Hundreds of state regulations were passed during the “managed care backlash” of the late 1990s and early 2000s. Many of these anti-managed care regulations eased or eliminated constraints on patient utilization of health care services imposed by managed care organizations. Other regulations gave managed care providers more flexibility in the way they practiced care or helped patients appeal denials of claims. Despite the effort undertaken to pass these regulations, limited research exists on whether the regulations achieved their goal. To fill this gap, this study takes advantage of the variety of regulations enacted during the managed care backlash of the late 1990s and early 2000s to investigate their impact on patient-reported quality of care and mortality for managed care enrollees. The results indicate the regulations did improve patient-reported outcomes, but to varying degrees and only in the latter period of the backlash. Specifically, managed care enrollees who lived in states that adopted moderate-intensity regulations between 2000 and 2004 reported relatively better improvements in access to care and confidence in their provider than did managed care enrollees in states with low-intensity backlash regulations. The positive effect on access to care was similar in states that adopted high-intensity regulations. However, no positive effect was found for any outcome in the first period (1996-2000). These results show that states with the most intense regulatory backlash did not realize better patient-reported outcomes. Instead, states that pursued moderate-intensity backlash regulations experienced relatively better outcomes for their managed care enrollees.

People living with heart failure (PLHF) should be screened for symptoms at every healthcare visit since they are 3 times more likely to experience ventricular arrhythmias. This quality improvement project (QIP) compared 3 self-administered HF symptoms questionnaires to determine the best screening tool for a tertiary hospital arrhythmia devices clinic. The instruments included the Minnesota Living with Heart Failure Questionnaire (MLHFQ), the Kansas City Cardiomyopathy Questionnaire (KCCQ), and the Self-Reported Heart Failure Symptoms (SHEFS) questionnaire. For a 30-day period, 76 people were eligible to participate in the QIP, with 55 participants included in the final analysis (72.5% participation). The questionnaires were compared and assessed with the gold standard laboratory test for HF (NT-proBNP) for sensitivity and specificity. For HF, the SHEFS was the most sensitive (83%) compared to the NT-proBNP, but the MLHFQ was most specific (89%). When compared to the MLHFQ as the standard, SHEFS was 71% sensitive, and 73% specific for HF. Similarly, when compared to the KCCQ, the SHEFS was both, 75% specific and sensitive in identifying HF. However, the rate of correlation to a positive or negative NT-proBNP test results was the highest for the SHEFS (87%). All 3 questionnaires were statistically significant in predicting admission to hospital for HF in the past 6 months (p = 0.02 to 0.03). Finally, given the shortest length and simplicity of use, the SHEFS was selected by the stakeholders to be the standard screening tool for the clinic. This project contributes to positive social change by providing the first reported comparison in the literature to implement questionnaires in a clinic to assess symptoms for PLHF attending an arrhythmia devices clinic.

Adolescents spend a large proportion of their everyday life in school, and schooling is vital for future success and well-being. One group that are in risk for reduced school success are children with disabilities or long-term illnesses. The aim of this study is to investigate whether the factors age, gender, self-perceived relationship with teachers, self-perceived relationship with peers and parental bonding can predict school engagement of students with self-reported long term health conditions and impairment. School engagement is defined as having three aspects, behavioral, emotional and cognitive. HBSC (Health behaviors in School Children) data from Sweden is used. The result shows that self-perceived relationship with teachers and age are related to all three components of school engagement, behavioral, emotional and cognitive in this study.  Self-perceived relationship with peers is related to emotional school engagement only. Gender is related to cognitive engagement. Parent bonding cannot predict any of the three aspects of school engagement. This study demonstrated that school environment, especially teachers, is important for the school engagement of students with long-term health condition and impairment. Dispite the inconsistent results with previous reseach which focus on typical functioning students, School and educators should focus on how to maintain and improve and promote school engagement of students with long-term health condition and impairment in mainstream school setting.

