Health and quality of care from older peoples' and formal caregivers' perspective

Aim: The overall aim of this thesis was to gain a deeper understanding of older people's view of health and care while dependent on community care. Furthermore to describe and compare formal caregivers' perceptions of quality of care, working conditions, competence, general health, and factors associated with quality of care from the caregivers' perspective. Method: Qualitative interviews were conducted with 19 older people in community care who were asked to describe what health and ill health((I), good and bad care meant for them (II). Data were analyzed using content analysis (I) and a phenomenological analysis (II). The formal caregivers; 70 nursing assistants (NAs) 163 enrolled nurses (ENs) and 198 registered nurses (RNs), answered a questionnaire consisting of five instruments: quality of care from the patient's perspective modified to formal caregivers, creative climate questionnaire, stress of conscience, health index, sense of coherence and items on education and competence (III). Statistical analyses were performed containing descriptive statistics, and comparisons between the occupational groups were made using Kruskal-Wallis ANOVA, Mann-Whitney U-test and Pearson's Chi-square test (III). Pearson's  product moment correlation analysis and multiple regression analysis were performed studying the associations between organizational climate, stress of conscience, competence, general health and sense of coherence with quality of care (IV). Results: The older people's health and well-being were related to their own ability to adapt to and compensate for their disabilities and was described as negative and positive poles of autonomy vs. dependence, togetherness vs. being an onlooker, security vs. insecurity and tranquility vs. disturbance (I).  The meaning of good care (II) was that the formal caregivers respected the older people as unique individuals, having the opportunity to live their lives as usual and receiving a safe and secure care. Good care could be experienced when the formal caregivers had adequate knowledge and competence in caring for older people, adequate time and continuity in the care organization (II). Formal caregivers reported higher perceived quality of care in the dimensions medical-technical competence and physical-technical conditions than in identity-oriented approach and socio-cultural atmosphere (III). In the organizational climate three of the dimensions were close to the value of a creative climate and in seven near a stagnant climate. The formal caregivers reported low rate of stress of conscience. The RNs reported to a higher degree than the NAs/ENs a need to gain more knowledge, but the NAs and the ENs more often received training during working hours. The RNs reported lower emotional well-being than the NAs/ENs (III). The formal caregivers' occupation, organizational climate and stress of conscience were associated with perceived quality of care (IV). Implications: The formal caregivers should have an awareness of the importance of kindness and respect, supporting the older people to retain control over their lives. The nursing managers should employ highly competent and adequate numbers of skilled formal caregivers, organize formal caregivers having round the clock continuity. Improvements of organizational climate and stress of conscience are of importance for good quality of care.

COMPARISON OF PARTIAL SHADING LOSSES IN FREE FIELD PV-PLANTS WITH DIFFERENT ARRAY CONFIGURATIONS

A common problem when planning large free field PV-plants is optimizing the ground occupation ratio while maintaining low shading losses. Due to the complexity of this task, several PV-plants have been built using various configurations. In order to compare the shading losses of different PV technologies and array designs, empirical performance data of five free field PV-plants operating in Germany was analyzed. The data collected comprised 140 winter days from October 2011 until March 2012. The relative shading losses were estimated by comparing the energy output of selected arrays in the front rows (shading-free) against that of shaded arrays in the back rows of the same plant. The results showed that landscape mounting with mc-Si PV-modules yielded significantly better results than portrait one. With CIGS modules, making cross-table strings using the lower modules was not beneficial as expected and had more losses than a one-string-per-table layout. Parallel substrings with CdTe showed relatively low losses. Among the two CdTe products analyzed, none showed a significantly better performance.

Från generell bild till individuellt ansikte : att hantera oförståelse och stereotypt bemötande i fyra lågstatusyrken

From general images to individual features: managing lack of understanding and stereotypes in four low-status occupations Individuals shape an image of themselves and their surroundings in relation to how they assume that others regard them. In these situations occupation is essential. Categorizations, valuations and rewards associated with occupations are among the most fundamental instruments used for domination in the social world. Hence it is interesting to study how groups and individuals who experience low occupational status manage their social positions. This article, based upon interviews with workers in food industry, waitresses/waiters, storesmen and dustmen, analyzes how the interviewees handle low respect, here expressed as lack of understanding and stereotyping. Three different positions are distinguished, arguing that one of them implies a stronger identification with the occupation than do the other two, which to a greater extent agree with stereotyped images. In the first position, the workers disagree with stereotypes of low-status jobs as apathetic, heavy or simple, and assert that their occupation has specific values such as self-development, qualifications or advantage to society. In the second position, low recognition is avoided through little identification with the occupation. The interviewees separate themselves and who they are from their jobs, and find it ridiculous to speak about it in terms of self-development or qualifications when so many are able to do the job. In the third position, the interviewees emphasize that their own place of work is less heavy than the job in general. Through the third strategy their particular tasks are seen as exceptional and their identification with the occupation is local rather than embedded in a wider occupational identity.

