parenchyma, developing benign tumors, migrating to the other organs, and ultimately leading to respiratory failure and death. Despite existing literature mainly on clinical aspects of LAM, there is a gap of literature in regards to the knowledge, attitude, and lifestyle practices (KAPs) of LAM patients and their effects on their quality of life. The purpose of this quantitative study was to investigate the KAPs of the sporadic LAM patients as measured by the Bristol Chronic Obstructive Pulmonary Disease Knowledge Questionnaire, Beliefs and Behavior Questionnaire, Determinants of Lifestyle Behavior Questionnaire; these KAPs were then analyzed for their relationship to quality of life reports as measured by the St George’s Quality of Life Questionnaire. Transtheoretical model (TTM) was used to describe the relationship among the variables. The data were collected through online survey questionnaires from 143 sporadic LAM patients registered at the LAM Foundation. Pearson’s correlations and linear regression were used to analyze the data. The results of the analysis showed that there was a significant positive relationship between attitude, lifestyle practices, and quality of life and a negative relationship between knowledge and quality of life. The outcome achieved by this study and its implication on social change identifies the need to initiate more study-specific KAPs within LAM populations, including individuals with tuberous sclerosis complex LAM. The results could also encourage the LAM community as well as other stakeholders to implement programs, workshops, and interventions that could promote and enhance quality of life.

In the report Ungar &amp; Medier 2012/13, statistics show that the users of social media are becoming increasingly younger at age and that social media has become a natural part of children and young people's everyday lives (Statens medieråd, 2013). The purpose of this study is to examine how five teachers experiencing and think about social media's impact on their students and teaching. And also what effects the teachers describe that social media has contributed to in students' identity work. I have, based on the purpose of this study issued following questions: What is social media, according to the teachers?, How do the teachers think about their students' use of social media?, How do the teachers think that social media has influenced their teaching? And how do the teachers describe / experiencing the impact that social media has contributed to in the students' identity work? This study is made through a qualitative method based on interviews with five teachers. The results show that all of the teachers agree that social media is a part of our present. The teachers’ talk about various ways social media has affected their teaching, but most often the discussion has been about values, laws and regulations, concerning the etiquette on social media. The teachers’ believe that social media has had an effect on the children's identity. They believe that children today, focus on appearance, perfection, performance and material objects, which automatically will affect children’s self-image. According to the teachers, social media has created a new way to show appreciation between individuals, where they are appreciated by comments and likes. But let’s all agree that social media is a social place, where children can feel part of their social togetherness and culture.

Bakgrund: Hjärt- och kärlsjukdomar är ett globalt växande folkhälsoproblem som dessutom är en ekonomisk last på samhället. Forskning har uppskattat att majoriteten av dödsfall kommer att bero på hjärt- och kärlsjukdomar vid år 2030. Några riskfaktorer för att utveckla hjärt- och kärlsjukdom är ett högt BMI, rökning och låg fysisk aktivitet. Forskning har visat att primärpreventivt arbete med livsstilsförändringar är något som minskar riskfaktorerna och är kostnadseffektivt för samhället. Syftet: var att beskriva vilka primärpreventiva metoder sjuksköterskan använder för att uppmuntra till livsstilsförändringar hos patienter med risk för  hjärt- och kärlsjukdom samt att beskriva hur dessa primärpreventiva metoder påverkar riskfaktorerna. Syftet var också att beskriva urvalsgrupperna i de valda vetenskapliga artiklarna. Metod: För att besvara syftet och frågeställningarna hade denna litteraturstudie en beskrivande design där tolv vetenskapliga artiklar har analyserats. Databaserna PubMed och CINAHL användes vid sökningen för att finna de vetenskapliga artiklarna. Resultat: Sjuksköterskor använde olika metoder för att uppmuntra till livsstilsförändring hos hjärt- och kärlsjuka patienter. Dessa metoder innebar att sjuksköterskan antingen fungerar som en informationsgivare eller samarbetspartner gentemot patienten. Effekten av metoderna varierade och enligt vissa studier gav de ej gav någon effekt. Slutsats: Utifrån litteraturstudiens resultatet går det ej med säkerhet att säga vilka metoder som är mest effektiva. Sammanfattningsvis kan sjuksköterskan i sitt kliniska arbete ta hänsyn till båda förhållningssätt i mötet med patienterna och anpassa metoden utifrån ett individuellt perspektiv. / Background: Coronary heart disease is a growing health issue from a global perspective. Research has estimated that coronary heart disease will stand for the majority of deaths by the year 2030.  