The Patient Protection and Affordable Care Act (PPACA) expanded access to insurance coverage and health care services for many citizens, and has increased access for women in particular by including preventive reproductive health services as essential health benefits. The current national rates of sexually transmitted infections (STIs), reproductive cancer diagnoses, and unintended pregnancy serve as major areas of concern for women’s health and public health. The present study examined how knowledge of the PPACA influences receipt of preventive reproductive health services among women. Results indicate that higher levels of knowledge of the PPACA are associated with a greater likelihood of receiving cancer and STI screenings, as well as contraceptive counseling, and that increasing contraceptive knowledge, rates of contraceptive counseling, and pap screenings are related to greater use of highly effective contraception. The present study offers support for increased outreach and education efforts, along with additional policy and provider involvement.

<p>In this dissertation, I discuss two important factors in individuals' decision-making processes: subjective expectation bias and time-inconsistent preferences. In Chapter I, I look at how individuals' own subjective expectations about certain future events are different from what actually happens in the future, even after controlling for individuals' private information. This difference, which is defined as the expectation bias in this paper, is found to have important influence on individuals' choices. Specifically, I look into the relationship between US elderly's subjective longevity expectation biases and their smoking choices. I find that US elderly tend to over-emphasize the importance of their genetic makeup but underestimate the influence of their health-related choices, such as smoking, on their longevity. This finding can partially explain why even though US elderly are found to be more concerned with their health and more forward-looking than we would have concluded using a model which does not allow for subjective expectation bias, we still observe many smokers. The policy simulation further confirms that if certain public policies can be designed to correct individuals' expectation biases about the effects of their genes and health-related choices on their longevity, then the average smoking rate for the age group analyzed in this paper will go down by about 4%.</p><p>In Chapter II, my co-author, Hanming Fang, and I look at one possible explanation to the under-utilization of preventive health care in the United States: procrastination. Procrastination, the phenomenon that individuals postpone certain decisions which incur instantaneous costs but bring long-term benefits, is captured in economics by hyperbolic discount factors and the corresponding time-inconsistent preferences. This chapter extends the semi-parametric identification and estimation method for dynamic discrete choice models using Hotz and Miller's (1993) conditional choice probability approach to the setting where individuals may have hyperbolic discounting time preferences and may be naive about their time inconsistency. We implement the proposed estimation method to US adult women's decisions of undertaking mammography tests to evaluate the importance of present bias and naivety in the under-utilization of mammography, controlling for other potentially important explanatory factors such as age, race, household income, and marital status. Preliminary results show evidence for both present bias and naivety in adult women's decisions of undertaking mammography tests. Using the parameters estimated, we further conduct some policy simulations to quantify the effects of the present bias and naivety on the utilization of preventive health care in the US.</p> / Dissertation

Bakgrund: Historiskt sett har fokus gällande hälsoinsatser främst handlat om förebyggande åtgärder samt att rehabilitera redan skadade och/eller sjuka. Denna syn på hälsa och hälsoarbete har på senare tid förändrats mot att nu ha en starkare tro på vikten av hälsofrämjande insatser. Vi tycker båda att förändringsarbeten är mycket intressanta och ville därför undersöka huruvida hälsoprofilsbedömningen är ett lämpligt verktyg för just friskvårdsinsatser i företagsmiljö. Syfte: Syftet med studien är att undersöka deltagarnas upplevelser under deltagande i en friskvårdssatsning med hälsoprofilsbedömning som metod samt om hälsoprofilsbedömningen kan motivera till en hälsosammare livsstil. Metod: Detta har undersökts med hjälp av en kvalitativt inriktad studie på ett företag med totalt tio anställda. Empirisk data har samlats in genom semistrukturerade intervjuer och sedan analyserats med inspiration från fenomenologisk analysmetod. Resultat: Deltagarna upplevde att hälsoprofilsbedömningen tillhandahöll ett nuläge att förhålla sig till då de ska påbörja eller fortsätta en livsstilsförändring mot ett hälsosammare liv. De ansåg att friskvårdsinsatsen vittnar om hur verksamhetscheferna värderar hälsa högt samt visar på en förståelse för sambandet mellan god medarbetarhälsa och framgångsrik verksamhet. Slutligen verkar det ha skett en positiv förändring i hur de tänker kring kost, träning och stress, där detta nu värderas högre än tidigare / Background: Historically health efforts mainly have been focusing on prevention and to rehabilitate already injured and/or sick people. This vision of health and health work has recently changed towards now having a stronger belief in the importance of health promotion actions. We both think that change management is very interesting and therefore wanted to investigate whether health profile assessment is an appropriate method for preventive health care in the organizational environment. Purpose: The purpose of the study is to investigate the participants experiences during a healthcare project with health profile assessment as method and if it can motivate to a healthy lifestyle. Method: This has been investigated with the help of a qualitatively oriented study on a corporation with a total of ten employees. Empirical data have been gathered through semi-structured interviews and been analyzed with inspiration from phenomenological analyze method. Result: The participants experienced that the health profile assessment provided a current state to relate to when they are going to start or continue a lifestyle change to a more healthy life. They believed that the wellness intervention is a sign of how the business managers highly value health and that it shows an understanding of the relationship between good employee health and business success. Finally it seems to have been a positive change in how they think about diet, exercise and stress, where it now has a higher value than before

