Pasitelkiant mišriojo tipo nuosekliąją tiriamąją tyrimo strategiją disertacijoje nagrinėjamas bedarbystės patyrimo fenomenas bei atskleidžiamos bedarbystės patyrimo ir psichologinės gerovės sąsajos. Bedarbystės patyrimui analizuoti naudojamas iki šiol postsovietinėse šalyse empiriškai netikrintas teorinis M. Jahoda (1982) deprivacijos modelis, kurį sudaro šie komponentai (modelyje vadinami netiesioginėmis darbo naudomis): aktyvi veikla, laiko struktūra, socialiniai kontaktai, statusas bei kolektyvinis tikslas. Atlikus reprezentatyvų populiacijos tyrimą, M. Jahoda deprivacijos modelis patvirtintas Lietuvoje. Rasta, kad netiesioginės darbo naudos bei tiesioginė nauda teigiamai prognozuoja bedarbių psichologinę gerovę (optimalų funkcionavimą, subjektyviai suvokiamą gerą psichinę sveikatą bei subjektyviai suvokiamą gerą fizinę sveikatą). Kokybinių tyrimų radinių analizė atskleidė, kad bedarbystės patyrimo fenomenas pasireiškia kaip kokybiniai socialinių santykių, statuso ir identifikacijos, tikslų kūrimo, dienos struktūros, aktyvumo bei psichologinės gerovės pokyčiai. / Using sequential exploratory design of mixed-methods approach the phenomenon of unemployment experience and its relation with psychological well-being is analyzed in dissertation. Theoretical Jahoda’s (1982) deprivation model (composed of so called latent functions of employment – activity, time structure, social contact, status, and collective purpose), which has not been empirically tested in post-Soviet countries so far, is invoked for analysis of unemployment experience. Based on the results of a representative population study, Jahoda’s model was confirmed in Lithuania. Latent employment functions and manifest function positively predict psychological well-being (optimal functioning, subjectively perceived good mental health, and subjectively perceived good physical health) of the unemployed people. Analysis of the results of qualitative studies revealed that the phenomenon of unemployment experience manifests as qualitative changes in social relationships, status and identification, goal setting, daily structure, activity and psychological well-being.

Almost every year, Aboriginal communities are evacuated from northern regions of Canada to nearby cities because of threats due to forest fires and flooding. In this thesis, I present the perspectives of twenty members of the Hatchet Lake First Nation, who were evacuated from Wollaston Lake in northern Saskatchewan during the summer of 2011. My main research question is, how do residents of Wollaston Lake describe experiences of disruptions to well-being and distress during the evacuation and in the evacuation centers? My methods are qualitative, as I conducted open-ended interviews and participant observation while residing in the community for six weeks during the summer of 2012. Following the approaches of Geertz (2000), Garro (2000), and Mattingly (1998), I engaged in a narrative analysis of these data. Three main themes are evident in community members’ discussions of their experiences. First, participants focus on the ways that the fire and displacement disrupted the well-being of fellow community members and, to a lesser degree, their relationships with the land surrounding their town, and their roles within the community. Residents of Wollaston Lake portray a version of well-being that is rooted in the social, rather than individual, self. The second theme relates to family roles, as mothers, fathers, adult children, and guardians describe the various ways that these roles were disrupted during the fire and evacuation, and the distress elicited by these disruptions. These narratives are indicative of the discrepancies between the circumstances experienced during the fire and evacuation, and the values and behaviors that they associate with family roles. The third theme relates to expectations and blame, as community members recall the various ways that the evacuation failed to meet their expectations, and they attribute blame to those that they deem responsible for these inadequacies. Specifically, community members focus on expectations relating to the handling of the threat of fire, the organization of the evacuation, and their interactions with members of the host communities. These findings indicate the incongruities between current emergency management practices in Saskatchewan and the needs of this community. The implication of these findings is that, in order to minimize distress during future disasters, organizers must develop plans that account for the distinct social norms and vulnerabilities of the communities with which they work.

