| 1. |
- Abboud, Amina, et al.
(författare)
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Årsbok 2018 : Socialhögskolan, Lunds universitet
- 2019
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Socialhögskolans årsbok ger en liten inblick i vad vi gör och vi hoppas att den bidrar till att presentera utsnitt från vår verksamhet på ett trevligt och samlat sätt. Årsboken som är Socialhögskolans tredje uppmärksammar inte bara det som skett på Socialhögskolan under 2018. Den uppmärksammar även att 2018 var året då svensk äldreomsorg fyllde 100 år. Årsbokens gästredaktör Per Gunnar Edebalk inleder därför bokens forskningsavsnitt med att i år skriva om just hundraåringens historia. Det är inledningen på ett avsnitt där flera forskare vid Socialhögskolan bjuder på bidrag som lyfter fram aspekter av äldreomsorg och åldrande.Håkan Jönson och Tove Harnett resonerar om de begrepp som omgärdar äldreomsorgens möten och organisering sett i ett socialt arbetets perspektiv. De två har även skrivit en artikel om huruvida behov ska ses annorlunda mellan grupper bara för att man passerat en viss ålder.Däremellan presenteras en text av Erika Werner som låter oss möta frågor kring en sviken generation, här genom ett möte med Agnes, som hamnade mitt i skarven när pensionssystemet reformerades. Elisabeth Carlstedt presenterar en text om hur äldreomsorgens särskilda boenden arbetar i relation till Socialtjänstlagens direktiv om meningsfullhet och värdighet, och hur svårt det är. Lars Harrysson presenterar därefter ett avsnitt om två forskningsprojekt som han och Erika Werner gjort där fokus har legat dels på pensioner för personer i ekonomiskt utsatta grupper, speciellt med migrantbakgrund, dels om hur tro och äldreomsorg samspelar, eller inte. Äldreomsorgsavsnittet avslutas sedan med en intervju som Patrik Hekkala gjort med Peter Andersson som startade kursen socialt arbete med äldre och med Tove Harnett som tagit över och fortsatt utvecklingsarbetet till dags datum.Årsboken avslutas sedan med fyra texter. En av Amina Abboud, snart färdig socionom, som skriver om sina erfarenheter av och i uppsatsskrivandet. Sedan en där vi får möta Carina Olsson som arbetat hos oss länge, men som faktiskt arbetat vid universitetet i 40 år 2018. Emelie Dahlström, Joakim Grina och Jan Abrahamsson ger sedan en bakgrundsteckning till en hos Socialhögskolan verksam social accelerator, SoPact. Som avrundning finner du sedan lite mer information om vår verksamhet här vid Socialhögskolan.
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| 2. |
- Andrén, Anna, 1970-
(författare)
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Freezing Temperature Flows in Railway Tunnels and its Consequence on the Rock Supporting Structure, the Rock and the Reinforcing Elements
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Water in the surrounding rock mass flows into the tunnel via naturally occurring joints and via cracks caused by the blasting used to excavate the tunnel. The most common method in Sweden to reduce or prevent leakage problems are first and foremost the use of grouting. However, experience shows that despite extensive pre-grouting and supplementary post-grouting, it is difficult to seal the rock mass so that drips and moisture are completely eliminated. Although the water itself causes degradation of the tunnel, the degradation process increases dramatically when the water is exposed to freezing temperatures. Water expands during freezing and due to water migration, which occurs in rock in a similar way as in soil, the ice causes frost shattering of the interface between rock and shotcrete and also to the shotcrete and the rock itself. This can damage the main load-bearing system. The ice formation itself is a maintenance problem, as the tunnels must be kept clear of icicles, ice pillars and ice layers in the tracks or on the roads. One of the main tasks in this research project has been to identify which problems cause the most maintenance work and where and when these problems occur in the tunnel.During the field observations carried out as part of this doctoral study, many problems with water and ice were discovered, all of which contribute to increased maintenance. Many ice problems are directly linked to frost insulated drain mats. Leakage and ice formations occur at the edge of the drains, in mat splices and when brackets for cable racks, handrails or other installations puncture a drain and it has not been properly sealed. In drains covered with shotcrete, frost shattering and cracking in the shotcrete can be a problem. Frost cycles in the tunnel cause the water to freeze and thaw alternately, allowing more water to reach the freezing area due to water migration, resulting in frost shattering of the rock and the shotcrete. If not anchored with bolts, the reinforcing effect and the stability of shotcrete in a tunnel is dependent on the adhesion to the rock surface. It is, therefore, important to take all available measures to ensure good adhesion. Poor adhesion in itself is not a degradation problem, but a void can form in the interface between rock and shotcrete as a result of poor adhesion. If this void is filled with water that cannot