Bakgrund: Delirium hos intensivvårdspatienten är ett komplext neuropsykiatriskt syndrom med fluktuerande karaktär som kan leda till sämre prognos och ökat vårdlidande för patienten. Dessutom leder tillståndet till ökade samhällskostnader. Genesen tros vara multifaktoriell där risk och utlösande faktorer kan påverka förekomsten. Farmakologiska åtgärder har hittills tillämpats med otillräcklig framgång varför även omvårdnadsåtgärder rekommenderas. Syfte: Att sammanställa evidens för omvårdnadsåtgärder som kan förebygga delirium hos patienten på intensivvårdsavdelningen. Metoden: Metoden utgjordes av en integrativ litteraturstudien för att kartlägga och sammanställa aktuell forskning om omvårdnadsåtgärder som kan förebygga delirium. Totalt 15 artiklar från CINAHL och PubMed inkluderades. Resultat: Utifrån de inkluderade artiklarnas resultat kunde preventiva omvårdnadsåtgärder identifieras vilka presenteras i fyra huvudkategorier; Involvera närstående, Kognitivt stimulera patienten, Fysiskt stimulera patienten och Främja patientens sömn. Konklusion: Det framkommer att intensivvårdssjuksköterskan med till synes enkla omvårdnadsåtgärder kan förebygga delirium hos patienten. Flertalet omvårdnadsåtgärder kan ses som kopplade till människans fundamentala omvårdnadsbehov som idag redan är implementerade i vården. En viktig del i intensivvårdssjuksköterskans preventiva arbete är således att identifiera faktorer som kan utlösa delirium, och ständigt arbeta strukturerat och medvetet genom sina omvårdnadshandlingar. För att möjliggöra det behövs ett personcenterat förhållningssätt med utgångspunkt i patientens resurser. / Background: Intensive care unit delirium is a complex neuropsychiatric syndrome with a fluctuating nature that can impair the prognosis and increase suffering for the patient. In addition, the permit leads to increased societal costs. The genesis is considered multifactorial where risk and triggering factors may affect the occurrence. Common experiences among healthcare professionals is that the condition can be difficult to identify, manage and treat. Pharmacological interventions implemented have resulted in insufficient success, therefore nursing interventions are also recommended. Aim: To compile evidence about nursing interventions to prevent intensive care delirium. Method: The method consisted of an integrative literature study to map and compile current research involving delirium. A total of 15 articles from CINAHL and PubMed were included. Results: Based on the results of the included articles, preventive interventions could be identified into four main categories; Involve next of kind to the patient, Cognitively stimulate the patient, Physically stimulate the patient and Promoting patients normal sleep cycle. Conclusion: It appears that the intensive care nurse, with seemingly simple nursing measures, can prevent delirium in the patient. Most nursing measures can be seen as linked to the person's fundamental nursing needs that are already implemented in healthcare today. An important part of the intensive care nurse's preventive work is to be able to identify factors triggering delirium, and continuing structured work in a conscious way through their nursing actions. To enable this, a person-centered approach based on the patient's resources is needed.

