Changing healthcare: stakeholder perceptions of the burden of chronic disease and the value of teams, measurements and communication.

Canadian healthcare is changing. Over the course of the past decade, the Health Care in Canada Survey (HCIC) has annually measured the reactions of the public and professional stakeholders to many of these change forces. In HCIC 2008, for the first time, the public's perception of their health status and all stakeholders' views of the burden and effective management of chronic diseases were sought. Overall, Canadians perceive themselves as healthy, with 84% of adults reporting good-to-excellent health. However, good health decreased with age as the occurrence of chronic illness rose, from 12% in the age group 18-24 to 65% for the population =65 years. More than 70% of all stakeholders were strongly or somewhat supportive of the implementation of coordinated care, or disease management programs, to improve the care of patients with chronic illnesses. Concordant support was also expressed for key disease management components, including coordinated interventions to improve home, community and self-care; increased wellness promotion; and increased use of clinical measurements and feedback to all stakeholders. However, there were also important areas of non-concordance. For example, the public and doctors consistently expressed less support than other stakeholders for the value of team care, including the use of non-physician professionals to provide patient care; increased patient involvement in decision-making; and the use of electronic health records to facilitate communication. The actual participation in disease management programs averaged 34% for professionals and 25% for the public. We conclude that chronic diseases are common, age-related and burdensome in Canada. Disease management or coordinated intervention often delivered by teams is also relatively common, despite its less-than-universal acceptance by all stakeholders. Further insights are needed, particularly into the variable perceptions of the value and efficacy of team-delivered healthcare and its important components.

'Biased' Risk Perceptions of Longevity and Disability in Old Age

Rational learning theories postulate that information channels and cognitive biases such as individual optimism may influence an individual¿s assessment of the risk of undesired events, especially with regard to those that have a cumulative nature. This is the case with disability in old age, which may take place upon survival to an advanced age, and such factors have been regarded as responsible for certain individual behaviours (for example, the limited incidence of insurance purchase). This paper examines the determinants of individual perceptions with regard to disability in old age and longevity. The cumulative nature of such perceptions of risk is tested, and potential biases are identified, including `optimism¿ and a set of information determinants. Empirical evidence from a representative survey of Catalonia is presented to illustrate these effects. The findings from this research suggest a significant overestimation of disability in old age, yet this is not the case with longevity. Furthermore, individual perceptions with regard to disability in old age, unlike those with regard to longevity, exhibit on aggregate an `optimistic bias¿ and, are perceived as `cumulative risks¿. Gender influences the perceived risk of disability in old age at a population level but not at the individual level, and the opposite holds true for age. Finally, self-reported health status is the main variable behind risk perceptions at both the individual and population level.

Public perceptions of collectives at the outbreak of the H1N1 epidemic: Heroes, villains and victims

Lay perceptions of collectives (e.g., groups, organizations, countries) implicated in the 2009 H1N1 outbreak were studied. Collectives serve symbolic functions to help laypersons make sense of the uncertainty involved in a disease outbreak. We argue that lay representations are dramatized, featuring characters like heroes, villains and victims. In interviews conducted soon after the outbreak, 47 Swiss respondents discussed the risk posed by H1N1, its origins and effects, and protective measures. Countries were the most frequent collectives mentioned. Poor, underdeveloped countries were depicted as victims, albeit ambivalently, as they were viewed as partly responsible for their own plight. Experts (physicians, researchers) and political and health authorities were depicted as heroes. Two villains emerged: the media (viewed as fear mongering or as a puppet serving powerful interests) and private corporations (e.g., the pharmaceutical industry). Laypersons' framing of disease threat diverges substantially from official perspectives.

A Picture of Performance Goals in the Social Plenum: The Interpersonal Antecedents and Consequences of Performance Goals

