Should I stay or should I go – Factors associated with hospitalization risk among older persons in Sweden

An increasingly older population will most likely lead to greater demands on the health care system, as older age is associated with an increased risk of having acute and chronic conditions. The number of diseases or disabilities is not the only marker of the amount of health care utilized, as persons may seek hospitalization without a disease and/or illness that requires hospital healthcare. Hospitalization may pose a severe risk to older persons, as exposure to the hospital environment may lead to increased risks of iatrogenic disorders, confusion, falls and nosocomial infections, i.e., disorders that may involve unnecessary suffering and lead to serious consequences. Aims: The overall aim of this thesis was to describe and explore individual trajectories of cognitive development in relation to hospitalization and risk factors for hospitalization among older persons living in different accommodations in Sweden and to explore older persons' reasons for being transferred to a hospital. Methods: The study designs were longitudinal, prospective and descriptive, and both quantitative and qualitative methods were used. Specifically, latent growth curve modelling was used to assess the association of cognitive development with hospitalization. The Cox proportional hazards regression model was used to analyse factors associated with hospitalization risk overtime. In addition, an explorative descriptive design was used to explore how home health care patients experienced and perceived their decision to seek hospital care. Results: The most common reasons for hospitalization were cardiovascular diseases, which caused more than one-quarter of first hospitalizations among the persons living in ordinary housing and nursing home residents (NHRs). The persons who had been hospitalized had a lower mean level of cognitive performance in general cognition, verbal, spatial/fluid, memory and processing speed abilities compared to those who had not been hospitalized. Significantly steeper declines in general cognition, spatial/fluid and processing speed abilities were observed among the persons who had been hospitalized. Cox proportional hazards regression analysis showed that the number of diseases, number of drugs used, having experienced a fall and being assessed as malnourished according to the Mini Nutritional Assessment scale were related to an increased hospitalization risk among the NHRs. Among the older persons living in ordinary housing, the risk factors for hospitalization were related to marital status, i.e., unmarried persons and widows/widowers had a decreased hospitalization risk. In addition, among social factors, receipt of support from relatives was related to an increased hospitalization risk, while receipt of support from friends was related to a decreased risk. The number of illnesses was not associated with the hospitalization risk for older persons in any age group or for those of either sex, when controlling for other variables. The older persons who received home health care described different reasons for their decisions to seek hospital care. The underlying theme of the home health care patients’ perceptions of their transfer to a hospital involved trust in hospitals. This trust was shared by the home health care patients, their relatives and the home health care staff, according to the patients. Conclusions: This thesis revealed that middle-aged and older persons who had been hospitalized exhibited a steeper decline in cognition. Specifically, spatial/fluid, processing speed, and general cognitive abilities were affected. The steeper decline in cognition among those who had been hospitalized remained even after controlling for comorbidities. The most common causes of hospitalization among the older persons living in ordinary housing and in nursing homes were cardiovascular diseases, tumours and falls. Not only health-related factors, such as the number of diseases, number of drugs used, and being assessed as malnourished, but also social factors and marital status were related to the hospitalization risk among the older persons living in ordinary housing and in nursing homes. Some risk factors associated with hospitalization differed not only between the men and women but also among the different age groups. The information provided in this thesis could be applied in care settings by professionals who interact with older persons before they decide to seek hospital care. To meet the needs of an older population, health care systems need to offer the proper health care at the most appropriate level, and they need to increase integration and coordination among health care delivered by different care services.

CSR Communication - An Employee Perspective : Tailoring Internal Communication using Employee Preferences for Content, Style and Channel.

Corporate Social Responsibility (CSR) represents a theory and practice that is well-known and communicating its content has shown to play an important role in order to exploit its advantages and engage stakeholders on CSR issues. Even though, CSR communication has shown to be a real challenge, since corporations are encouraged to engage in CSR, but not to communicate too loud about this engagement. This study was inspired by Jenny Dawkins (2005) and her initial idea that tailoring CSR messages by exploring stakeholder preferences for content, style and channel, would solve the communication challenge. One stakeholder group that corporations are highly dependent on is employees and exploring their preferences for CSR communication became the purpose of this thesis: to understand employee preferences for style and channel within the content of CSR. This was of specific interest, since existing research on CSR communication has mainly been centered around financial and external issues on the expense of internal. In addition, the idea of a tailored approach has not gained any interest in research so far, and a possible explanation might be its diffuse meaning, a problem this thesis has addressed. In order to understand employee preferences for internal CSR communication, a qualitative case study research was conducted with in-depth interviews, observations and exercises at site. A total of 20 interviews were arranged in order to collect primary data during a one week prolong engagement at the case. The empirical findings from the respondents’ answers were then transcribed and analyzed using both inductive and theoretical thematic analysis. Based on the findings, the authors of this thesis contribute with two models that help practitioners to understand how to best communicate about various CSR content to employees. The first model developed suggests an implementation of the tailored approach for content, style and channel, and demonstrates a relationship between nature of content and constraint recognition. Also, the model explains how practitioners can provide CSR explanation in order to reduce skepticism and enable endorsement processes where employees communicate CSR to third parties. To show a more dependent relationship between how changes in nature of content and constraint recognition affect employee preferences, the authors created the "CSR Communication Grid". The authors made a theoretical contribution by clarifying and providing a framework for the tailoring approach as initially developed by Dawkins (2005). Additionally, the authors managed to draw a relation between Public Relations (PR) and CSR by referring models of PR to communication styles, which filled this gap in previous research.