Risk factors include a high BMI, smoking and low level physical activity. Research has also shown that lifestyle change can decrease the risk factors and is cost-effective for the society. Aim: The aim with the litterature study was to describe which primary prevention methods nurses use to encourage lifestyle change for patients at  risk of developing coronary heart disease, and to describe how these methods affect the risk factors. The purpose was also to describe the sample groups in the chosen articles. Method: To answer the study questions, the literature study had a descriptive design where twelve scientific articles were analysed and categorized. The databases PubMed and CINAHL were used to find the scientific articles. Results: Nurses use an array of different methods to encourage life style change in patients with coronary heart disease. These methods include the nurse either acting as a information giver or a collaboration partner towards the patient. The effect of these methods varied and some of the studies didn’t show any effect whatsoever. Conclusion: On the basis of the literature study, the methods nurses use and their effectiveness are inconclusive. In conclusion, the nurse can consider all of the methods in the work place, and decide which method is adequate based on the individual variations of the patients.

Cardiovascular disease (CVD) is a major public health problem and a primary cause of morbidity and mortality in the United States. Regular physical activity is recommended for prevention and management of CVD. Despite the cardiovascular health benefits of physical activity most adults are physically inactive. Therefore, the aim of this dissertation was to examine the factors associated with adherence to physical activity among individuals with or without CVD. The first paper is a report of a study conducted to examine which baseline demographic (age, gender, marital status, socioeconomic status, and place of residency), psychosocial (social support, depression, anxiety, and fatalism), and clinical (past history of exercising, comorbidity, and health literacy) variables predicted successful adoption of the active lifestyle recommendation of increasing moderate-to-vigorous physical activity by an accumulated 15 minutes or more each day following a CVD risk reduction intervention and 2) to identify which of those same factors predicted dropout from the CVD risk reduction intervention among at-risk individuals in rural America. The study sample consisted of 399 rural Americans. The results revealed that a higher anxiety level was a predictor of active lifestyle modification following a CVD risk reduction intervention. In contrast, younger age and low health literacy were predictors of dropout from a CVD risk reduction intervention. The second paper is a literature review of studies investigating the factors that affected enrollment in cardiac rehabilitation in patients with heart failure (HF). The aims of this review were to: (a) describe enrollment rates of patients with HF in cardiac rehabilitation programs, (b) review the literature on factors affecting enrollment of patients with HF, and (c) identify areas for future research. It is difficult to draw conclusion about enrollment rates because the period of time after hospital discharge that enrollment was measured varied across studies. A wide array of demographic, psychosocial, and clinical variables have been identified as potential barriers of enrollment in cardiac rehabilitation programs. Additional research including patients with HF is needed. The third paper is a report of a cross-sectional study of 279 patients with HF. The aims were to determine 1) the amount of variance in the functional status predicted by depressive symptoms, perceived control, self-rated health, HF self-care maintenance behaviors, and serum N-terminal pro-B-type natriuretic peptide ( NT-pro-BNP) biomarker of cardiac dysfunction in patients with HF and 2) whether NT-pro-BNP mediated the relationship between self-care maintenance behaviors and functional status. Depressive symptoms, poor self-rated health, non-adherence to physical activity, and greater serum NT-pro-BNP levels were independently associated with worse perceptions of functional status. Serum NT-pro-BNP levels partially mediated the association between adherence to physical activity and perception of functional status. The findings from this dissertation provided further evidence of the importance of adherence to physical activity and identify key variables that promote participation in interventions to promote heart healthy lifestyles and adherence to physical activity.

