abstract: Advances in health care have resulted in an increase in life expectancy causing a rapid growth in the number of older adults at a global level. At the same time, socioeconomic development is transitioning family structures and social relationships. With reduced family engagement, many older adults are more at risk for physical and psychological health issues including loneliness, which is considered a public health issue affecting their quality of life and well-being. This descriptive, exploratory study aims to describe the significance of loneliness in three northern regions of the Sultanate of Oman. The purpose of this study is to examine the prevalence and correlates of loneliness and the relationship of loneliness to health statuses among older Omani adults aged 60 years and above. A demographic data questionnaire, the UCLA loneliness scale, and SF-12-v-1 health status instruments were used for data collection. The sample includes 113 Omani older adults, male (n = 36) and female (n = 77), who experienced a mixture from low to high and severe levels of loneliness. Among these older adults, 34.5% perceived low level, 34.5% moderate level, 22.1% high, and 8.8% were severely lonely. The main demographic factors that were associated with the older adults level of loneliness were female gender, older age 80 years and above, living with others who were not a family member, and being unemployed. When controlling for demographic and environmental factors loneliness was a significant predictor (p < .001) for lower mental health status but not for physical health status (p > .05). / Dissertation/Thesis / Doctoral Dissertation Nursing 2019

Research suggests evidence of an association between sociodemographic determinants and illicit drug use. However, these data do not take into consideration the effect an economic obstacle, such as a recession, could have on an individual's urge to cope with this stressful period with illicit drugs. Furthermore, there is no research to suggest how clinicians and/or treatment institutions can forecast whether the use of monetary resources will be sustainable due to private and/or governmental fund reductions during an economic recession. Based on theories of social learning and social disorganization within an ecological framework, this study employed a quantitative trend analysis to explore the impact the 2007-2009 economic recession had on illicit drug use throughout the United States. A sample of respondents from the Substance Abuse and Mental Health Data Archive from 2006 to 2010 surveys was used to run the statistical analysis. Based on the analyses, age and gender (covariates) and all variables (social disorganization and Gross Domestic Product) were found to be significant predictors of illicit drug use. Although methamphetamine was not significant for prevalence over time, total drug use, cocaine, and heroin were prevalent over time based on predictors. These findings suggest local, state, and federal policies regarding the prosecution and imprisonment of nonviolent and minor drug offenders should be reprioritized towards the rehabilitation of addicts while enforcing firmer laws upon the most disruptive and severe aspects of the drug trade in order to promote a genuine positive change towards social organization.

A decline in Human Immunodeficiency Virus (HIV) prevalence rates have been observed among females ages 15 to 19 years and 20 to 24 years in Zimbabwe between 2005 and 2010. However, for males 15 to 19 years, rising trends were observed, whereas for males ages 20 to 24 years, rates fluctuated between 2005 and 2011. The purpose of this cross-sectional study was to examine relationships between sexual behaviors and practices and HIV prevalence among young males and females ages 15 to 24 years in Zimbabwe. Guided by constructs of proximate determinants framework, extracted data from two National Demographic Health surveys of 2005/06 and 2010/11 were analyzed using chi square and binary logistic regression. This study revealed that sexual practices, relationship status, and education status increase the odds of being HIV positive differently among 15 to 19-year-olds and 20 to 24-year-olds based on gender and changes through time. Significant relationship existed between HIV positive serostatus and total number of life time partners among females 15 to 19 years and 20 to 24 years; lack of condom use among males 20 to 24 years in 2005/06; early sexual debut and lower education status among females 20 to 24 years; and being widowed, separated, or divorced among males and females 20 to 24 years in 2010/11. The Odds of being HIV positive for males ages 15 to 19 years was not predicted by sexual practice, creating a need for future study. This study can contribute to positive social change by providing information about the associations between HIV serostatus and the assessed risk factors, which may help promote awareness about HIV infection risk, thereby helping develop and implement targeted public health interventions to reduce the burden of HIV.