ABSTRACT Background and aims: Nutrition is a part of the medical treatment, and also a part of the nursing care. In spite of this, malnutrition is a common problem in the health care sector. Studies show that nurses have too little knowledge about nutrition and malnutrition and that nutrition has low priority in the daily work. The aim with this study was to find out the nurses self-reported knowledge about and their attitudes towards malnutrition, nutrition screening, prevention and treatment of patients with malnutrition. Methods: A questionnaire was handed out to 65 nurses in two different care units and 36 questionnaires were answered. Results: The respondents from the two care units self-reported their knowledge about nutrition and malnutrition low. Most of the respondents stated to have a big need of education about nutrition screening and more than half of the respondents stated that they have a need of education for prevention and treatment of malnutrition. None of the respondents stated that there were good routines to discover and treat malnutrition in their care units. Less than half of the respondents stated that the patient´s nutrition had high priority to them. Conclusion: The self-reported knowledge about nutrition and malnutrition, nutrition screening, prevention and treatment of patients with malnutrition is low among nurses. There is a big need of education about nutrition screening, prevention and treatment of malnutrition. Good and transparent routines and policies for nutrition screening and treatment of malnutrition are missing. Patient´s nutrition has low priority.To educate nurses within nutrition screening, prevention and treatment of malnutrition and to implement clear and simple-to-use nutrition screening instruments seems to be very important for improvement of patient´s nutritional care.

Background: Health-Related Quality of Life (HRQOL) can be negatively affected in patients living with arrhythmias and many patients experience a pronounced symptom burden. The arrhythmia can cause both uncertainty and limitations, including interference with work, reluctance to perform and plan for leisure activities and leading to self-imposed restrictions in daily life situations. There are patients striving to find strategies to manage the arrhythmia and for some this can become the focus in their lives. Treatment options are often a choice between pharmaceuticals and radiofrequency ablation (RFA) where RFA is an option for many arrhythmia-patients to be cured. In the care of arrhythmia-patients it is of great importance to combine objective examinations with patient-reported outcomes (PROs) to achieve patient’s own experiences of treatment efficacy and arrhythmias interference in daily life situations. Aims: The overall aims of this thesis were to assess symptom burden and HRQOL in patients with arrhythmias and to develop and validate an arrhythmia-specific questionnaire, suitable for most arrhythmia-patients. Design and Methods: Studies I and II were single-centre studies including patients referred for RFA, with two different arrhythmia diagnoses. Assessments of patient-reported outcomes (PROs) concerning HRQOL were performed using two questionnaires, SF-36 and EQ-5D (I-II). Further, patients were asked some disease-specific questions (I). Study I describes assessments before the RFA treatment and Study II the follow-up assessments at three and twelve months after RFA. Patients’ scoring of HRQOL was compared to age and gender matched reference groups before and after RFA (I-II). Studies III and IV describe the development and validation of a disease-specific questionnaire ASTA (Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia) assessing symptom burden and HRQOL. Studies III and IV were multicentre studies. Patients planned for DC-conversion, AF patients seeking emergency care and those with different forms of arrhythmias referred for RFA were included. Results: Patients scored significantly lower HRQOL in seven of SF-36’s eight scales compared to the age and gender matched reference groups before RFA treatment. Frequent arrhythmia attacks had a great negative impact on HRQOL, and female gender and older age were factors contributing to worse HRQOL (I). Treatment with RFA restored the patients’ HRQOL. Most positive effects were seen at three months follow-up. One year after treatment patients and the matched reference group scored their HRQOL to a similar level, assessed with SF-36 and EQ-5D index (II). The validated ASTA questionnaire was found to have good psychometric properties. Construct validity was confirmed with sufficient levels of item-total correlations in the ASTA symptom burden scale and HRQOL scales. The dimensionality of the ASTA HRQOL scale was established with confirmatory factor analysis, supporting a physical and a mental subscale. The internal consistency, demonstrated with Cronbach’s alpha (α), was satisfactory for the ASTA symptom burden scale and the ASTA HRQOL scales, varying from α 0.79 to α 0.91 (III-IV). Conclusions and clinical implications: The studies in this thesis confirmed how negatively affected the arrhythmia-patients can be with a pronounced symptom burden and impaired HRQOL. Treatment with RFA was demonstrated to restore the patients HRQOL to an equal level of that of the matched reference group. PROs are important to take into consideration in the care of arrhythmia-patients, to achieve the patients’ subjective experiences of their daily life situation. To the best of our knowledge ASTA is the first arrhythmia-specific questionnaire assessing symptom burden and HRQOL, suitable for most arrhythmia forms. The newly validated ASTA questionnaire can be an important contribution to assessment of PROs in arrhythmia-patients.