男性保養品市場在近幾年相當受到市場注目，許多大型化妝品集團均針對男性開發男性專屬的皮膚保養用品，在2000年之後，每一年全球的市場均達到二位數之高度成長。從數據上看來，最近幾年的化妝品產業的連年成長，有很大部份是來自於男性消費者的消費主力逐漸產生，他們對於自我外貌的觀念，因為產業、媒體、社會環境的交相傳播影響，使得產品及品牌的觀念漸漸成型，品牌忠誠度與產品的再購也有不少提昇。 本研究即就此一現象做男性專櫃保養品之生活型態與購買決策研究。透過問卷調查，探析男性專櫃保養品消費者的生活型態，並輔以非專櫃保養品之消費者，做兩者的比較分析。本研究共回收937份有效問卷，其中591份是專櫃消費者，346份是非專櫃消費者。本研究利用利用因素分析及集群分析將消費者做生活型態分類；用ANOVA、卡方分析、獨立樣本t檢定分析消費者在購買行為、生活型態、人口變項上的差異；最後用迴歸分析探討品牌滿意度對品牌忠誠度的影響。 研究結果顯示，時尚先鋒族是男性專櫃保養品的目標消費者，其人口變項、生活型態都與其他集群有顯著差異。這個族群對於流行訊息非常敏感，在團體中很活躍、重視社交，並且在意自我形象。他們會透過多元的管道購買專櫃保養品，也會透過網路與其他使用者交換使用心得。而在非專櫃消費者中的時尚先鋒族則是男性專櫃保養品的潛在消費者，他們同樣重視自我的外貌，也會利用較低價的開架式保養品，只是年紀較輕，收入較少，尚未有足夠的預算購買專櫃產品。此外本研究也發現有部分消費者的需求並沒有完全被滿足，某些肌膚問題無法對應該有的專櫃產品。 根據研究結果，企業應加強對時尚先鋒族的行銷，加強價格定位，做好專櫃通路的品牌形象及服務，以提高時尚先鋒族的品牌態度，進而形塑品牌忠誠；強化網路在行銷溝通上的地位，做好網路上的議題管理與公關策略，以強化消費者的品牌滿意度；並且企業應針對目前尚未滿足的需求，發展出對應的專櫃產品，以增加獲利。 / It’s been a wide attention to the men’s skin care matkets in recent years. Many of the large cosmetic groups are developing skin care products specifically for men. After the year of 2000, men’s skin care markets around the world are enjoying double-digit growth every year. Also, based on the numbers, the growth of the entire cosmetic industry in these years has largely benefited from the emerging men’s skin care product consumers. The concept of male consumers’ own look, is changing by the communication of the skin care industry, media information, and the whole atmosphere in the society. This phenominon has the power to form the concept of men’s skin care brands and products, and also raises the brand loyalty and repeated product buying. This research is based on this situation and doing a survey of the consumer lifestyle and purchase decision of men’s skin care products. Through an Internet survey, this research is to analyze the lifestyle of men’s luxury skin care product comsumers, and to compare with the lifestyle of men’s non-luxury skin care product comsumers. Effective samples are in the amount of 937 in total, 591 in luxury consumers, and 346 in non-luxury consumers. The statistics are conducted with factor analysis and cluster analysis to categorize the consumers by their lifestyles; with ANOVA, Chi-square, and independent sample T-test to see the consumer differences in purchase behavior, lifestyles, and demographics; and with regression analysis to discover the impact of the brand satisfaction to the brand loyalty. Based on the prominent differences in demographics and lifestyles, the result shows that the trend-pioneers are the target of the men’s luxury skin care products. This cluster is especially sensitive to fashion information, active in a group, caring about social activities, and their self images. They purchase luxury skin care products in diversed channels, and exchange information after using products with other users through the Internet. And we discover that the potential consumers are inhabited in the trend-pioneers in the non-luxury product consumers. They’re younger, having less income, also caring about their looks, using cheaper skin care products sold in supermarkets and drugstores, and very willing to buy luxury products in the future. They just need some time to get enough budgets. Another discovery in this research is that some comsumer needs are not fulfilled entirely; certain skin problems do not correspond to products with specific solutions. Men’s luxury skin care companies, based on the research results, should reinforce the marketing strategies to trend-pioneers, the price positioning strategies, brand images and services in luxury products channels to raise the trend-pioneers’ brand attitudes, and then to form the brand loyalty. The Internet should get more attention in marketing communication, and be used to enhance the issue management and PR strategies in cyber world, to raise consumers’ brand satisfaction. Additionally, to raise the profits, companies involved should develop corresponding luxury products to specific unfulfilled needs.