There is an increasing number of International Baccalaureate programs in the United States that require instruction in an additional language to prepare culturally responsive global citizens, but there is little research on how the teaching of culture is addressed in elementary additional language programs. This study was guided by Vygotsky's and Dewey's social constructivism and investigated how the teaching of culture is integrated in additional foreign language classrooms in the State of Georgia's International Baccalaureate Primary Years Programs (IB PYP). It also investigated how personal, professional, or organizational factors such as values, beliefs, teacher training, or time constraints impact the integration of culture and language. This qualitative multiple-case comparative study examined the experiences of 3 teachers in Georgia who taught in K-5 additional language classrooms, using curriculum maps, student work samples, lesson plans, and semi-structured interviews as the data sources. Data were analyzed using Atlas.ti software and coded using constant comparative methods; the inductive qualitative content analysis included open coding, axial coding, and selective coding. The study findings showed that a variety of factors impacted program goals including the attitudes of school community, teacher isolation, philosophy, Georgia Standards, and practices of the IB PYP. Findings are applicable to additional language teachers for further discussion on the current state of elementary language programs in Georgia's IB PYP and for informing choices on program design. This study contributes to social change by expanding the body of professional literature in the field of foreign language education and on the issues that affect teachers in additional language classrooms in the IB PYP.

Obesity has reached epidemic proportions in American society. However, not enough attention has been given to weight change by temporal and dynamic detailed social characteristics, controlled for unobserved heterogeneities nested in county and state. Using the National Longitudinal Survey Youth (NLSY79), this study examined weight change and its development into unhealthy conditions like being overweight or obese, in relation to change in social characteristics including life course events. This study also examined the social characteristics of remaining at a normal weight through all time intervals over a 19-year period. Using hierarchical linear multilevel analysis, this study found that changes in social characteristics over time could be linked to weight status for both males and females. Young males with normal weight are more vulnerable to changes in life events than females. This study's identification of risky life events among young adults could lead to prevention strategies for the obesity epidemic.