Formal caregivers' perceptions of quality of care for older people : associating factors

Background: Despite the growing number of studies concerning quality of care for older people, there is a lack of studies depicting factors associated with good quality of care from the formal caregivers' perspective. The aim was to describe formal caregivers' perceptions of quality of care for older people in the community and explore factors associated with these perceptions. In total, 70 nursing assistants, 163 enrolled nurses and 198 registered nurses from 14 communities in central Sweden participated in the study. They filled out the following questionnaires: a modified version of Quality from the Patient's Perspective, Creative Climate Questionnaire, Stress of Conscience Questionnaire, items regarding education and competence, Health Index and Sense of coherence questionnaire. The overall response rate was 57 % (n = 431). Results: In the perceived reality of quality of care respondents assessed the highest mean value in the dimension medical-technical competence and physical technical conditions and lower values in the dimensions; identity-oriented approach, socio-cultural atmosphere and in the context specific dimension. The caregivers estimated their competence and health rather high, had lower average values in sense of coherence and organizational climate and low values in stress of conscience. Conculsions: The PR of quality of care were estimated higher among NA/ENs compared to RNs. Occupation, organizational climate and stress of conscience were factors associated with quality of care that explained 42 % of the variance. Competence, general health and sense of coherence were not significantly associated to quality of care. The mentioned factors explaining quality of care might be intertwined and showed that formal caregivers' working conditions are of great importance for quality of care.

Understanding the "black box" of a health-promotion program : keys to enable health among older persons aging in the context of migration

Although the need to make health services more accessible to persons who have migrated has been identified, knowledge about health-promotion programs (HPPs) from the perspective of older persons born abroad is lacking. This study explores the design experiences and content implemented in an adapted version of a group-based HPP developed in a researcher-community partnership. Fourteen persons aged 70-83 years or older who had migrated to Sweden from Finland or the Balkan Peninsula were included. A grounded theory approach guided the data collection and analysis. The findings showed how participants and personnel jointly helped raise awareness. The participants experienced three key processes that could open doors to awareness: enabling community, providing opportunities to understand and be understood, and confirming human values and abilities. Depending on how the HPP content and design are being shaped by the group, the key processes could both inhibit or encourage opening doors to awareness. Therefore, this study provides key insights into how to enable health by deepening the understanding of how the exchange of health-promoting messages is experienced to be facilitated or hindered. This study adds to the scientific knowledge base of how the design and content of HPP may support and recognize the capabilities of persons aging in the context of migration.

Gender blind? Australian immigration policy and practice, 1901-1930

This paper seeks to explore the nature of Australian immigration policies and practices, particularly their impact on women, from federation in 1901 to the cessation of large-scale assisted immigration to Australia brought about by the 1930s depression. The characteristics that influenced and affected female immigrants may have differentiated their experiences from those of male immigrants in the same period. Differential treatment of men and women has often been an unstated given in the formulation and implementation of immigration policies. It was as common to non-government organisations (of which there were, and still are, a great many associated with immigration and settlement), as to governments, both federal and state. Several inequities can be identified in the making and implementation of immigration and settlement policies, and in the access to government grants, concessions and services, not only in terms of race, ethnicity, class or occupation (which is well trodden ground in this field) but also in terms of gender.[1] Such differentiation is part of the broader framework of changing conceptions about the place and roles of women in Australian society and their expected contribution to the nation, but it has remained largely unexplicated in this period and field.

Longitudinal relationships among overweight, life satisfaction, and aspirations in young women

Objective: This study investigated associations of overweight status and changes in overweight status over time with life satisfaction and future aspirations among a community sample of young women.
Research Methods and Procedures: A total of 7865 young women, initially 18 to 23 years of age, completed two surveys that were 4 years apart. These women provided data on their future life aspirations in the areas of further education, work/career, marital status, and children, as well as their satisfaction with achievements to date in a number of life domains. Women reported their height and weight and their sociodemographic characteristics, including current socioeconomic status (occupation).
Results: Young women's aspirations were cross-sectionally related to BMI category, such that obese women were less likely to aspire to further education, although this relationship seemed explained largely by current occupation. Even after adjusting for current occupation, young women who were obese were more dissatisfied with work/career/study, family relationships, partner relationships, and social activities. Weight status was also longitudinally associated with aspirations and life satisfaction. Women who were overweight or obese at both surveys were more likely than other women to aspire to "other" types of employment (including self-employed and unpaid work in the home) as opposed to full-time employment. They were also less likely to be satisfied with study or partner relationships. Women who resolved their overweight/obesity status were more likely to aspire to being childless than other women.
Discussion: These results suggest that being overweight/obese may have a lasting effect on young women's life satisfaction and their future life aspirations.