Bien que les activités où la compétence est un enjeu (p. ex. : problème académique) prennent souvent place dans des contextes interpersonnels (p. ex. : classe), hiérarchiques (p. ex. : enseignant-e/élèves), et spécifiques en termes de normes et de valeurs (p. ex. : culture), l'étude des buts de performance-le désir de se montrer compétent-e relativement à autrui-a le plus souvent été conduite au seul niveau intrapersonnel. S'appuyant sur le modèle transactionnel du stress et du coping, le modèle circumplexe des comportements interpersonnels, ainsi que sur la théorie de l'élaboration du conflit, la première partie de cette thèse révèle les conséquences interpersonnelles des buts de performance sur la régulation d'un comportement spécifique, à savoir le conflit sociocognitif (c.-à-d., une situation de confrontation avec un intéractant en désaccord) : les buts de performance-approche-le désir d'être meilleur-e qu'autrui-prédisent une régulation du conflit fortement agentique (dominante), soit la validation de son point de vue au détriment de celui de l'intéractant (que nous désignons régulation compétitive) ; alors que les buts de performance-évitement-le désir de ne pas être moins bon-ne qu'autrui-prédisent une régulation du conflit faiblement agentique (soumise), soit l'invalidation de son point de vue au bénéfice de celui de l'intéractant (que nous désignons régulation protective). De plus, les effets susmentionnés augmentent à mesure que l'intéractant est présenté comme supérieurement (vs. similairement) compétent. S'appuyant sur la littérature sur les structures de buts de groupe, et celle sur la socialisation des valeurs, la seconde partie de cette thèse révèle les antécédents interpersonnels des buts de performance, et plus spécifiquement le rôle du superviseur dans la socialisation des buts de performance : les buts de performance-approche d'un superviseur sont positivement associés avec l'émergence au cours du temps des buts de performance-approche de ses subordonnés (particulièrement lorsqu'ils se perçoivent comme compétents) et celle de leurs buts de performance-évitement (particulièrement lorsqu'ils se perçoivent comme incompétents). En outre, ce phénomène consistant en un processus de socialisation, les effets susmentionnés augmentent lorsque l'identification à l'endogroupe des subordonnées augmente, et lorsque l'adhésion aux valeurs culturelles occidentales dominantes (c.-à-d., rehaussement de soi) du superviseur augmente. Dans leur ensemble, ces résultats soulignent la nécessité d'étudier les buts dans leur plenum social, autrement dit, en adoptant une perspective interpersonnelle (c.-à-d., étudier les effets des buts entre les individus), positionnelle (c.-à-d., entre des individus de différentes positions sociales), et idéologique (c.- à-d., entre des individus se conformant à des normes spécifiques et adhérant à des valeurs spécifiques). -- Although competence-relevant activities (e.g., solving an academic problem) are often embedded in interpersonal (e.g., classroom), hierarchical (e.g., teacher/pupils), and norm-/value-specific (e.g., culture) settings, the study of performance goals-the desire to demonstrate competence relative to others-has mostly been conducted at the intrapersonal level alone. Drawing on the transactional model of stress and coping, the circumplex model of interpersonal behaviors, as well as on the conflict elaboration theory, the first part of this thesis reveals the interpersonal consequences of performance goals on the regulation of a specific behavior, namely socio-cognitive conflict (i.e., a situation of confrontation with a disagreeing interactant): Performance-approach goals-the desire to outperform others- predicted a highly agentic (dominant) conflict regulation, that is, the validation of one's point of view at the expense of that of the interactant (which we labeled competitive regulation); whereas performance-avoidance goals-the desire not to be outperformed by others- predicted a poorly agentic (submissive) conflict regulation, that is, the invalidation of one's point of view to the benefit of that of the interactant (which we labeled protective regulation). Furthermore, both the aforementioned effects were found to increase when the interactant was presented as being superiorly (vs. equally) in competence. Drawing on the literature on group goal structure, as well as on research on socialization of supervisors-based values, the second part of this thesis reveals the interpersonal antecedents of performance-based goals endorsement, focusing-more specifically-on the role of group-supervisors in performance goals socialization: Supervisor's performance-approach goals were positively associated with the emergence over time of subordinates' performance-approach (especially when perceiving themselves as competent) and -avoidance goals (especially when perceiving themselves as incompetent). Furthermore, providing evidence that this phenomenon essentially reflects a socialization process, both the aforementioned effects were found to increase as subordinates' in-group identification increased, and as supervisors' adherence to dominant Western values (i.e., self-enhancement values) increased. Taken together, these results advocate the need to study performance goals in their social plenum, that is, adopting an interpersonal (i.e., studying the effects of goals between individuals), positional (i.e., between individuals from different social positions), and ideological (i.e., between individuals following specific norms and endorsing specific values) perspective.

