| 1. |
- Abramsson, Linnea, et al.
(author)
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Use of heart failure medications in older individuals and associations with cognitive impairment
- 2023
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In: BMC Geriatrics. - : BioMed Central (BMC). - 1471-2318 .- 1471-2318. ; 23:1
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Journal article (peer-reviewed)abstract
- Background: To achieve the best treatment of heart failure, it is important to use all recommended drugs at their target doses. Given that underuse of medications can occur in individuals with cognitive impairment, we investigated the filled prescriptions and target doses of heart failure medication for older individuals with and without cognitive impairment as well as associated factors.Methods: The study was based on two separate datasets. The first dataset, which was based on data from questionnaires sent to nursing homes in Sweden, included 405 individuals with heart failure. The data were linked with the Swedish Prescribed Drug Register and the National Patient Register to obtain information regarding filled prescriptions of heart failure medications and heart failure diagnoses among the population. In the second dataset, medical records of individuals aged 75 years or older admitted to a hospital in northern Sweden were reviewed and individuals with heart failure were identified. Target doses of heart failure medications were evaluated in 66 individuals who lived at home.Results: Filled prescriptions of mineralocorticoid receptor antagonists and loop diuretics were significantly more common in individuals without cognitive impairment (OR 1.087; 95% CI 1.026–1.152, p < 0.05) and (OR 1.057; 95% CI 1.017–1.098, p < 0.05), respectively. There were no significant differences between individuals with and without cognitive impairment in terms of achieving target doses for any of the drug classes. A higher age was associated with fewer filled prescriptions and less ability to reach the target doses of beta blockers (OR 0.950; 95% CI 0.918–0.984, p < 0.05) and (OR 0.781; 95% CI 0.645–0.946, p < 0.05), respectively.Conclusions: Our results suggest that individuals with cognitive impairment are partly undertreated for heart failure in that they had fewer filled prescriptions of important heart medications. Separately, the relatively low proportion of older individuals reaching target doses is an important observation and indicates that treatment of heart failure could be further optimised among older individuals.
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| 2. |
- Edvardsson, Maria, 1972-
(author)
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Circulating levels and assessment of clinical laboratory analytes, in >80-year-old, apparently healthy, moderately healthy, and frail individuals
- 2019
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Doctoral thesis (other academic/artistic)abstract
- Blood samples are often used to investigate the possible presence of disease and to make treatment decisions. In the interpretation of the results, comparison either with previous values from the same individual or with a set of appropriate group-based reference intervals are used. Current reference intervals for common laboratory analytes are often based on measurements from apparently healthy persons aged 18–65 years. Age is accompanied by a general decline in organ functions and it is difficult to determine whether a change in levels of laboratory analytes in an elderly individual can be attributed to age alone, independent of environmental or disease processes. Frailty can be seen as a consequence of age-related multifactorial deterioration – physical, cognitive and sensory – resulting in vulnerability and lack of adaptability to internal stressors such as infection or new medication and/or external stressors such as fall at home. Consensus about the definition of “frail” and “frailty” is missing, both nationally and internationally, the question arises whether different definitions of “frailty” affect the interpretation of analytes when comparing different groups of elderly.The overarching aim of the thesis was to interpret and assess circulating levels of some clinical laboratory analytes in relation to conventional reference values in ≥80-year-old, “apparently healthy”, “moderately healthy”, and “frail” individuals. Data originated from other studies, in which blood samples were collected from individuals ≥80-year-old. Comparisons in Paper I of levels of some laboratory analytes, from 138 nursing home residents (NHRs), was made with blood from reference populations, both blood donor and the NORIP study. The results indicated differences for some immunological (complement factor 3 and 4, immunoglobulin G and M) and chemical analytes (alanine aminotransferase (ALT), phosphate, albumin, sodium, creatinine and urea), but no differences in levels occurred for aspartate aminotransferase (AST), gamma-glutamyltransferase (γ-GT) or lactate dehydrogenase (LDH). It was unclear whether the differences were due to differences in age between the elderly and the reference populations or whether the elderly individuals had chronic diseases and were on medication. In Paper II, 569 individuals elderly individuals ≥80 years old were classified as “healthy”, “moderately healthy”, and “frail”, based on diseases, medications and physical and cognitive abilities. Statistical differences between the groups were found for the investigated analytes; albumin, ALT, AST, creatinine and γ-GT. In Paper IV, individuals from Paper II (n=569) were divided into two groups and thereafter divided into “apparently healthy”, “moderately healthy”, and “frail”. One group was subdivided into “apparently healthy”, “moderately healthy” and “frail” based on physical and cognitive abilities and the other group was divided based on the frailty index (FI). There was no statistical difference found between “apparently healthy” and “moderately healthy" groups, regardless of classification model used. Among “frail” individuals, differences in levels occurred for three out of the five investigated analytes: ALT, creatinine and g-GT, with lower levels occurring when the FI classification model was used. No differences in levels occurred for albumin or AST in “frail” individuals, regardless of classification model used. The aim of Paper III was to study whether 1-year changes in complete blood count (CBC) (including haemoglobin (Hb), red blood cell (RBC), erythrocyte volume fraction (EVF), mean corpuscular volume (MCV), mean corpuscular Hb concentration (MCHC), white blood cell (WBC) and platelet count (PLT)), C-reactive protein (CRP) and interleukin (IL)-1β, IL-1RA, IL-6, IL-8 and IL-10 are associated with survival in elderly NHRs aged >80 years. Elevated levels of CRP and IL-8 during 1-year follow-up were associated with reduced length of survival in elderly NHRs. Based on the present thesis it is clear that there is need for reference intervals that consider both age and health status in elderly individuals. A reasonable conclusion when interpreting levels of analytes in elderly individuals with disease or frailty is that individual evaluation based on the individual’s previous levels, is recommended.