Dagens samhälle ställer höga krav på individer att vara sociala, kommunikativa och inneha en förmåga att hantera ett ökande informationsflöde. Samtidigt som det ligger mycket ansvar på den enskilde individen att sålla bland stora mängder information har olika individer skilda förutsättningar att möta dessa krav. Studiens syfte var att undersöka om upplevelse av kontroll och välbefinnande hos medarbetarna påverkar kommunikationstillfredsställelse och föredragna kommunikationskanaler. Som teoretisk referensram har teori om kommunikation och subjektivt välbefinnande samt Rotters (1966) teori om Locus of Control använts. En kvantitativ enkätstudie genomfördes på en förvaltning i Tidaholms kommun i Västra Götalands län där de upplevt kommunikationsproblem i sin internkommunikation. Resultatet visade signifikanta samband mellan upplevd kontroll på arbetsplatsen och kommunikationstillfredsställese (β = -.98) samt mellan välbefinnande och kommunikationstillfredsställelse (β = 1.43). De med hög upplevelse av kontroll föredrog elektroniska och skriftliga kommunikationskanaler mer än de med låg upplevelse av kontroll. Resultatet indikerade därmed på att upplevelse av kontroll och välbefinnande inte bara påverkar hur man kommunicerar, vilket tidigare studier har visat, utan att det även påverkar hur man uppfattar kommunikation. / Today’s society places high demands on individuals to be social, communicative and to have the ability to process an increasing flow of information. While there is a lot of responsibility on the individual to screen large amounts of information, different individuals have various abilities to meet these requirements. The purpose of this study was to examine if the experience of control and well-being of the employees affect their communication satisfaction and preferred communication channels. As a theoretical framework, theories of communication and subjective well-being and Rotters (1966) theory of Locus of Control were used. A quantitative survey was conducted in Tidaholm municipal administration in Västra Götaland county, Sweden, where they had experienced problems in their internal communication. The results showed a significant correlation between Work Locus of Control and communication satisfaction (β = -.98) and between well-being and communication satisfaction (β = 1.43). The employees with internal Locus of Control preferred written and electronic communication channels more so than the employees with external Locus of Control. The results indicate therefore that Locus of Control and well-being not only affects how individuals communicate, which previous studies have shown, but it also affects how individuals perceive communication.

In today’s aging population, cerebrovascular health plays a pivotal role in maintaining independence. The identification of early markers of change might help to plan more appropriate preventative and/or therapeutic measures. Recent focus has been placed on the relationship between peripheral vascular characteristics and cerebral hemodynamics. Given the compliant nature of the cerebral circulation, examination of passive properties, including critical closing pressure (CrCP) and resistance area product (RAP), might provide sensitive information about early functional changes. The purpose of this thesis was to provide a comprehensive view of peripheral vascular and cerebrovascular regulation in community-living older adults. In doing so, the thesis covered a spectrum, ranging from an examination of lifestyle factors, including habitual physical activity and sleep quality, to the impact of cerebrovascular health on functional status, characterized by gait speed. Key findings included the observation that while participants showed the ability to regulate cerebral blood flow (CBF) appropriately in most circumstances, the underlying mechanisms used to achieve this regulation was dependent on baseline vascular tone. During sit-to-stand transitions, individuals with lower baseline resistance relied primarily on fluctuations in RAP, which have been suggested to more closely reflect myogenic pathways. In contrast, individuals with elevated resistance had lower baseline CBF and relied relatively more on fluctuations in CrCP during the dynamic transition. The greater reliance on CrCP might indicate that these individuals were required to tap further into reserve pools to avoid hypoperfusion during the transition. Notably, those who exhibited a smaller dynamic RAP response during the posture change also had slower gait speed and higher occurrence of falls over the past year. These results provide evidence that passive cerebrovascular dynamics are sensitive markers linking peripheral and cerebrovascular properties with functional consequences for brain health in the elderly.