drain away, ice pressure can occur in the layer between rock and shotcrete. The ice pressure can cause cracking and degradation of the shotcrete if the pressure exceeds the tensile strength of the adjacent material. In some of the reported fall-outs of rock and shotcrete, an ice layer was discovered between the rock surface and the edges of the remaining shotcrete layer. Therefore, frost shattering is a likely cause of the fall-outs. Many frost cycles combined with water leakage can cause frost shattering. The field measurements conducted as a part of the doctoral study have shown that most frost cycles do not occur closest to the tunnel entrances, but instead about 100 to 200 m into the longer tunnels. The results from the laboratory tests performed as part of the doctoral study showed that the adhesive strength between rock and shotcrete decreased significantly when the test panels were subjected to freeze-thaw cycles. Furthermore, more of the micro seismic events (AE - acoustic emission monitoring) occurred in the test panels that had access to water during freezing. Therefor, maintenance personnel and inspectors should pay particular attention to water leakage in sections that have an increased number of frost cycles, to avoid future problems with frost shattering of rock or shotcrete. In the longer tunnels studied in this work, a greater number of ice formations occurred in the inner parts of the tunnel, than close to the entrances. The rock mass emits heat, which heats up the cold outside air that enters the tunnel. Due to the heat transfer from the rock mass, leakage points located further along the tunnels can remain unfrozen. A leak that is closer to the tunnel entrances in the longer tunnels or a leak in a shorter tunnel are exposed to higher freezing rates. The entire rock mass freezes and the leak ‘freezes dry’, that is, ice forms in the water-bearing fracture, preventing further water leakage.Where and when ice problems occur along a tunnel depends on many factors. Besides the obvious water leakage, the length of frost penetration into the tunnel is the main reason for where and when ice problems occur. The predominant cause of frost penetration in most of the tunnels is the thermally induced airflow. In the longer tunnels, the inclination of the tunnel affects frost penetration the most. The field observations showed that there was a difference in where and when leakage points appear during the year and also in terms of variation in the amount of leakage water. There was also a variation over different years. The conclusions of the field observations are that it is difficult to estimate where the insulated drain mats should be located along a tunnel. Based on experience from this survey, the location of the drains should be determined only after several inspections and especially after a winter period, when the main problems with ice formation occur. Previous perception regarding ice problems have been that ice formation only occurs at the tunnel entrances and in the outer parts of the tunnel. A proposed measure has, therefore, been to cover the first 300 m from each entrance with frost insulated drains to try to completely eliminate the ice problems. However, this is not an effective solution to the problem. The insulation not only prevents the cold from reaching the leakage point, but it also prevents the rock mass from emitting heat that warms up the cold outside air entering the tunnel. Thus, the frost can penetrate further into the tunnel and the problems with ice formation are only moved further into the tunnel. As the amount and location of the frost insulation affects frost penetration, the dimensioning of insulation must, therefore, be carried out in several iterations, where each new distribution of insulation along the tunnel is calculated separately.For the tunnels that have been studied as part of this doctoral study, the following has emerged. The central and southern parts of Sweden have shorter cooling periods and the tunnels are exposed to many temperature fluctuations around 0°C during the winter. The frost does not have time to penetrate as far here as in the tunnels in the northern parts of Sweden. Therefore, more ice problems arise around the entrances of the tunnels in the southern parts of Sweden than for those in the northern parts. For northern parts of Sweden, the problem of growing ice formations in sections near the tunnel entrance usually occurs only during the autumn and spring, but not in winter. The field observations showed that the problems with ice growth and temperature fluctuations around 0°C occur further along the longer tunnels in the northern parts of Sweden. This is because the temperature of the tunnel air is higher due to heat transfer from the rock mass. For shorter tunnels that adopt the same temperatures as the outside air, ice formations can occur along the entire length of the tunnel in the sections that have leakage problems. The Swedish Transport Administration’s regulations are currently being updated and the observations and measurements carried out in this doctoral work are now being used to evaluate new requirements regarding frost penetration in tunnels.