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| 3. |
- Nordström, Maria
(author)
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Is time money? Philosophical perspectives on the monetary valuation of travel time
- 2020
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Licentiate thesis (other academic/artistic)abstract
- This licentiate thesis consists of an introduction (‘kappa’) and three papers discussing various aspects of time as a commodity and the practice of valuing travel time.The first paper is an analysis of the properties of time as an economic resource taking into account literature on behavior with regard to time. The intent is to provide better understanding of the underlying assumption of transferability between time and money in the context of transportation.The second paper builds on the analysis in the first paper combined with the findings of a study of commuters travel experiences during disruptions in the train traffic on the Øresund strait between Sweden and Denmark. It contrasts the theoretical account of value of travel time with the experiences reported by commuters and argues that the view of travel time as strictly a disutility can be limiting from a planning perspective. Instead, it is argued that an alternative approach can be to make travel time ‘plannable’, meaning viewing travel time as time travellers can plan to spend in a certain way at a certain time.The third paper argues that the diversity of possible mobility solutions based on self-driving vehicles has been somewhat overlooked in the current literature on value of travel time. Thus, the complexity of valuing travel time for self-driving vehicles has not been fully addressed. The paper consists of a morphological analysis of the parameters that might impact value of travel time for self-driving vehicles and a deeper analysis of five plausible self-driving vehicle mobility concepts. It is claimed that not all such concepts can be easily mapped into transport modes and that it might be more appropriate to differentiate value of travel based on travel characteristics.
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| 4. |
- Nordström, Maria
(author)
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Time, justice and the future of mobility : Essays in philosophy of transport
- 2022
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Doctoral thesis (other academic/artistic)abstract
- This thesis in philosophy consists of an introduction and five papers on three themes related to transport: valuations of time, the metric of transport justice, and future mobility solutions. The first paper analyses the properties of time as an economic resource taking into account literature on behaviour concerning time. The intent is to add to the understanding of the underlying assumption of transferability between time and money in the context of transportation.The second paper is on the metric of transport justice. If we are concerned with distributive justice in the context of transportation, what type of good is being distributed? So far, most of the transport literature on transport justice takes accessibility to be the most appropriate metric. However, I argue that many operationalisations of accessibility are insufficient as metrics of justice. They are both too narrow and exclude relevant burdens of transportation. Additionally, accessibility can be achieved by other, non-travel-based means. I end by formulating tentative criteria for an alternative metric of transport justice. The third paper considers temporal justice in the context of transportation. Building on an argument against the claim of substitutability between time and money, I argue that temporal perspectives have been overlooked in the literature on transport justice. In part, this might be due to accessibility being the established metric of justice. Most common measures of accessibility do not capture temporal constraints and might consequently not capture temporal inequalities. Based on the case of gender differences in travel patterns and behaviour, I argue that an alternative account of the appropriate metric of transport justice is needed to capture temporal constraints and reflect gender inequalities sufficiently. The fourth paper argues that the diversity of possible mobility solutions based on self-driving vehicles has been somewhat overlooked in the current literature on the value of travel time. Thus, the complexity of valuing travel time for self-driving vehicles has not been fully addressed. The paper consists of a morphological analysis of the parameters that might impact the value of travel time for self-driving vehicles and a deeper analysis of five plausible self-driving vehicle mobility concepts. It is claimed that not all such concepts can be easily mapped into transport modes. It might be more appropriate to differentiate the value of travel based on travel characteristics.The fifth paper is a literature review of work on attitudes toward automation technology, specifically self-driving vehicles. In particular, I examine the narratives and values related to gender. Generally, women tend to be more sceptical of the prospect of automated vehicles. The review found that this tendency is often explained by women being more risk-averse and less tech-savvy. Moreover, the policy recommendations in the examined literature based focus on educational efforts. Such perspectives can downplay or neglect valid reasons why women are less enthusiastic. Moreover, needs related to women's specific travel patterns might not be considered in the design and planning process. In conclusion, more awareness in needed of the gender differences, needs and expectations to ensure that future transport solutions are designed with everyone in mind.