In today’s aging population, cerebrovascular health plays a pivotal role in maintaining independence. The identification of early markers of change might help to plan more appropriate preventative and/or therapeutic measures. Recent focus has been placed on the relationship between peripheral vascular characteristics and cerebral hemodynamics. Given the compliant nature of the cerebral circulation, examination of passive properties, including critical closing pressure (CrCP) and resistance area product (RAP), might provide sensitive information about early functional changes. The purpose of this thesis was to provide a comprehensive view of peripheral vascular and cerebrovascular regulation in community-living older adults. In doing so, the thesis covered a spectrum, ranging from an examination of lifestyle factors, including habitual physical activity and sleep quality, to the impact of cerebrovascular health on functional status, characterized by gait speed. Key findings included the observation that while participants showed the ability to regulate cerebral blood flow (CBF) appropriately in most circumstances, the underlying mechanisms used to achieve this regulation was dependent on baseline vascular tone. During sit-to-stand transitions, individuals with lower baseline resistance relied primarily on fluctuations in RAP, which have been suggested to more closely reflect myogenic pathways. In contrast, individuals with elevated resistance had lower baseline CBF and relied relatively more on fluctuations in CrCP during the dynamic transition. The greater reliance on CrCP might indicate that these individuals were required to tap further into reserve pools to avoid hypoperfusion during the transition. Notably, those who exhibited a smaller dynamic RAP response during the posture change also had slower gait speed and higher occurrence of falls over the past year. These results provide evidence that passive cerebrovascular dynamics are sensitive markers linking peripheral and cerebrovascular properties with functional consequences for brain health in the elderly.

Self-regulation capacity allows individuals to manage their thoughts, feelings, and actions to attain personal goals (e.g., well-being and performance), as well as adjust to their changing social and physical environment (Zimmerman, 2000). Self-regulation as a positive adaptive skill and process has not been examined in relation to well-being in the context of medicine. The purpose of the current study was to examine self-regulation with 37 medical students and 25 supervising physicians to determine whether or not it may enhance well-being and performance, and reduce stress and burnout. A mixed-methods design was used to collect and analyze the data, and findings from the quantitative and qualitative phases were presented in two separate articles. Self-regulation capacity appears to be an important skill that may help both physicians and medical students to meet the demands of the medical profession and maintain an adequate level of well-being and performance in their work and daily life.

Performing emotional labour in health care has been widely studied. However, there is a gap in the literature regarding mental health care. Therefore, the aim of this study was to identify (1) the method of emotional labour (i.e. hiding, faking, deep acting) adopted by mental health workers when interacting with patients; (2) the consequences associated with performing emotional labour- burnout, job satisfaction, and stress; and (3) which of these variables mentioned above predict the health and well-being of mental health workers. Findings revealed greater use of hiding emotions, than deep acting or faking emotions with patients. Several consequences, both positive and negative were identified. Among the negative consequences found, performing emotional labour through hiding and faking emotions was associated with burnout, job dissatisfaction, and stress. Conversely, through deep acting, increased personal accomplishment and job satisfaction was confirmed. No association between emotional labour and psychological distress, and physical symptoms were found.

