| 1. |
- Nilsson, Kerstin
(författare)
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To work or not to work in an extended working life? Factors in working and retirement decisions
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In most of the industrialised world, the proportion of older and retired people in the population is continuously increasing. This will have budgetary implications for maintaining the welfare state, because the active working section of the population must fund the non-active and old population. Aim: The overall aim of this thesis was to obtain knowledge about older workers’ work and life situation in association with their planning and decision to retire from working life. Method: The thesis includes one qualitative and three quantitative studies conducted in Sweden. Result: Self-rated health was found to be a better measure than diagnosed disease of whether older workers believed they could work until 65 years or beyond. Health seems not to be a general impediment to working in old age if older workers are satisfied with their work situation and have enough time and opportunities to recover from fatigue. In one of Sweden’s most hazardous work environments, older workers were not injured significantly more often than younger workers. Good mental and physical work environment, moderate working pace and working time, and the right competence and possibility for skills development were factors determining whether older workers believed they can extend their working life. Attitude to older workers in the organisation, motivation and work satisfaction were factors determining whether older workers want to extend working life. Health, personal economic incentives, family/leisure pursuits and attitude to pension in society affected both whether people believed they can and wanted to extend their working life. In their final retirement decision, older workers considered: i) their possibility to balance and adapt functional ageing and health to a sustainable work situation; ii) their economic situation; iii) possibilities for social inclusion and coherence; and iv) possibilities for meaningful activities. Whether these requirements were best fulfilled in or outside working life determined the decision to continue working or to retire. Conclusion: If it is desirable for society that people will to extend their working life, both the “can work” and the “want to work” factors need to be met. It is important to provide a good fit inside working life. This requires a focus not only on older workers, but also on organisations and managers in order to provide incentives that keep older workers in the work force.
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| 2. |
- Petersson, Jesper, 1974
(författare)
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Geographies of eHealth: Studies of Healthcare at a Distance
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis examines the proliferation of healthcare services using information and communication technology to overcome spatial and temporal obstacles. These services are given such names as telemedicine and telecare, which are sometimes grouped together as telehealthcare under the umbrella term eHealth. My main argument is that a prevalent and overoptimistic rhetoric of how the possibilities of digitalization are expected to produce a homogenous and ubiquitous healthcare space conceals many of the spatiotemporal complexities involved in introducing telehealthcare and in the overall organizing of healthcare. To counteract such simplifications, I contend that we need a relational understanding of the technical and the geographical as always nested in the social and vice versa. With such an approach, it is arguably possible to begin to tease apart the many spatiotemporal entanglements of these innovations and to trace their political ramifications. This position is developed by integrating perspectives from science and technology studies with insights from human geography. The four constituent papers of this thesis pursue this argument in qualitatively grounded case studies of telehealthcare and its geographies. Paper I looks at various initiatives for fetal tele-ultrasonography, demonstrating that this practice cannot be reduced to a mere transparent relay for the speedy transmission of digital information across space and time. The paper investigates how its introduction could affect medical knowledge production, power hierarchies, and subject positions, for example, the status attributed to the fetal figure. Paper II traces Swedish transformations of telehealthcare. The use of telemedicine to reach those outside medicine’s range has arguably been accompanied by efforts to achieve intra-organizational streamlining via telemedicine. This process has continued with the emergence of telecare for personal use directed toward the overlapping groups of the elderly people and patients with chronic conditions. I contend that this shift can be understood through a geographical lens as attempts to save space and time by keeping as many patients as possible out of costly hospitalization and preventing them from engaging scarce specialist resources. Paper III compares four telemedicine projects in Sweden. In detailing how the purpose of practicing telemedicine differed between these projects in relation to, for example, the specifics of distance, care availability, and treated medical conditions, the paper demonstrates the existence of many versions of telemedicine. Whereas this fluidity could further the spread of telemedicine, it could also cause problems. To various actors wanting to use telemedicine in a homogenous and fixed way for national streamlining purposes, this diversity has generated confusion when they wished to align telemedicine in a preferred direction. The paper concludes that technology travels best when it can contain both fluid and fixed relationships. Paper IV argues that, whatever is claimed about creating a space- and time-independent healthcare by means of telehealthcare, the use of telecare to connect the standardized spaces of healthcare with the fluid everyday lives of elderly people and patients with chronic conditions actually works by unfolding new spaces of visibilities and establishing new temporalities as well. By investigating these spatiotemporalities, I demonstrate how these applications draw together discourses on individual freedom with medically derived algorithms and concerns about how to make best use of scarce healthcare resources.