As the population of older adults in the US increases so do their rates of chronic disease (CDC, 2020). There is limited availability of occupational therapy led health promotion programs for older adults despite being shown to prevent and/or manage chronic disease while helping them thrive (Berger et al., 2018; Cassidy et al., 2017; Clark et al., 2012; Smallfield & Lucas Molitor, 2018b). Factors contributing to limited programming include lack of training for occupational therapy practitioners in preventive health (Metzler et al., 2012), occupational therapy having little recognition as a provider in preventive care amongst health professionals (Halle et al., 2018), and lack of referrals and reimbursement for occupational therapy services in preventive care (Hildenbrand & Lamb, 2013; Metzler et al., 2012). ageWISE is an innovative evidence-based preventive occupational therapy program developed to improve the mental and physical health of older adults. The six-month program develops participant efficacy in optimizing self-selected health behaviors through topics including fall prevention, sleep and rest, ADL performance, socialization, and navigating healthcare technology by utilizing a blend of didactic lecture, experiential learning, peer discussion, goal-setting, and journaling. Comprised of eight in-person group-based sessions and two telephone-based individual sessions, all ageWISE sessions are led by an occupational therapy practitioner and supported by an occupational therapy doctoral student. ageWISE is positioned to not only improve the health of older adults but to expand the reach of occupational therapy in a setting where its value is a necessity…preventive care.

PhD dissertation: "Demand in the wellness market for services in the Czech Republic and abroad" deals with an emerging sphere in the market for services. The service sector contributes not only to the GDP but participates in improving living standards in developed countries. Wellness market for services could influence the way how to spend free time, increase the whole quality individual lives and contribute to reduce spending on health care in the future. In the introductory part there is analyzed the current situation on the wellness market in the Czech Republic. The view of some Czech businessmen on the wellness market for services is often considered (for the purpose) as a way of earnings regardless the broader content of the sphere connected with the healthy lifestyle. The term "wellness" often includes activities which do not concern this sphere, only use this term for marketing purpose. The dissertation is based on the own definition as a term. This term is defined as a permanent feeling of higher quality of life achieved through performing physical and mental activities and internal acceptance of the healthy lifestyle. The goal of this dissertation is a demand survey for these services, it specifically concerns the research of public awareness in this sphere, finding the attitude to activities, which are connected with wellness and acquiring next information which is principal for development in successful business activities, particularly for the strategic decision in pricing policy, the equipment in wellness premises and the quality provided services. In the dissertation were assumed three basic hypotheses: 1. On the basis of research there will be possible to put a qualified customer group and to determine chosen activities. They are suitable as a content of offered programmes for clients who are informed of this sphere or seek to achieve outlined goals. 2. Customers with interest and knowledge of the sphere will be interested in the healthy nutrition, the consumption of dietary supplements and in next activities concerning wellness. 3. Next assumption is a fact that the level of knowledge and understanding the whole conception will be at a lower level in the public. The theoretical part of the dissertation is based on the classical microeconomic theory. The attention is mainly paid to the theory of consumer optimum. Subsequently the dissertation focuses on the issue of marketing research, particularly on the analysis of appropriate quantitative methods which could and should be used in the application part. Great emphasis is placed on the communication policy which is a very important tool for the marketing mix. The application part of the dissertation focuses on its own demand research within that over nineteen thousand data from more than three hundred respondents were obtained. The results were presented after analyzing the obtained data. They showed that all age groups of respondents included in the population survey have within their categories very different features. Thanks to that fact popular sports have been identified, it was possible to determine a client's price concept about services suitable for this sphere and to describe an opinion on the quality and the equipment of wellness premises. Next, for purposes of comparison, two researches from abroad were used and these have become a valuable source of information and serve as a basis for comparative research i.e. comparison of foreign experience with the situation on the Czech market. Both differences and facts generally applicable in the Czech Republic and abroad were found. The result of the investigation was not only the recommendation for following research directions, particularly the need to do research in specialized wellness premises among informed customers with regard to data which were not possible to find out during the overall market research. Another task resulted from the finding that the respondents have very little awareness of the sphere and it will be necessary to establish the wellness programme conception and to introduce this concept to the public particularly by focusing on high schools oriented on physical education and sport and other public institutions. There is a fact that the Czech institutions in the health sector do not consider the prevention in the field of diseases of civilization important enough. It will be necessary to carry out next education of the public in order to achieve savings in the treatment of diseases of civilization in the Czech health care in the future. At the end of the dissertation it is stated that the goals and tasks were fulfilled despite difficulties in obtaining foreign materials and information suitable for comparison with the market in the Czech Republic. In the introduction the presented hypotheses were mostly confirmed, excluding the customer's price concept. It could not be determine intended consumer optimum because of significant heterogeneity of statistical results. In any case the dissertation showed the low level of public awareness of the concept wellness (as expected), the necessity of more distinctive defining of mental activities suitable for this field and the need to unite different opinions on the whole sphere of these services.