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| 3. |
- Brunström, Mattias, et al.
(författare)
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Association of education and feedback on hypertension management with risk for stroke and cardiovascular disease
- 2022
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Ingår i: Blood Pressure. - : Informa UK Limited. - 0803-7051 .- 1651-1999. ; 31:1, s. 31-39
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Education and feedback on hypertension management has been associated with improved hypertension control. This study aimed to assess the effectiveness of such interventions to reduce the risk of stroke and cardiovascular events. Materials and Methods Individuals >= 18 years with a blood pressure (BP) recording in Vasterbotten or Sodermanland County during the study period 2001 to 2009 were included in 108 serial cohort studies, each with 24 months follow-up. The primary outcome was risk of first-ever stroke in Vasterbotten County (intervention) compared with Sodermanland County (control). Secondary outcomes were first-ever major adverse cardiovascular event (MACE), myocardial infarction, and heart failure, as well as all-cause and cardiovascular mortality. All outcomes were analysed using time-to-event data included in a Cox proportional hazards model adjusted for age, sex, hypertension, diabetes, coronary artery disease, atrial fibrillation, systolic BP at inclusion, marital status, and disposable income. Results A total of 121 365 individuals (mean [SD] age at inclusion 61.7 [16.3] years; 59.9% female; mean inclusion BP 142.3/82.6 mmHg) in the intervention county were compared to 131 924 individuals (63.6 [16.2] years; 61.2% female; 144.1/81.1 mmHg) in the control county. A first-ever stroke occurred in 2 823 (2.3%) individuals in the intervention county, and 3 584 (2.7%) individuals in the control county (adjusted hazard ratio 0.96, 95% CI 0.90 to 1.03). No differences were observed for MACE, myocardial infarction or heart failure, whereas all-cause mortality (HR 0.91, 95% CI 0.87 to 0.95) and cardiovascular mortality (HR 0.91, 95% CI 0.85 to 0.98) were lower in the intervention county. Conclusions This study does not support an association between education and feedback on hypertension management to primary care physicians and the risk for stroke or cardiovascular outcomes. The observed differences for mortality outcomes should be interpreted with caution.
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| 4. |
- Brunström, Mattias, et al.
(författare)
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Association of physician education and feedback on hypertension management with patient blood pressure and hypertension control
- 2020
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Ingår i: JAMA Network Open. - : American Medical Association (AMA). - 2574-3805. ; 3:1
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Tidskriftsartikel (refereegranskat)abstract
- Elevated systolic blood pressure (SBP) is the most important risk factor for premature death worldwide. However, hypertension detection and control rates continue to be suboptimal.To assess the association of education and feedback to primary care physicians with population-level SBP and hypertension control rates.This pooled series of 108 population-based cohort studies involving 283 079 patients used data from primary care centers in 2 counties (Västerbotten and Södermanland) in Sweden from 2001 to 2009. Participants were individuals aged 18 years or older who had their blood pressure (BP) measured and recorded in either county during the intervention period. All analyses were performed in February 2019.An intervention comprising education and feedback for primary care physicians in Västerbotten County (intervention group) compared with usual care in Södermanland County (control group).Difference in mean SBP levels between counties and likelihood of hypertension control in the intervention county compared with the control county during 24 months of follow-up.A total of 136 541 unique individuals (mean [SD] age at inclusion, 64.6 [16.1] years; 57.0% female; mean inclusion BP, 142/82 mm Hg) in the intervention county were compared with 146 538 individuals (mean [SD] age at inclusion, 65.7 [15.9] years; 58.3% female; mean inclusion BP, 144/80 mm Hg) in the control county. Mean SBP difference between counties during follow-up, adjusted for inclusion BP and other covariates, was 1.1 mm Hg (95% CI, 1.0-1.1 mm Hg). Hypertension control improved by 8.4 percentage points, and control was achieved in 37.8% of participants in the intervention county compared with 29.4% in the control county (adjusted odds ratio, 1.30; 95% CI, 1.29-1.31). Differences between counties increased during the intervention period and were more pronounced in participants with higher SBP at inclusion. Results were consistent across all subgroups.This study suggests that SBP levels and hypertension control rates in a county population may be improved by educational approaches directed at physicians and other health care workers. Similar strategies may be adopted to reinforce the implementation of clinical practice guidelines for hypertension management.