Au cours de la Seconde Guerre mondiale se produit un phénomène éditorial sans précédent : alors que le contexte y est peu favorable, d’innombrables revues francophones sont créées, aussi bien en France métropolitaine que dans les colonies et à l’étranger, à l’instar de Fontaine, Poésie, Confluences, L’Arbalète, Cahiers de Poésie, Les Lettres françaises et bien d’autres encore. Elles viennent s’adjoindre aux périodiques qui existaient avant 1939 et qui ont réussi à se maintenir, afin de souligner la grandeur intellectuelle du pays. Ensemble, ils reprennent à leur compte la mission de La Nouvelle Revue Française, qui se trouve peu à peu dénaturée du fait de ses positions politiques avant d’être interdite : s’ils publient les textes d’écrivains reconnus, ils s’attachent aussi à lancer de jeunes auteurs qui, sans eux, n’auraient pu atteindre la notoriété qui a été la leur. Ainsi, jusqu’en 1953, date à laquelle La N.R.F. obtient l’autorisation de reparaître, ils contribuent à dessiner le paysage littéraire de la seconde moitié du XXe siècle.Les revues publiées entre 1939 et 1953 apparaissent comme la condition même de l’émergence de la poésie durant cette période. Elles contribuent à replacer ce genre au centre de toutes les attentions et favorisent son renouvellement. Elles font ainsi découvrir à leurs lecteurs les poèmes d’écrivains comme Olivier Larronde, Adrian Miatlev ou encore un certain Noël Mathieu, qui deviendra bientôt le fameux Pierre Emmanuel. Elles diffusent leurs textes aux côtés de ceux d’auteurs reconnus comme Paul Éluard ou Aragon, dont l’œuvre est alors en pleine mutation, et remettent sur le devant de la scène des écrivains du passé.Aux côtés des poèmes eux-mêmes se déploie dans les revues un important discours critique, dans lequel les chroniqueurs s’interrogent en profondeur sur les évolutions de la poésie. S’ils dessinent ses lignes de force, évoquant tour à tour un néo-classicisme, un renouvellement du lyrisme et une poésie tantôt engagée, tantôt matérialiste, tantôt spiritualiste, ils s’interrogent aussi sur leur mission et engagent de ce fait la critique dans une dimension autoréflexive. Leurs articles et chroniques, dont la fonction première est de contribuer au rayonnement de la poésie, apparaissent ainsi comme le berceau dans lequel s’éveille, peu à peu, la Nouvelle Critique, qui connaîtra son plein essor après 1953 et rayonnera durant toute la seconde moitié du XXe siècle. / The editorial scene during World War II was a witness to an unprecedented phenomenon. Beating the odds, a great number of French-speaking magazines were created, whether it be in Metropolitan France, in colonies or abroad. Among them : Fontaine, Poésie, Confluences, L’Arbalète, Cahiers de Poésie, Les Lettres françaises, and many more. These just add to the list of periodicals that predate 1939 and managed to stay afloat in order to underline the country’s intellectual greatness. Together - and in their own way - they upheld the mission of La Nouvelle Revue Française, whose nature was slowly altered because of its political views, before being shut down altogether. Not only did they publish renowned authors’ works, but they helped launch the careers of young authors who would not have been known otherwise. Hence, they contributed to the French literary landscape until 1953 - when La N.R.F. magazine was authorized to be published again.Without these magazines published between 1939 and 1953, poetry would have been completely forgotten during that era. Not only did they help make this genre the centre of attention and allowed its renewal but, thanks to them, readers discovered writers such as Olivier Larronde, Adrian Miatlev and Noël Mathieu – the latter would soon become the famous Pierre Emmanuel. Their work is published along those already renowned by Paul Éluard and Aragon – whose work was undergoing changes at the time – and they published long forgotten writers.Alongside these poems, criticism could be found in the columns of these magazines, in which chroniclers raise fundamental questions about the evolution of poetry. Pointing out main tendencies, they wrote about a newly found lyricism of a politically committed, materialistic or spiritualist poetry, but also about their own mission, which led to self-criticism. Their articles and chronicles whose prime goal was to help the prestige of poetry, slowly gave birth to the New Criticism, which knew full bloom after 1953 and shone throughout the second half of the twentieth century.

Improving the quality use of medicines (QUM) among seniors, particularly those using multiple medicines, is a national priority. The National Prescribing Service??s Seniors QUM Program was developed in collaboration with consumers to address seniors?? medicines information needs. Seniors are trained as peer educators to convey QUM messages to other seniors in a single group session. However, there is a dearth of research assessing peer education for seniors about medicines, and little understanding of what peer educators do in practice. This research investigated how peer educators empower seniors toward the quality use of their medicines. A participatory action research inquiry was undertaken nationally with organisational leaders and locally with peer educators. The design was a nested case study with multiple sites, where the Seniors Program was the overarching case containing eight disparate local sites. The participatory inquiry engaged peer educators from each local site. Qualitative data were collected through participant observation and interviews. Data were analysed using grounded theory methods and findings were triangulated with other data sources. Peer educators demonstrated five main functions in the program ?? one primary function within QUM sessions and four support functions outside of sessions. The primary function of facilitating peer learning comprised 10 elements. A model depicts these elements in the context of varying session conditions and consequences. Educators?? lived experience as seniors and lay persons was an overarching contributor to peer learning, used strategically through storytelling to assist other elements. Sharing QUM outside of sessions occurred frequently, but requires development to reach isolated seniors. Peer educators exceeded expectations in getting QUM messages to seniors, applying unique skills to the information exchange within sessions. Their status as lay persons tackling the complex topic of QUM reflected an understanding of the disempowerment seniors may feel when seeking information about medicines. Peer educators?? ability to model an active partner role by applying their lived experience through storytelling in an interactive, mutually sharing session challenged seniors to rethink their medicines management and interactions with health professionals. As the population ages and medicines use increases, understanding and using seniors effectively as educators has great potential.