Population aging in Canada is associated with a rising burden of heart failure (HF), a condition associated with substantial morbidity, mortality and health service use. HF management involves pharmacotherapy, exercise, dietary restrictions and symptom monitoring. First-line combination pharmacotherapy for HF consists of an angiotensin converting enzyme inhibitor (ACE inhibitor) or angiotensin receptor blocker (ARB) in conjunction with a β-adrenergic receptor blocker (β-blocker). This combination therapy can reduce mortality, improve symptoms and reduce health service use. However, evidence about the benefits of these therapies has been derived from randomized controlled trials in younger patients from acute care and specialty clinic settings. Little work has explored outcomes among older individuals and those in the community setting. In purposely studying an older cohort of individuals with HF, the goals of this research were three-fold: to comprehensively describe their sociodemographic, clinical and service use characteristics; to describe rates of usage of first-line HF pharmacotherapy and correlates of non-use; and to examine the outcomes of mortality, long-term care (LTC) admission, long-stay hospitalization, admission, new cognitive decline and new functional decline as well as predictors of these outcomes. To achieve these aims, this work made use of the extensive data available through the Resident Assessment Instrument – Home Care (RAI-HC) database in Ontario. The RAI-HC is mandated for use in Ontario to assess all long-stay home care clients (those expected to receive home care service for at least 60 days). This assessment contains over 300 items about sociodemographic and clinical characteristics, diagnoses, service use and geriatric conditions, such as functional abilities and cognition. The study samples included long-stay home care clients older than 65 years of age. The descriptive analyses (N=264,030) demonstrated that older home care clients with HF are a more complex group than home care clients without HF, with more comorbidity and higher use of medications and health care services. From the analyses examining pharmacotherapy use (N=176,860), rates of use of first-line pharmacotherapy were low, with only 30% of clients with HF receiving recommended combination first-line therapies, a similar proportion receiving no therapies and the remainder receiving at least one therapy. The multivariate analyses revealed that hypertension and diabetes mellitus diagnoses affect first-line therapy use. Regardless of clinical subgroup, use of these therapies was less likely among older clients and those with functional impairment, airway disease or behavioural symptoms. Longitudinal analyses were done using Cox proportional hazards regression modeling (N=9,283) in which individuals were followed for nine months after each RAI-HC assessment. Results from these analyses showed that female gender and living alone reduced the risk of all outcomes except LTC admission, while age over 85 years generally increased the risk of all examined outcomes. Comprehensive clinical indicators, the Changes in Health, End-stage disease, Signs and Symptoms (CHESS) scale and Method for Assigning Priority Level (MAPLe) algorithm, increased the risk of all outcomes except new cognitive decline. ACE inhibitor use was protective of LTC admission and functional decline, but not mortality, long-stay hospitalizations or cognitive decline. The complexity of older individuals with HF could impair self-care abilities and points to the need for initiatives to help such individuals manage their care at home with appropriate support and services. The low rates of use of first-line pharmacotherapy among older home care clients with HF highlights the need for better understanding of which factors affect prescribing practices. Better evidence, that is more applicable to older individuals with HF, is needed about the therapeutic benefits of first-line therapies to help enhance the evidence base and improve patient care.

Background: Quality of life (QoL) of long term care facility (LTC) residents is being recognized as an important outcome of care by LTC providers, researchers, and policy makers. For residents, measurement of QoL is a valued opportunity to express their perception of the quality of their daily life in the LTC facility. For clinicians, self-reported QoL provides useful information in planning and implementing resident-centred care. Purpose: The purposes of this study were: (1) to examine the distributional and psychometric properties of the interRAI Self-Report Nursing Home Quality of Life Survey (interRAI_QoL Survey); and (2) to explore the relationship of selected socio-demographic and clinical characteristics of residents and LTC facility attributes with residents’ self-reported QoL. Methodology: This was a cross-sectional observational study. A convenience sample of 48 volunteer LTC facilities from six Canadian provinces was involved in this study. Nine hundred and twenty eight (928) residents agreed to participate in this study. Resident inclusion required an interRAI Cognitive Performance Scale score of 0 (intact) to 3 (moderate impairment). Residents’ self-reported QoL was measured by trained surveyors using the interRAI_QoL Survey instrument. Residents’ socio-demographic and clinical characteristics were obtained from the most recentResident Assessment Instrument –Minimum Data Set 2.0 prior to the QoL interviews. LTC facility attributes were measured by a survey form specifically designed for this purpose. Descriptive statistics were used to describe the participating LTC facilities, the sample of residents, and residents’ self-reported QoL. Psychometric tests for reliability (test-retest and internal consistency) and validity (content and convergent) were conducted. Bivariate analyses were conducted to examine the relatioships between QoL and resident and facility charateristics. Multivariate linear and logistic regression analyses were conducted to identify predictors of residents’ QoL. Results: The study confirmed the feasibility of assessing LTC facility residents’ self-reported QoL. The findings showed positive ratings of some aspects of residents’ daily lives while negative ratings in other aspects. Psychometric tests showed that the interRAI_QoL Survey instrument had test-retest reliability, internal consistency, content validity and construct (convergent) validity. Several resident and facility characteristics were associated with self-reported QoL. Religiosity and highest education level attained were significantly and positively associated with QoL. Other resident characteristics such as age, gender and marital status were not. Mild cognitive impairment, depression, aggressive behaviour, hearing impairment, bowel and bladder incontinence, and extensive assistance in activities of daily living were significantly but negatively associated with QoL. LTC facility ownership showed significant association with QoL. Residents in municipal LTC facilities followed by private LTC facilities reported higer QoL in contrast to charitable LTC facilities. Profit status, accreditation and leadership stability were not associated with QoL. Residents in rural settings reported significantly higher QoL than those in urban settings. Facility size (measured in number of beds), registered nurse hours of care, nursing staff turnover, and ratios of registered to non-registered nursing staff did not have a significant association with QoL. However, higher management hours and total hours of care had significant and positive associations with residents’ overall QoL. Multiple linear regression showed that residents’ religiosity, degree of social engagement, post secondary education, dependence in activities of daily living, and positive global disposition, and LTC facilities situated in rural settings and ownership type together accounted for 24% (adjusted R2=0.24) of the variance in overall QoL (the dependent variable). In logistic regression, low QoL was used as the binary dependent variable. Residents who were religious, were socially engaged and had a positive global disposition were less likely to report low QoL. In contrast, residents with dependence in activities of daily living and post secondary education were more likely to report low QoL. Residents in LTC facilities located in rural settings and operated by municipal or private operators were less likely to report low QoL compared to charitable facilities. Strengths and Limitations: This study had several strengths, including a sample of 928 residents who self-reported on their QoL and the use of RAI-MDS 2.0 for objective, external indicators of QoL. This study had several limitations, including response bias due to method of sample selection, inability to draw causal inferences due to study design; limited generalizability due to use of a convenience sample, lack of monitoring of surveyors for the integrity of resident interviews, and exclusion of residents with cognitive performance scale scores of more than three or inability to communicate in English. Future research should address these limitations. As well, future research should conduct more stringent psychometric analyses such as factor analysis and use multi-level modeling procedures. Implications: The findings of this study have implications for improving residents’ QoL, LTC facility programming, future research, and social policy development. Conclusion: QoL can be measured from resident self-reports in LTC facilities. Self-reports from residents may be used by clinicians to plan and implement resident-centred care. There are significant associations of residents’ QoL with select resident socio-demographic and clinical characteristics and facility attributes. Some of these resident characteristics and facility attributes may serve as predictors of QoL.