The test-retest reliability of the child-initiated pretend play assessment

OBJECTIVE: The purpose of this study is to establish the test–retest reliability of the Child-Initiated Pretend Play Assessment (ChIPPA) (Stagnitti, 2002a; Stagnitti, Unsworth, & Rodger, 2000).

METHOD: The first author rated 38 preschool children ages 4 and 5 years (4 with developmental delay and 34 typically developing) on the ChIPPA. The ChIPPA employs conventional play materials and unstructured play materials to assess three qualities of a child's play ability: elaborateness of play action, ability to substitute objects during play, and the child's need to imitate the modelled actions of the examiner. The ChIPPA was administered twice, at a 2-week interval, to each participant.

RESULTS: Test–retest intraclass correlation coefficients (ICCs) (Type 2,1) calculated for each of the three elaborate play measures ranged from .73 to .84. A test–retest ICC of .56 was obtained for object substitution with unstructured play materials. The test–retest ICC obtained for the combined score for unstructured and conventional play materials was .57. Percentage agreement figures ranging from 63.2% to 84.2% were obtained on test–retest of the object substitution with conventional toys and imitated actions measures. There was no significant difference between test and retest scores for these measures based on a Wilcoxon Matched Pairs Signed-Ranks Test (Wilcoxon Sign Test).

CONCLUSION: Elaborate play scores, object substitution with conventional toys score, and imitation scores on the ChIPPA showed stability over time. Object substitution scores using unstructured materials were the least stable play measures and appeared to be related to the child's play themes. Since play is the primary occupation of children, it is essential that therapists have a reliable measure of play behavior. The test–retest reliability results from the ChIPPA provide evidence that this assessment produces a stable measure of play behavior that can then guide therapists when planning intervention strategies for children.

Understanding play: the implications for play assessment

This article reviews the current literature on play and play assessment in occupational therapy. The concept of play and play theories are examined and reasons are investigated for the low use of play assessment in paediatric occupational therapy practice. Within contemporary occupational therapy practice, the concept of play is being readdressed and play behaviour is understood to be important in child development. Available assessments of play in occupational therapy assess the child in a familiar environment to the child. Since many paediatric occupational therapists work in clinical settings, it is concluded that a clinically viable assessment of observation of play behaviour is required within occupational therapy. Parameters for such an assessment are proposed.

Socioeconomic status and weight change in adults: a review

In developed countries, obesity is inversely associated with socioeconomic status (SES) among women, and less consistently among men; whereas, in developing countries, the association is direct. However, the relationship of SES to weight change over time is unknown. This relationship was the focus of the present literature review. It was hypothesized that, compared with persons of higher SES, persons of low SES would show greater weight gain or risk of weight gain over time. A search of electronic databases identified 34 relevant articles from developed countries reporting on studies that assessed the relationship of various measures of SES with weight change over time in adults (there were too few papers from developing countries (n=1) to include). Results of the methodologically strongest studies (those which obtained objectively measured adiposity data and used a follow-up period of 4 years or more) showed that, among non-black samples, there were relatively consistent inverse associations between occupation and weight gain for men and women. When SES was assessed using education, evidence was slightly less consistent, but still provided some support for the hypothesized relationship. However, when income was used as the indicator of SES, findings were inconsistent, although there were fewer studies available. There was little support for a relationship between SES and weight gain for black samples. In the context of the worldwide epidemic of obesity, these findings suggest that in developed countries, weight gain prevention efforts might best be focused on those who are most socioeconomically disadvantaged, particularly those in lower status occupations.

Whose socioeconomic status influences a women's obesity risk: her mother's, her father's, or her own?

Background Evidence on the relative influence of childhood vs adulthood socioeconomic conditions on obesity risk is limited and equivocal. The objective of this study was to investigate associations of several indicators of mothers', fathers', and own socioeconomic status, and intergenerational social mobility, with body mass index (BMI) and weight change in young women.

Methods This population-based cohort study used survey data provided by 8756 women in the young cohort (aged 18–23 years at baseline) of the Australian Longitudinal Study on Women's Health. In 1996 and 2000, women completed mailed surveys in which they reported their height and weight, and their own, mother's, and father's education and occupation.