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| 5. |
- Brunström, Mattias, et al.
(författare)
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From efficacy in trials to effectiveness in clinical practice : The Swedish Stroke Prevention Study
- 2016
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Ingår i: Blood Pressure. - : Informa UK Limited. - 0803-7051 .- 1651-1999. ; 25:4, s. 206-211
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Tidskriftsartikel (refereegranskat)abstract
- Blood pressure treatment has shown great efficacy in reducing cardiovascular events in randomized controlled trials. If this is effective in reducing cardiovascular disease in the general population, is less studied. Between 2001 and 2009 we performed an intervention to improve blood pressure control in the county of Vasterbotten, using Sodermanland County as a control. The intervention was directed towards primary care physicians and included lectures on blood pressure treatment, a computerized decision support system with treatment recommendations, and yearly feed back on hypertension control. Each county had approximately 255000 inhabitants. Differences in age and incidence of cardiovascular disease were small. During follow-up, more than 400000 patients had their blood pressure recorded. The mean number of measurements was eight per patient, yielding a total of 3.4 million blood pressure recordings. The effect of the intervention will be estimated combining the blood pressure data collected from the electronic medical records, with data on stroke, myocardial infarction and mortality from Swedish health registers. Additional variables, from health registers and Statistics Sweden, will be collected to address for confounders. The blood pressure data collected within this study will be an important asset for future epidemiological studies within the field of hypertension.
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| 6. |
- Makubi, Abel, et al.
(författare)
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Heart failure in Tanzania and Sweden: Comparative characterization and prognosis in the Tanzania Heart Failure (TaHeF) study and the Swedish Heart Failure Registry (SwedeHF)
- 2016
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Ingår i: International Journal of Cardiology. - : ELSEVIER IRELAND LTD. - 0167-5273 .- 1874-1754. ; 220, s. 750-758
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Tidskriftsartikel (refereegranskat)abstract
- Background: Heart failure (HF) in developing countries is poorly described. We compare characteristics and prognosis of HF in Tanzania vs. Sweden. Methods: A prospective cohort study was conducted from the Tanzania HF study (TaHeF) and the Swedish HF Registry (SwedeHF). Patients were compared overall (n 427 vs. 51,060) and after matching 1: 3 by gender and age +/- 5 years (n 411 vs. 1232). The association between cohort and all-cause mortality was assessed with multivariable Cox regression. Results: In the unmatched cohorts, TaHeF (as compared to SwedeHF) patients were younger (median age [inter-quartile range] 55 [40-68] vs. 77 [64-84] years, p amp;lt; 0.001) and more commonly women (51% vs. 40%, p amp;lt; 0.001). The three-year survival was 61% in both cohorts. In the matched cohorts, TaHeF patients had more hypertension (47% vs. 37%, p amp;lt; 0.001), more anemia (57% vs. 9%), more preserved EF, more advanced HF, longer duration of HF, and less use of beta-blockers. Crude mortality was worse in TaHeF (HR 2.25 [95% CI 1.78-2.85], p amp;lt; 0.001), with three-year survival 61% vs. 83%. However, covariate-adjusted risk was similar (HR 1.07, 95% CI 0.69-1.66; p = 0.760). In both cohorts, preserved EF was associated with higher mortality in crude but not adjusted analysis. Conclusions: Compared to in Sweden, HF patients in Tanzania were younger and more commonly female, and after age and gender matching, had more frequent hypertension and anemia, more severe HF despite higher EF, and worse crude but similar adjusted prognosis. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
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| 7. |
- Mossmark, Fredrik, 1975, et al.