<p>Bakgrunden till undersökningen är att arbetsplatsen är en viktig arena att arbeta hälsofrämjande på, eftersom en stor del av befolkningen nås via denna och olika hälsobeteenden kan påverkas innan ohälsa uppstår. En framgångsrik strategi för att skapa hälsosammare arbetsplatser är att arbeta med friskvård. Om människor ska kunna leva hälsosamt krävs att de får möjlighet att göra det även på arbetsplatsen, då hälsa bör ses ur ett helhetsperspektiv. EduTainer har utarbetat en metod för att arbeta med friskvård på företag. Ett företag som arbetat efter denna metod, med gott resultat, är Måleriproduktion AB. Syftet med uppsatsen är att undersöka vilka faktorer som underlättar respektive försvårar för friskvårdsarbete på Måleriproduktion AB samt att studera vilka faktorer som är viktiga hos den externa aktören för att uppnå ett framgångsrikt friskvårdsarbete på arbetsplatsen. Undersökningen baseras på kvalitativ metod och intervjuer har genomförts med åtta deltagare i friskvårdsarbetet. Resultatet och slutsatserna visar att faktorer som underlättar för friskvårdsarbete är inställning, socialt stöd, motivation, förändrade rutiner och en extern aktör. Faktorer som försvårar för friskvårdsarbete är tidsbrist, brist på gemensamma aktiviteter och andra faktorer på själva arbetsplatsen. Viktiga faktorer hos den externa aktören är att den förmedlar bred information samt att upplägget är varierande med föreläsningar, individuell rådgivning, tester och uppföljning.</p> / <p>The background for the study is that the workplace is an important arena to work with health promotion, since a large amount of the population can be reached by the workplace and different health behaviors can be affected before ill health appears. A successful strategy for creating healthy workplaces is to work with preventive health care. If people are going to be able to live healthy lives, they need to get the opportunity to live healthy even at the workplace, because health is supposed to be seen from a holistic point of view. EduTainer has created a method, used for companies, to work with preventive health care. A company which has adopted this method, with good results, is Måleriproduktion AB. The aim of this study is to examine what factors that simplify respectively complicate working with preventive health care at Måleriproduktion AB and to study what factors that are important for the external operator to achieve a successful preventive health care-work at the workplace. The study is based on qualitative method and interviews have been made with eight participants of the preventive health care-work. The result and the conclusions show that the factors that simplify working with preventive health care-work are attitude, social support, motivation, a change of routines and an external operator. Factors that complicate working with preventive health care are lack of time, lack of common activities and other factors at the workplace itself. Important factors for the external operator are that the information is widely mediated and that the framing is varied with lectures, individual counselling, tests and follow up.</p>

Bakgrunden till undersökningen är att arbetsplatsen är en viktig arena att arbeta hälsofrämjande på, eftersom en stor del av befolkningen nås via denna och olika hälsobeteenden kan påverkas innan ohälsa uppstår. En framgångsrik strategi för att skapa hälsosammare arbetsplatser är att arbeta med friskvård. Om människor ska kunna leva hälsosamt krävs att de får möjlighet att göra det även på arbetsplatsen, då hälsa bör ses ur ett helhetsperspektiv. EduTainer har utarbetat en metod för att arbeta med friskvård på företag. Ett företag som arbetat efter denna metod, med gott resultat, är Måleriproduktion AB. Syftet med uppsatsen är att undersöka vilka faktorer som underlättar respektive försvårar för friskvårdsarbete på Måleriproduktion AB samt att studera vilka faktorer som är viktiga hos den externa aktören för att uppnå ett framgångsrikt friskvårdsarbete på arbetsplatsen. Undersökningen baseras på kvalitativ metod och intervjuer har genomförts med åtta deltagare i friskvårdsarbetet. Resultatet och slutsatserna visar att faktorer som underlättar för friskvårdsarbete är inställning, socialt stöd, motivation, förändrade rutiner och en extern aktör. Faktorer som försvårar för friskvårdsarbete är tidsbrist, brist på gemensamma aktiviteter och andra faktorer på själva arbetsplatsen. Viktiga faktorer hos den externa aktören är att den förmedlar bred information samt att upplägget är varierande med föreläsningar, individuell rådgivning, tester och uppföljning. / The background for the study is that the workplace is an important arena to work with health promotion, since a large amount of the population can be reached by the workplace and different health behaviors can be affected before ill health appears. A successful strategy for creating healthy workplaces is to work with preventive health care. If people are going to be able to live healthy lives, they need to get the opportunity to live healthy even at the workplace, because health is supposed to be seen from a holistic point of view. EduTainer has created a method, used for companies, to work with preventive health care. A company which has adopted this method, with good results, is Måleriproduktion AB. The aim of this study is to examine what factors that simplify respectively complicate working with preventive health care at Måleriproduktion AB and to study what factors that are important for the external operator to achieve a successful preventive health care-work at the workplace. The study is based on qualitative method and interviews have been made with eight participants of the preventive health care-work. The result and the conclusions show that the factors that simplify working with preventive health care-work are attitude, social support, motivation, a change of routines and an external operator. Factors that complicate working with preventive health care are lack of time, lack of common activities and other factors at the workplace itself. Important factors for the external operator are that the information is widely mediated and that the framing is varied with lectures, individual counselling, tests and follow up.