Results Multiple linear regression models showed that both childhood and adulthood socioeconomic status were associated with women's BMI and weight change, generally in the hypothesized (inverse) direction, but the associations varied according to socioeconomic status and weight indicator. Social mobility was associated with BMI (based on father's socioeconomic status) and weight change (based on mother's socioeconomic status), but results were slightly less consistent.

Conclusions Results suggest lasting effects of childhood socioeconomic status on young women's weight status, independent of adult socioeconomic status, although the effect may be attenuated among those who are upwardly socially mobile. While the mechanisms underlying these associations require further investigation, public health strategies aimed at preventing obesity may need to target families of low socioeconomic status early in children's lives.

Obesity and undernutrition in sub-Saharan African immigrant and refugee children in Victoria, Australia

The study assessed the anthropometric status of 337 sub-Saharan African children aged between 3-12 years who migrated to Australia. These children were selected using a snowball sampling method stratified by age, gender and region of origin. The prevalence rates for overweight and obesity were 18.4% (95%CI: 14 - 23%) and 8.6% (95%CI: 6% -12%) respectively. The prevalence rates for the indicators of undernutrition were: wasting 4.3% (95%CI: 1.6%-9.1%), underweight 1.2% (95%CI: 0.3%-3.0%), and stunting 0.3 (95%CI: 0.0%-1.6%). Higher prevalence of overweight/obesity was associated with lower household income level, fewer siblings, lower birth weight, western African background, and single parent households (after controlling for demographic and socio-economic factors). Higher prevalence rates for underweight and wasting were associated with lower household income and shorter lengths of stay in Australia respectively. No effect was found for child's age, gender, parental education and occupation for both obesity and undernutrition indices. In conclusion, obesity and overweight are very prevalent in SSA migrant children and undernutrition, especially wasting, was also not uncommon in this target group.

The first 50 years of the annual endowed accounting research lecture series at the University of Melbourne

Carnegie and Edwards (2001) suggest that the formation of an organisational body is just one of the 'signals of movement' within the dynamic process of professionalisation of an occupation and they list the sponsoring of professorial posts and research activities at universities as further examples. While the literature on this process in Australia does refer to the sponsorship of chairs of accounting (Carnegie & Williams, 2001), little has been written identifying the range of other areas of sponsorship by the organised accounting bodies. This paper presents details of the first fifty years presentations of the Annual Accounting Research Lectures held at The University of Melbourne, Australia. They have been presented continuously since 1940, when they were inaugurated with sponsorship from the Commonwealth Institute of Accountants. The paper presents the first complete listing of details relating to the presenter (including name, gender, residency and occupational area), title of the paper, date of presentation (where known) and details of publication (where appropriate). The initial and subsequent motivation for the presentation of the series and the influence of the lectures in promoting research and fostering relations between the professional bodies and the university, during a period of great significance in the development of accounting education and the professionalisation of accounting in Australia, is also discussed.

The impact of communications and understanding on the success of business/IT alignment

This article reports on an investigation of IS stakeholders communication and mutual understanding, and their impact on the success of business / IT alignment. In particular, by following a hermeneutic study of transcripts of two focus groups and several interviews conducted with senior business and IT executives, the paper explores the issues of modern business context and practices, project scope and structure, trust, language and nomenclature, and the barriers to the effective stakeholder communication and  understanding. The study results are finally compared against the standard model of business and IT alignment. The main unexpected finding being executives' pre-occupation with issues of "marginal" value to the alignment model, such as day-to-day management of communicative and understanding effectiveness, as opposed to the fundamental issues of strategy and infrastructure fit.

Professionalisation and accounting in China: a historical and comparative review

While applied broadly within the setting of accounting and some other occupations, “a profession” is a particularly Western concept with peculiarly British origins. Additionally, the significance of such status and the process of “professionalisation” by which it is acquired remain beset by lingering uncertainties. Examination of the sociology of the accounting occupation within non-Western locations can contribute to exposing and clarifying these problematic and contingent aspects of occupational stratification, as well as assist in redressing the bias towards English-speaking and European countries within the accounting history literature. Proceeding from these theoretical premises, a historical and comparative study of the accounting occupation within China is undertaken. This seeks to integrate the world’s most populous nation into the historical narrative of the professionalisation of accounting, and reinforces – often vividly – that accountants’ work status is not bound to any predetermined trajectory which is innate to the occupation. Instead, the variety of localised and time-specific variables which constitute the occupational context are shown to exert a dominating influence.