(författare)
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Aggressive groundwater chemistry caused by underground constructions
- 2008
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Ingår i: Proceedings of the 33rd International Geological Congress, Oslo, Norway, August 2008.
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Konferensbidrag (refereegranskat)abstract
- When considering the degradation process and lifetime of the support system and equipment in underground facilities, the selection of materials is (normally) based on established criteria for the chemical composition of the groundwater. This is important for decisions regarding the steel quality and protection of reinforcement bolts, as well as the material used for the waterproofing system and lining. The criteria are imposed through groundwater sampling and analysis of groundwater prior to the construction of an underground facility. However, studies of the impact on groundwater chemistry from the construction of underground structures and experiments with groundwater extraction indicate that the groundwater chemistry is likely to change over time. Underground facilities are known to cause hydrological changes, especially during the construction phase. However, extensive monitoring programmes of groundwater chemistry are unusual. To further investigate possible changes of water chemistry due to hydrological changes, an experiment with groundwater extraction has been carried out. The experiment was conducted through the constant extraction of groundwater for a period of five years (between the years 2000 and 2005) from within a small watershed (28000 m2) at Lake Gårdsjön, located 50 km north of Gothenburg in Sweden. The area was also monitored during a few years before the extraction started and during the recovery phase. The area of the experiment is characterized by Precambrian crystalline bedrock covered by a thin overburden of glacial till and organic soils. The extraction caused the runoff from the watershed to decrease by nearly 50 % and the groundwater level to fluctuate more than at a nearby reference area. The hydrological impact of the experiment, with increased groundwater recharge, lead to changes and increased seasonal variations in the chemical composition of the groundwater in the bedrock. The hydrochemical variations were caused by seasonal variations in both the amount of water available for groundwater recharge and the chemical composition of the recharging water. Compared to the reference area, the seasonal variations were observed to increase for all the parameters included in the criteria used by the Swedish authorities for selection of construction materials (pH, hardness (Ca), alkalinity, salinity (EC)). An established method to assess the impact of the water composition on the corrosion of steel materials is the use of Langeliers index. The experiment with groundwater extraction caused a larger fluctuation of Langeliers index in the test area compared to the reference area. The results from the experiment confirm the observations from previous tunnelling projects, and show that the methods commonly used to assess the expected future aggressivity of the groundwater in the planning for underground facilities should be reviewed.
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| 8. |
- Agvall, Björn, 1963-, et al.