Introduction: Cancer survivors continue to experience psychological distress and challenges in their daily lives long after the completion of treatment. Caregivers play a pivotal role in the lives of cancer survivors by providing support in various domains of their lives. The cancer experience between support persons and cancer survivors is intertwined. The interdependence theory will serve as a theoretical framework to guide the purposes of this study. Objective:The purpose of this research was to gain a better understanding of unmet needs of caregivers supporting long-term cancer survivors and explore how fulfilling the needs of caregivers influenced the psychological well-being of cancer survivors. Specifically, an emphasis was placed on exploring the level of dependence present in marital relationships, and how this impacted the relationship between caregiver unmet needs and the psychological outcomes of cancer survivors. Method: Data was drawn from The Cancer Support Persons’ Unmet Needs Survey (SPUNS) (Campbell et al., 2009) and The Cancer Survivors’ Unmet Needs Survey (SUNS) (Campbell et al., 2009). Regression models tested for significant interactions between caregiver unmet needs and factors influencing survivor dependence with psychological distress in cancer survivors. Results: Findings revealed main effects between caregivers’ depression, anxiety, and stress with the respective psychological outcomes in cancer survivors. Caregivers’ concerns about the future predicted elevated depression in cancer survivors. Caregivers with needs pertaining to information or emotions predicted higher anxiety in cancer survivors. Information needs, future concerns, and health care access and continuity needs of caregivers predicted higher survivor stress. Conversely, work and financial needs of caregivers predicted lower depression, anxiety and stress in cancer survivors. Significant interactions were found for caregivers’ concerns about the future by recurrence of diagnosis with decreased survivor anxiety, health care needs of support persons by recurrence of illness with increased survivor anxiety, caregivers’ personal needs by severity of illness with higher survivor anxiety, support persons’ emotional needs by severity of illness with lower survivor anxiety, caregivers’ emotional needs by severity of illness and decreased survivor stress, and finally, support persons’ health care needs by severity of illness with higher survivor stress. Conclusion: Findings did not fully support the hypotheses of this present study. Nonetheless, the significant results revealed in the findings would be useful to generate alternative hypotheses in future studies regarding interdependence, unmet needs and psychological well-being. The findings for the present study will also provide direction towards improvement in treating caregivers and cancer patients as a conglomerate, and inform programs, services and policies in cancer care.