“Jag vet faktiskt inte varför ingen vill anställa någon som mig” : En studie om arbetslösas upplevda delaktighet i aktivitet.

Syftet med studien var att beskriva hur arbetslösa personer i tjänsten Stöd och matchning upplever delaktighet i aktivitet. Författaren använde kvalitativ metod med induktiv ansats. Datainsamlingen genomfördes genom intervjuer med bedömningsinstrumentet OCAIRS-S som grund. Fem deltagare rekryterades med bekvämlighetsurval på en mindre ort i Sverige. Författaren spelade in intervjuerna för att sedan transkribera och bearbeta dem genom en kvalitativ innehållsanalys med stöd av komponenter i ICF. Resultatet visade bland annat att deltagarna hade lätt att ge upp och saknade rutiner i sitt vardagsliv. Alla upplevde även att de klarar sig bra på sin inkomst och hade möjlighet att utföra alla aktiviteter de ville och behövde göra. De spenderade mycket tid ensamma och hade några få nära relationer. De flesta trivdes i arbetslösheten och alla såg positivt på framtiden. Ingen av dem letade aktivt efter möjligheter till arbete och de var inte heller initiativtagande. Slutsatserna som gjordes var att deltagarna saknar proaktivitet och motivation till att skaffa arbete. De skulle ha nytta av arbetsterapi för aktivitetsträning och/eller anpassning av aktiviteten ”att söka arbete”. Vidare forskning med större underlag behövs för en djupare förståelse.

Tals del-helhetsrelationer : Elevers sätt att urskilja del-helhetsrelationer i öppna utsagor.

På vilket sätt kan vi hjälpa alla elever att bli förtrogna med matematikens uttrycksformer? Ett sätt är att bygga en stadig aritmetisk grund för eleverna där de befäster talens innehåll. Det är vad den här uppsatsen handlar om. Uppsatsen beskriver vad som skiljer användandet av del-helhetsrelationer från andra sätt att lösa öppna utsagor på. Uppsatsen beskriver även vilka kritiska aspekter om öppna utsagor som kan förekomma hos elever i årskurs 1 och 2. Uppsat-sen är skriven ur en fenomenografisk ansats med variationsteoretiska inslag eftersom de två teorierna är nära besläktade. Studien genomfördes genom filmade intervjuer med 11 elever som valdes ut genom en munt-lig och en skriftlig diagnos samt ett skriftligt arbetsblad. Resultatet visar att elever som använ-der automatiserade del-helhetsrelationer har en fördel när de löser öppna utsagor jämfört med elever som använder andra lösningsmetoder. Skillnaderna syns tydligt när det gäller lösandet av öppna subtraktionsutsagor där helheten saknas. En väg till den abstrakta förståelsen för tals del-helhetsrelationer går via fingertalen. Min slutsats är att eleverna redan tidigt i skolan måste få undervisning om fingertalen samt talens del-helhetsrelationer för att undvika att de utvecklar matematiksvårigheter.

Möjlighet till delaktighet i meningsfulla aktiviteter under sjukhusvistelse. : En beskrivning av barns egna upplevelser

Tidigare forskning inom detta område har fokuserat på barns vård, däremot har barns upplevelser utifrån ett aktivitetsperspektiv under sjukhusvistelse inte uppmärksammats. Författarnas uppfattning var att aktiviteter som erbjuds på barn- och ungdomskliniker oftast passar yngre barn och därför ansågs det relevant att tillfråga äldre barn om deras upplevelser av att kunna vara delaktiga i aktiviteter på sjukhus. Syftet var att beskriva barns upplevelser av möjlighet till delaktighet i meningsfulla aktiviteter under sjukhusvistelse. Kvalitativ metod användes med semi-strukturerade intervjuer. Ett bekvämlighetsurval användes och respondenterna var 12 barn i åldrarna 8-15 som befann sig på två barn- och ungdomskliniker i södra Sverige. Datamaterialet bearbetades med en kvalitativ innehållsanalys. Tolkningen av datamaterialet resulterade i det övergripande temat “Upplevelse av möjlighet till delaktighet i meningsfulla aktiviteter”. Resultatet delades in i tre kategorier; delaktighet, meningsfull aktivitet och aktiviteter på sjukhus. Slutsatsen var att barnen upplevde både möjligheter och begränsningar i att kunna vara delaktiga i aktiviteter under sin sjukhusvistelse. Majoriteten av barnen upplevde sig ha goda möjligheter till att kunna vara delaktiga i meningsfulla aktiviteter såsom att vistas på lekterapi, spela tv-spel och umgås med familj och vänner.