(författare)
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Cost of heart failure in Swedish primary healthcare
- 2005
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 23, s. 227-232
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. To calculate the cost for patients with heart failure (HF) in a primary healthcare setting. Design. Retrospective study of all available patient data during a period of one year. Setting. Two healthcare centers in Linköping in the southeastern region of Sweden, covering a population of 19 400 inhabitants. Subjects. A total of 115 patients with a diagnosis of HF. Main outcome measures. The healthcare costs for patients with HF and the healthcare utilization concerning hospital days and visits to doctors and nurses in hospital care and primary healthcare. Results. The mean annual cost for a patient with HF was SEK 37 100. There were no significant differences in cost between gender, age, New York Heart Association functional class, and cardiac function. The distribution of cost was 47% for hospital care, 22% for primary healthcare, 18% for medication, 5% for nursing home, and 6% for examinations. Conclusion. Hospital care accounts for the largest cost but the cost in primary healthcare is larger than previously shown. The total annual cost for patients with HF in Sweden is in the range of SEK 5.0–6.7 billion according to this calculation, which is higher than previously known.Read More: http://informahealthcare.com/doi/abs/10.1080/02813430500197647
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| 9. |
- Agvall, Björn, 1963-
(författare)
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Heart failure in primary care with special emphasis on costs and benefits of a disease management programme
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and aim. Heart failure (HF) is a common condition associated with poor quality of life (QoL), high morbidity and mortality and is frequently occurring in primary health care (PHC). It involves a substantial economic burden on the health care expenditure. There are modern pharmacological treatments with evident impact on QoL, morbidity, mortality, and proved to be cost-effective. Despite this knowledge, the treatment of HF is considered somewhat insufficient. There are several HF management programmes (HFMP) showing beneficial effects but these studies is predominantly based in hospital care (HC).The first aim of this thesis was to describe patients with HF in the PHC regarding gender differences, diagnosis, treatment and health related costs (I, II).The second aim was to evaluate whether HFMP have beneficial effects in the PHC regarding cardiac function, quality of life, health care utilization and health care-related costs (III,IV).Methods. The initial study involved retrospective collection of data from 256 patients with symptomatic HF in PHC (I). The data collected were gender, age, diagnostics and ongoing treatment. The second study was an economic calculation performed on 115 patients (II). The economic data was retrospectively retrieved as the number of hospital days, visits to nurses and physicians in HC and PHC, prescribed cardiovascular drugs and performed investigation during retrospectively for one year. The third and fourth study was based on a randomized, prospective, open-label study which was subsequently performed (III,IV). The study enrolled 160 patients with systolic HF who were randomized to either an intervention or a control group. The patients in the intervention group retrieved follow-up of HF qualified nurses and physicians in the PHC, involving education about HF and furthermore, optimizing the treatment according to guidelines if possible. The patients in the control group had a followup performed by their regular general practitioner (GP) receiving customary management according to local routines but there was no contact with HF nurses. The primary endpoint of the study was a composite endpoint consisting of changes in survival, hospitalization, heart function and quality of life (QoL) and to compare differences in resource utilization and costs (III,IV).Results. In the first study, the prevalence was 2% and the average age was 78 years (I). The most frequent cause of HF was IHD followed o hypertension. The diagnosis in the study population was based on clinical criteria and only 31% had been subjected to echocardiography. The most common treatment was diuretics (84%) and angiotensin converting enzyme inhibitors (ACEI) were used in 56% of patients. In the following prospective study, the intervention group had significant improvements in composite endpoints. There were in the intervention group more patients with reduced levels of NTproBNP (p=0.012) and improved cardiac function (p=0.03). No significant changes were found in New York Heart Association (NYHA) functional class or QoL. The intervention involved less health care contacts (p=0.04), less emergency ward visits (p=0.002) and hospitalizations (p=0.03). The total cost for HC and PHC was EUR 4471 in the intervention group and EUR 6638 in the control group which implies a cost reduction of EUR 2167 (33%).Conclusions. HF is common in PHC with a prevalence of 2% the study population had an average age of 78 years. Only 31 % of the HF patients have performed an echocardiographic investigation. Treatment with ACEI occurred in 56 %. Differences were found between genders since women had performed significantly fewer echocardiographic investigations and, had less treatment with ACEI. When implementing HFMP in PHC, beneficial effects were found regarding cardiac function and health care-related costs in patients with systolic HF. These findings indicate that HFMP might be used even in PHC.
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| 10. |
- Ahlsén, Bertil, et al.
(författare)
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Ombyggnad Torslanda
- 1990
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Consumer report for the company in question (the Volvo Automobile Company and the Volvo Torslanda plant) which is financed by the company and partly also by a research foundation. It is a matter of a work that in this particular case were carried out during nine years in a number of experimental workshops located outside the Chalmers University of Technology. These workshops were financed by the Volvo Automobile and Truck companies. This achievement, as the final contribution to the Swedish automotive industry after having already treated this research field/problem area for more than two decades before this particular period if time (involving several junior and senior research competencies, as well as industrial and governmental foundings).
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