No description available.

Bakgrund: Informationsteknik är något som utvecklas i snabb takt. Idag finns det teknik som på distans kan överföra information trådlöst. Egenmonitorering via hälso- och sjukvården kan erbjuda patienten en ökad flexibilitet och tillgänglighet. Via egenmonitorering kan patienten kommunicera och få råd och stöd av hälso- och sjukvården. Distriktsköterskan kan utbilda och informera patienten i sin egenvård. Syfte: Var att beskriva distriktsköterskans erfarenheter av omvårdnad i egenmonitorering. Metod: En kvalitativ empirisk design med semistrukturerade intervjuer. Utifrån Graneheim och Lundmans innehållsanalys analyserades intervjuerna med manifest innehåll. Resultat: Fyra kategorier och sju underkategorier identifierades. Kategori - Att förmedla kunskap; trygghet och förebyggande. Kategori - Att skapa relation; kontinuitet och tillit. Kategori - Att effektivisera arbetet; ett förlängt verktyg och tidsbesparande. Kategori - Tankar inför framtiden; Det nya mottagningsrummet. Diskussion: Egenmonitorering var ett stöd för distriktsköterskan att förmedla kunskap till patient i deras egenvård. Patienterna kände sig trygga och sökte mindre kontakt med hälso- och sjukvården. Via egenmonitoreringen kunde distriktsköterskan arbeta förebyggande. Det skapade en ömsesidig tillit och kontinuitet. Arbetet underlättades för distriktssköterskan och de hann med fler patienter. Egenmonitorering är något som kommer att utvecklas och finnas i framtiden. Slutsats: Studien visade att arbeta med egenmonitorering är en stor fördel ur distriktssköterskans perspektiv. Via egenmonitorering kan distriktssköterskan arbeta förebyggande. Det har varit under stark framväxt under Covid-19 Pandemin. Egenmonitorering är ett flexibelt arbetssätt. / Background: Information technology is something that is developing at a rapid pace. Today, there is technology that can remotely transmit information wirelessly. Self-monitoring via health care can offer the patient increased flexibility and accessibility. Through self-monitoring, the patient can communicate and receive advice and support from the health service. The district nurse can train and inform the patient in her self-care. Purpuse: Where to describe the district nurse's experiences of nursing in self-monitoring. Method: A qualitative empirical design with semi-structured interviews. Based on Graneheim and Lundman's content analysis, the interviews were analyzed with manifest content. Results: Four categories and seven subcategories were identified. Category - To impart knowledge; security and prevention. Category - Creating a relationship; continuity and trust. Category - To streamline work; an extended tool and time saving. Category - Thoughts for the future; The new reception room. Discussion: Self-monitoring was a support for the district nurse to pass on knowledge to patients in their self-care. Patients felt safe and sought less contact with the healthcare system. Through self-monitoring, the district nurse was able to work preventively. It created mutual trust and continuity. The work was made easier for the district nurse and they managed to get more patients. Self-monitoring is something that will develop and exist in the future. Conclusion: The study showed that working with self-monitoring is a great advantage from the district nurse's perspective. Through self-monitoring, the district nurse can work preventively. It has been growing strongly during the Covid-19 Pandemic. Self-monitoring is a flexible way of working. / <p>Datum för godkännande: 2021-11-01</p>