Privacy emerges as a critical issue in an e-commerce environment because of a fundamental tension among corporate, consumer, and government interests. By reviewing prior Internet-privacy research in the fields of information systems, business, and marketing published between 1995 and 2006, we consider the following research questions: 1) how an individual’s privacy behaviour is affected by privacy policy disclosures and by the level of the individual’s involvement regarding the sensitivity of personal information; 2) how companies’ privacy policies vary with respect to regulatory approaches and cultural values; and 3) whether there is a gap between the privacy practices valued by individuals and those emphasized by companies. A three-stage study is conducted to answer these questions. The first two stages, consisting of a Web-based survey and an online ordering experiment with 210 participants, found that individuals are more likely to read the privacy policy statements posted on Web sites and less likely to provide personal information, when they are under a high privacy involved situation as compared to being in a low privacy involved situation. However, the existence of a privacy seal did not affect individuals’ behaviour, regardless of involvement conditions. This study also found a gap between self-reported privacy behaviour and actual privacy behaviour. When individuals were requested to provide personal information, their privacy policy statement reading behaviour was close to their self-report behaviour. However, their personal information providing behaviour was different from their self-reported behaviour. The third stage, which entailed the study of 420 privacy policies spanning six countries and two industries, showed that privacy policies vary across countries, as well as with varying governmental involvement and cultural values in those countries. Finally, the analysis of all the three stages revealed a gap between individuals’ importance ratings of companies’ privacy practices and policies that companies emphasize in their privacy disclosures.

Communicative strategies not only play an important role in communication but they also contribute to second language acquisition. Communicative strategies (CS) can help to keep the communication channel open, encourage hypothesis formation and automatization. The overall aim of this essay is to find out whether there is a relationship between Chinese English learners’ attitudes toward the use of communicative strategies and the reported frequency of using them in actual communication. Forty Chinese English majors are selected randomly to participate in this investigation. They were divided into two different groups according to their different level of language proficiency. The main methods of this essay are two questionnaires and an interview.   Based on the framework of achievement strategies and reduction strategies and through the investigation of the relationship between the attitude toward communicative strategies and the reported frequency of using them in communication, three tentative conclusions have been drawn. Firstly, a learner’s attitude of CS has some influence on the use of CS. Secondly; Chinese learners of English tend to use reduction strategies most often. Finally, Chinese learners seldom use achievement strategies although they tend to believe the important role of achievement strategies in communication. What is more, this essay also analyzes the two groups of students’ different attitudes and different reported frequency of using CS and finds some reasons for those differences. After the above analyses, the essay categorizes three main factors which affect learners’ attitudes and their reported frequency of using CS. It includes the learner itself, the learning context, and the communication context.

Privacy emerges as a critical issue in an e-commerce environment because of a fundamental tension among corporate, consumer, and government interests. By reviewing prior Internet-privacy research in the fields of information systems, business, and marketing published between 1995 and 2006, we consider the following research questions: 1) how an individual’s privacy behaviour is affected by privacy policy disclosures and by the level of the individual’s involvement regarding the sensitivity of personal information; 2) how companies’ privacy policies vary with respect to regulatory approaches and cultural values; and 3) whether there is a gap between the privacy practices valued by individuals and those emphasized by companies. A three-stage study is conducted to answer these questions. The first two stages, consisting of a Web-based survey and an online ordering experiment with 210 participants, found that individuals are more likely to read the privacy policy statements posted on Web sites and less likely to provide personal information, when they are under a high privacy involved situation as compared to being in a low privacy involved situation. However, the existence of a privacy seal did not affect individuals’ behaviour, regardless of involvement conditions. This study also found a gap between self-reported privacy behaviour and actual privacy behaviour. When individuals were requested to provide personal information, their privacy policy statement reading behaviour was close to their self-report behaviour. However, their personal information providing behaviour was different from their self-reported behaviour. The third stage, which entailed the study of 420 privacy policies spanning six countries and two industries, showed that privacy policies vary across countries, as well as with varying governmental involvement and cultural values in those countries. Finally, the analysis of all the three stages revealed a gap between individuals’ importance ratings of companies’ privacy practices and policies that companies emphasize in their privacy disclosures.