'Biased' Risk Perceptions of Longevity and Disability in Old Age

Rational learning theories postulate that information channels and cognitive biases such as individual optimism may influence an individual¿s assessment of the risk of undesired events, especially with regard to those that have a cumulative nature. This is the case with disability in old age, which may take place upon survival to an advanced age, and such factors have been regarded as responsible for certain individual behaviours (for example, the limited incidence of insurance purchase). This paper examines the determinants of individual perceptions with regard to disability in old age and longevity. The cumulative nature of such perceptions of risk is tested, and potential biases are identified, including `optimism¿ and a set of information determinants. Empirical evidence from a representative survey of Catalonia is presented to illustrate these effects. The findings from this research suggest a significant overestimation of disability in old age, yet this is not the case with longevity. Furthermore, individual perceptions with regard to disability in old age, unlike those with regard to longevity, exhibit on aggregate an `optimistic bias¿ and, are perceived as `cumulative risks¿. Gender influences the perceived risk of disability in old age at a population level but not at the individual level, and the opposite holds true for age. Finally, self-reported health status is the main variable behind risk perceptions at both the individual and population level.

Development of Performance Properties of Ternary Mixtures and Concrete Pavement Mixture Design and Analysis (MDA): Effect of Paste Quality on Fresh and Hardened Properties of Ternary Mixtures, TPF-5(117), 2012

The purpose of this study was to investigate the effect of cement paste quality on the concrete performance, particularly fresh properties, by changing the water-to-cementitious materials ratio (w/cm), type and dosage of supplementary cementitious materials (SCM), and airvoid system in binary and ternary mixtures. In this experimental program, a total matrix of 54 mixtures with w/cm of 0.40 and 0.45; target air content of 2%, 4%, and 8%; a fixed cementitious content of 600 pounds per cubic yard (pcy), and the incorporation of three types of SCMs at different dosages was prepared. The fine aggregate-to- total aggregate ratio was fixed at 0.42. Workability, rheology, air-void system, setting time, strength, Wenner Probe surface resistivity, and shrinkage were determined. The effects of paste variables on workability are more marked at the higher w/cm. The compressive strength is strongly influenced by the paste quality, dominated by w/cm and air content. Surface resistivity is improved by inclusion of Class F fly ash and slag cement, especially at later ages. Ternary mixtures performed in accordance with their ingredients. The data collected will be used to develop models that will be part of an innovative mix proportioning procedure.

Development of Performance Properties of Ternary Mixtures: Field Demonstrations and Project Summary, TPF-5(117), 2012

Supplementary cementitious materials (SCM) have become common parts of modern concrete practice. The blending of two or three cementitious materials to optimize durability, strength, or economics provides owners, engineers, materials suppliers, and contractors with substantial advantages over mixtures containing only portland cement. However, these advances in concrete technology and engineering have not always been adequately captured in specifications for concrete. Users need specific guidance to assist them in defining the performance requirements for a concrete application and the selection of optimal proportions of the cementitious materials needed to produce the required durable concrete. The fact that blended cements are currently available in many regions increases options for mixtures and thus can complicate the selection process. Both Portland and blended cements have already been optimized by the manufacturer to provide specific properties (such as setting time, shrinkage, and strength gain). The addition of SCMs (as binary, ternary, or even more complex mixtures) can alter these properties, and therefore has the potential to impact the overall performance and applications of concrete. This report is the final of a series of publications describing a project aimed at addressing effective use of ternary systems. The work was conducted in several stages and individual reports have been published at the end of each stage.

Assessing small non-zero perceptions of chance: The case of H1N1 (swine) flu risks

Feelings of invulnerability, seen in judgments of 0% risk, can reflect misunderstandings of risk and risk behaviors, suggesting increased need for risk communication. However, judgments of 0% risk may be given by individuals who feel invulnerable, and by individuals who are rounding from small non-zero probabilities. We examined the effect of allowing participants to give more precise responses in the 0-1% range on the validity of reported probability judgments. Participants assessed probabilities for getting H1N1 influenza and dying from it conditional on infection, using a 0-100% visual linear scale. Those responding in the 0-1% range received a follow-up question with more options in that range. This two-step procedure reduced the use of 0% and increased the resolution of responses in the 0-1% range. Moreover, revised probability responses improved predictions of attitudes and self-reported behaviors. Hence, our two-step procedure allows for more precise and more valid measurement of perceived invulnerability. [Authors]