Preventive care for the elderly originated with a study in Great Britain in 1964 that reported a large number of unmet health needs in the elderly and advocated early intervention. Subsequent randomised controlled trials (RCT) used a broad assessment of health including bio-medical, functional, psychological and social /environmental components but inconsistently demonstrated improved outcome for the elderly. 'Health checks' were introduced for all patients in British general practice in 1990. European and American models of care evolved similarly and justify a multidisciplinary team assessment, thorough training of assessment staff and medical supervision of recommendations. Two literature reviews published in 2000 have not reported sound evidence in favour of health assessments. Medicare funding of health assessments for the Australians aged 75 years and over was introduced in November 1999. A protocol for conducting 75+ Health Assessment (75+ HA) was developed and a pilot study was conducted in Yarrawonga in 1995 to initiate Australian research of this model of care. A RCT in the Adelaide Western Division of General Practice tested this model of care. The intervention group (n=50) had two 75+ HA one year apart. The control group (n=50) was left to usual care and had a 75+ HA one year later. Demographic data and the Short Form-36 were used to ensure both groups were comparable. Primary outcome measures did not demonstrate statistically significant reduction in problems nor mortality in the intervention (75+ HA) group compared to the control group. Significant improvements in secondary outcome measures in the intervention group were in self-rated health, depression score and decreased numbers reporting falls. 75+ HAs have been widely taken up by Australian general practitioners. It is no longer possible to conduct a RCT due to the inability to find a legitimate control group. Recommendations arising form this literature review and RCT include; evaluation studies of 75+ HA, concentration on a functional model of health and that nurses or allied health professionals should conduct the assessment in the elderly person's home. A consistent framework for analysis of 75+ HA is proposed. The elderly can be conceived to occupy one of 3 cohorts defined by their function state: No impairment of Activities of Daily Living (ADL), Impairment of Instrumental ADL only or Impairment of Basic ADL. The elderly without ADL impairment have not been demonstrated to benefit from 75+ HA and should be left to access the acute care stream of health services. The most disabled elderly with Basic ADL impairment have not consistently been shown to benefit from 75+ HA probably because they need a more intense level of community care. They should have Care Plans renewed regularly, as tested in the Australian Coordinated Care Trials. The cohort with Instrumental ADL impairment only seems most likely to benefit from annual 75+ HA. An evaluation of screening the elderly for Instrumental and Basic ADL impairment and providing appropriate services for each cohort is recommended. / Thesis (M.D.)--Department of General Practice, 2001.

Thesis (M.A. (Clinical Psychology))--North-West University, Potchefstroom Campus, 2005.

We report a 40 year record of eutrophication and hypoxia on an estuarine ecosystem and its recovery from hypereutrophication. After decades of high inorganic nutrient concentrations and recurring anoxia and hypoxia, we observe a paradoxical increase in chlorophyll-a concentrations with decreasing nutrient inputs. We hypothesise that algal growth was inhibited due to hypereutrophication, either by elevated ammonium concentrations, severe hypoxia or the production of harmful substances in such a reduced environment. We study the dynamics of a simple but realistic mathematical model, incorporating the assumption of algal growth inhibition. It shows a high algal biomass, net oxygen production equilibrium with low ammonia inputs, and a low algal biomass, net oxygen consumption equilibrium with high ammonia inputs. At intermediate ammonia inputs it displays two alternative stable states. Although not intentional, the numerical output of this model corresponds to observations, giving extra support for assumption of algal growth inhibition. Due to potential algal growth inhibition, the recovery of hypereutrophied systems towards a classical eutrophied state, will need reduction of waste loads below certain thresholds and will be accompanied by large fluctuations in oxygen concentrations. We conclude that also flow-through systems, heavily influenced by external forcings which partly mask internal system dynamics, can display multiple stable states.