This thesis features a qualitative study of student source use and speech representation in two corpora of review essays that acknowledges the complexity of classroom writing contexts and the rhetorical nature of school genres. It asks how students engage with the texts they review, for what reasons, and in response to what aspects of the writing context. When considered as a distinct genre of student assignment, review essays make for a particularly interesting study of source engagement because they challenge students to maintain an authoritative voice as novices evaluating the work of an expert. In addition, citation issues in the review assignment might not be as obvious to students or their instructors as they would be, for instance, in a research paper for which multiple sources are consulted and synthesized. The review essays interrogated in this study were collected with appropriate ethics clearance from two undergraduate history courses. The analysis is extended to a small corpus of published reviews assigned as model texts in one of these courses. The study features a robust method that combined applied linguistics and discourse analysis to tease out connections between the grammatical structures of speech reports and their argumentative roles. This method involved a recursive process of classifying speech reports using Swales’ (1990) concepts of integral and non-integral citation, Thompson and Yiyun’s (1991) classifications of speech act verbs, and Vološinov (1929/1973) and Semino and Short’s (2004) models of speech reporting forms. In addition, the analysis considered the influence of the writing context on the students’ citation practices and took into account theories of rhetorical genre and student identity. The results show connections between assignment instructions and the effective and problematic ways students engaged with the texts they reviewed, such as a correlation between a directive to reduce redundancy and the absence of in-text attributions. Most notably, this study offers a fluid set of descriptors of the forms and functions of speech reports in student coursework that can be used by students, educators, plagiarism adjudicators, as well as scholars of rhetoric and composition, to illuminate some of the methods and motives of student source use.

Vest, H. (2012).Möjligheter och hinder för samverkan inom offentlig sektor. Uppsats i pedagogik på kandidatnivå. Högskolan i Gävle, Akademin för utbildning och ekonomi. Denna undersökning syftar till att belysa upplevda möjligheter och hinder för samverkan, i arbetet med ungdomar rörande alkohol, narkotika, doping och tobak (ANDT). Studiesubjekten utgörs av 14 anställda på en kommun i södra Norrland. Metoden som använts i undersökningen är semi-strukturerad enkät med ett fåtal öppna frågor som ger utrymme för respondenterna att uttrycka sina upplevelser. Respondenternas svar har kategoriserats utifrån en analysmodell som belyser inre och yttre möjligheter och hinder för samverkan. Tidigare forskning rörande studieobjektet visar att samverkan har blivit en nödvändighet inom offentlig sektor idag i takt med att verksamheter renodlats och organisatoriskt gått från en centraliserad styrmodell till en decentraliserad. Samtidigt saknas en helhetssyn inom offentlig sektor som gör att individer i behov av hjälp ofta slussas mellan olika myndigheter i takt med att de utfört sitt eget specifika uppdrag. En fungerande samverkan är beroende av en mängd möjligheter och hinder kopplade dels till individer och dels till organisationen och dess struktur. Undersökningen visar att en majoritet av respondenterna besitter inre möjligheter för samverkan, i form av en vilja att samverka och en upplevelse av att samverkan är något positivt som främjar arbetet och gynnar resultatet. En majoritet av respondenterna upplever att de begränsas av yttre hinder kopplade till organisationen, främst faktorer som tid, ledarskap, förankring och strukturer för samverkan.