Perceptions of diabetes obtained through drawing in childhood and adolescence

Objective: To examine whether drawing is useful in the detection of problems of psychosocial adaptation in children and adolescents with type 1 diabetes (T1D) and in improving communication with health professionals. Methods: We performed an exploratory descriptive study in 199 children and adolescents with T1D aged 413 years. The participants were asked to render a drawing on a suggested topic. The variables analyzed were related to the drawing and to clinical and sociodemographic data. Results: Most participants showed evidence of having a well-balanced personality, but there were also signs of affective or psychosocial difficulties. Conclusion: Drawing is a useful technique by which to identify children"s and adolescents" feelings and possible problems in adapting to T1D, as well as to gain information directly from the children themselves. Future studies should delimit the possibilities of this technique in clinical practice in greater detail.

THE INFLUENCE OF THE REGULATORY ENVIRONMENT ON THE DEFINITION OF PERFORMANCE: THE EXAMPLE OF THE SPORT BETTING AND LOTTERY SECTORS

This thesis examines the interplay between state regulation and the way organisations define performance. Performance is generally understood to be a multidimensional concept, but the extent to which its different facets are shaped by regulation remains an understudied question. This thesis aims to address this question and provide at least a partial answer to it. To do so, it examines whether the level of regulation amplifies or abates the multidimensionality of regulated entities' performance definition, i.e. the way they define the concept of performance. The leading question is whether an organisation's performance definition can be associated with the regulatory intensity its environment confronts it with. Moreover, the study explores whether the type of ownership-public or private-plays a role in regard to how a regulated entity defines performance. In order to undertake this investigation, the thesis focuses on the performance definitions of organisations in six different sport betting and lottery regulations. Qualitative data is gathered from primary and secondary documents as well as through semi-structured interviews with chief executive officers (CEO), members of executive management and gambling experts in each of these countries. The thesis concludes that the performance definitions of the organisations under study are indeed multidimensional, as well as clearly influenced by their respective regulatory environments. However, not all performance dimensions identified in the literature are present, nor can they all be estimated to be part of the performance definition. In addition, the public-private difference in defining performance-as conceptualised in the literature- seems to be abated in a regulated environment. The central role played by regulation in regard to the multidimensionality of the performance definition partially outweighs the effect of the nature of ownership.

Perceptions of diabetes obtained through drawing in childhood and adolescence

Objective: To examine whether drawing is useful in the detection of problems of psychosocial adaptation in children and adolescents with type 1 diabetes (T1D) and in improving communication with health professionals. Methods: We performed an exploratory descriptive study in 199 children and adolescents with T1D aged 413 years. The participants were asked to render a drawing on a suggested topic. The variables analyzed were related to the drawing and to clinical and sociodemographic data. Results: Most participants showed evidence of having a well-balanced personality, but there were also signs of affective or psychosocial difficulties. Conclusion: Drawing is a useful technique by which to identify children"s and adolescents" feelings and possible problems in adapting to T1D, as well as to gain information directly from the children themselves. Future studies should delimit the possibilities of this technique in clinical practice in greater detail.

Calidad de vida y percepción de la desigualdad de la mujer en la ciudad de Girona = Quality of life and inequality perception’s of women in the city of Girona

La igualdad de oportunidades para las mujeres, como factor clave para avanzar en la consecución de calidad de vida preocupa hoy en día a la sociedad en general y alas instituciones en particular. Antes de la elaboración de programas de intervención social es necesario conocer las percepciones de las propias mujeres acerca de sus problemas y de sus necesidades. Siguiendo esta línea de pensamiento presentamos un trabajo empírico en el que analizamos las percepciones de las mujeres de la ciudad de Girona, centrándonos en dos aspectos de manera particular: la percepción de calidad de vida proporcionada por su ciudad y la percepción de desigualdad de oportunidades y/o de discriminación. Los principales resultados, obtenidos a partir de las respuestas a un cuestionario auto-administrado, y proporcionados por una muestra de mujeres seleccionadas aleatoriamente a partir de un muestreo estratificado geográficamente, indican que en general están satisfechas con su ciudad aunque detectamos las principales causas de insatisfacción. Por otra parte, tas principales fuentes de desigualdad se refieren al mundo laboral (menos salario por el mismo trabajo, dificultades de encontrar trabajo si tienen hijos o si son ya mayores), y en la actitud general de la sociedad en el sentido de tener que cumplir el papel que tradicionalmente se les ha asignado