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.

International Branding Strategies : In Swedish and Russian Fashion Companies

There are a lot of different business strategies for any company. However, in the fashion industry, the best way to become successful is to develop the brand using special branding strategies. Hence, a brand is the main weapon for fashion companies, which helps to launch international market and to create loyal customers around the world. Nowadays, due to the difficult current political situations and the collapse of oil and the dollar a lot of companies in different industries have to change their business strategies. It is especially true for fashion companies, because they depend on consumers ' income and their purchasing power. In the case of the fashion industry, branding strategy development can be more effective, than just business strategy. Hence, this thesis discusses the following problem: What branding strategy should Russian and Swedish fashion companies choose in order to build a strong brand and enter the international market.  The purpose of this thesis is to analyze various branding strategies of Russian and Swedish fashion companies during the process of entering foreign markets. At the end of this thesis, practical contribution in their process of international branding strategy creation will be discussed. In order to answer research questions more broadly and accurately, the mixed research method, using quantitive and qualitative study through interviews and survey was chosen. Semi-structured interviews were made with the CEO and brand managers of Russian and Swedish fashion companies. Moreover, the survey was made with two different questionnaires: for Russian and for Swedish customers. In the case of qualitative research, the author found that fashion companies from Russia and Sweden have got not just some features and differences, but also common aspects. The primary data from interviews allowed the author to understand the specifics of brand management in the fashion industry. It was found, that there are some useful aspects in Swedish strategies, which can be used by Russian companies to develop their brands on the international market. In the case of quantitative research, preferences of consumers from Russia and Sweden were analyzed and also some features were identified. Survey results provided the author with a common understanding about purchase habits, attitudes and perceptions to fashion brands. According to these, some hypothesizes, which are formulated in the first part of the thesis, have been proven or disproven. It was found, that preferences of Russian and Swedish people are pretty the same, however Russian customers do not like to risk with new brands and prefer well-known and trusted brands while Swedish customers are open for any brand, which can satisfy their tastes.