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| 5. |
- Stålhammar, Anna, et al.
(author)
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Resource test-driving for service innovation : How ordinary employees innovate new value propositions
- 2012
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In: Proceedings of the 15th QMOD-ICQSS conference. - Poznan, Poland : COMPRINT, Poznan Univ. of Technology.
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Conference paper (peer-reviewed)abstract
- PurposeThe purpose of this paper is to investigate the role of ordinary employees in service innovation. Departing from the service-dominant (S-D) logic, service innovation is conceptualized as a resource integration process leading to the creation of value propositions.MethodologyThe paper reports on a case study of service development at three different organizations. Twenty ordinary employees were interviewed. Ordinary employees are defined as those lacking a formal innovation obligation, e.g. frontline employees. These normally have knowledge of both the customers’ needs and the firm’s ability to realize these.FindingsThe findings suggest that ordinary employees contribute to service innovation by test-driving resource integrations and potential value propositions. Specifically, the findings suggest that ordinary employees use three different ways of test-driving resources: Cognitive test-driving; Test-driving in practice, and Discursive test-driving. Although the findings suggest that these ways of test-driving resources are intertwined, they also suggest that parts of the innovation process are dominated by one of these.Research limitations/implicationsThis article is based on a case study of three organizations, thus limiting the possibility of statistical generalization.Originality/valueThe study is novel in several respects: (i) it introduces the notion of resource test-driving; (ii) it provides a systematic empirical analysis of how ordinary employees contribute to service innovation through test-driving resource integrations and new value propositions; (iii) it offers an S-D logic informed service innovation model; (iv) it contributes to the S-D logic by detailing how resource integration takes place in practice.
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| 6. |
- Åkesson, Maria, 1979-, et al.
(author)
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E-government and service orientation : gaps between theory and practice
- 2008
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In: International Journal of Public Sector Management. - : Emerald Group Publishing Limited. - 0951-3558 .- 1758-6666. ; 21:1, s. 74-92
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Journal article (peer-reviewed)abstract
- Purpose – The purpose of this paper is to review selected literature on e-government service orientation and highlight differences between academic theory and empirical findings. To date, there has been little support for predictions made in the e-government conceptual literature.Design/methodology/approach – The paper is a conceptual framework for a literature review of e-government and service orientation is presented. A systematic database search is then undertaken to identify the literature related to e-government and service orientation. Suitable papers are selected, carefully read, and systematically analysed according to the conceptual framework. A discussion and relevant conclusions are then presented.Findings – The paper finds that a gap appears to exist between conceptual literature and empirical findings. For example, conceptual research claims that e-government will result in a reduction of staff, yet no empirical findings have proven this. The present study applies institutional theory for understanding the fundamental reasons to this gap.Research limitations/implications – The paper is based on a literature review of 27 articles, three monographs and one edited volume focusing on service orientation and e-government. It does not attempt to examine the full range of the literature available within the field of e-government.Originality/value – This review paper uniquely considers the gaps between the theory and practice of e-government service orientation, and identifies where they exist. Some possible explanations for the gaps are explored which can be of interest to both academics and practitioners working in the field.
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| 7. |
- Åkesson, Maria, 1979-, et al.
(author)
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Value proposition test-driving for service innovation : How frontline employees innovate value propositions
- 2016
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In: Journal of service theory and practice. - 2055-6225 .- 2055-6233. ; 26:3, s. 338-362
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Journal article (peer-reviewed)abstract
- Purpose – The purpose of this paper is to investigate the role of frontline employees in service innovation from a service-dominant logic (SDL) perspective. Frontline employees lack a formal innovation obligation. Service innovation is a resource integration process resulting in the creation of new value propositions.Design/methodology/approach – A case study of service innovation projects that includes three different businesses in the IT sector and personal interviews with 25 frontline employees.Findings – The findings suggest that frontline employees contribute to service innovation by test-driving potential value propositions. Three types of value proposition test-driving have been identified: cognitive, practical, and discursive. The findings suggest interdependencies between the different modes of value proposition test-driving, as well as specific phases of the service innovation process dominated by one form or another.Research limitations/implications – Value proposition test-driving offers a fruitful context for managers to involve frontline employees and use their creativity and expertise. The case study approach, however, limits the statistical generalizability of the findings.Originality/value – The study is novel in that it introduces the notion of value proposition test-drivingfor service innovation; provides a systematic empirical analysis of how frontline employees contribute toservice innovation by test-driving value propositions; offers a service innovation model informed by the SDL; and contributes to the SDL by detailing how service innovation occurs in practice.
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