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| 3. |
- Talantsev, Anton, 1983-
(författare)
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Handling severe uncertainty in strategic project appraisal : Methods and applications of context analysis
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The long-term success or failure of a strategic project is largely shaped by its context. Therefore, the assessment of the external factors influencing the fulfilment of project long-term goals is vital for the effective project appraisal and planning.However, many projects are embedded in a complex, dynamic, and multi-stakeholder environment creating a condition of severe uncertainty. These aspects make both the assessment of a project context and the prediction of the outcomes challenging. In the face of these challenges, the overall aim of this thesis is to propose both conceptual thinking and practical approaches for the project context analysis.To this end, the presented work has adopted a design science research and formal approaches from the fields of systems analysis, risk assessment and decision sciences, to systematically understand the problems of the context analysis, and to develop and evaluate the solutions. This thesis presents novel methods for assessing project context, which have been implemented in the following decision support tools:• a tool for strategic fit assessment,• a tool for context factor analysis,• a tool for corporate reputation risk assessment,• a toolkit for stakeholder-based impact assessment of a policy,• a toolkit for assessing intervention strategies in pandemics.The proposed methods have been applied and evaluated in case-studies within various domains, such as business strategy, development aid, energy policy, and public healthcare. These studies have demonstrated the adequacy and usefulness of the proposed methods for supporting decision making in situations with varying levels of uncertainty. This indicates the potential of the methods to improve the effectiveness of the project appraisal practice.This research has concluded that a project context is a multi-faceted concept, and, thus, no single method is capable of the comprehensive assessment. Instead, an assembly of specialised but complementary approaches is required to adequately model and assess both the various aspects of the context and the uncertainties of different types.
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| 4. |
- Jing, Yujia, 1985
(författare)
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Hyperthermia-responsive liposomal systems
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Abstract Sophisticated liposomal systems are emerging at an increasing rate to meet the demands for multifunctional drug carriers in chemotherapies in combined with hyperthermia. For example, liposomal drug carriers for temperature-controlled drug release under hyperthermic conditions have recently been tested in clinical trials. More advanced designs of liposomes are expected to release encapsulated contents and activate hidden surface-functions in response to heat stimulus. Towards this aim, the present thesis is focused on formulating asymmetric lipid systems that can preserve functional moieties, and reactivate the targeted function as well as release the encapsulated compounds upon local heating. The design of the asymmetric liposomal systems utilizes the heat-activated transmembrane lipid diffusion during gel to liquid-crystalline phase transitions of the lipid membranes.Rational design of advanced liposomal drug-delivery systems will require understanding of the physicochemical properties of lipid membranes under, e.g., hyperthermic conditions. Here, supported lipid membranes on planar solid surfaces were used for model studies of lipid composition yielding a gel to liquid crystalline phase-transition temperature in the range 40 – 45 °C. It was found that the liposome-to-membrane formation process is not only size-dependent but also governed by temperature. Two methods of preparing supported asymmetric lipid membranes were investigated. As a proof-of-concept, the upper leaflets were either replaced or chemically transformed by enzymatic hydrolysis. The processes were monitored using surface sensitive techniques such as quartz crystal microbalance with dissipation (QCM-D) and dual polarization interferometry (DPI). The asymmetric structures were stable at a room temperature, while lipid flip-flop was induced upon increasing of the temperature. Transmembrane lipid exchange in the asymmetric structure under hyperthermic conditions was demonstrated by detecting, through streptavidin binding, biotinylated lipids appearing at the top leaflet which were first located in the lower leaflet. The protocols developed for the supported lipid systems were adapted for the preparation of asymmetric liposomes. Biotinylated asymmetric liposomes were used as a model system to demonstrate the principle of heat-activated targeting of asymmetric liposomes to streptavidin-coated surfaces. More biologically relevant interaction was utilized to replace the biotin-streptavidin function, where asymmetric cationic liposomes were binding to anionic supported membrane immobilized surfaces upon heating. The described strategies for assembly of asymmetric supported membranes provide a guide to the development of multifunctional drug carriers. The protocols used in experiments with supported membranes were readily adapted to the preparation of asymmetric liposomes. The ongoing study tests the asymmetric liposomes in vitro, which is designed to demonstrate hyperthermia treatment can enhance accumulation of liposomes in FaDu cells, and at the same time activate release of the encapsulated components. The results of in vitro tests can be used to analyze the feasibility of utilizing the asymmetric liposomes as a platform in vivo to explore further improvement in their functions upon microwave hyperthermia.
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| 5. |
- Nordlöf, Hasse
(författare)
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Prerequisites and Possibilities for Manufacturing Companies to Prioritize and Manage Occupational Health and Safety
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Legislation demands that health and safety of humans at work must be secured. Today, far from every company has a functioning systematic management of occupational health and safety (OHS) in place to fulfill its legal obligations. Instead, other day-to-day tasks appear to have greater priority.The overall aim of this thesis was to investigate prerequisites and possibilities for manufacturing companies to prioritize and manage OHS, with focus on professional roles, company size, safety culture, and financial performance.Four papers (I–IV) are included in this thesis, based on three data collections. A questionnaire measuring the priority accorded to work environment was completed by 249 representatives of 142 manufacturing companies (I & II). Focus group interviews were conducted with 66 workers at a large steel-manufacturing company, discussing their experiences and perceptions of safety and risks at work (III). A questionnaire measuring OHS management practices, safety culture, and priority given to work environment was completed by 280 representatives of 197 manufacturing companies (IV). Information regarding the companies’ financial performance was retrieved from a credit bureau database.The main findings of the four papers demonstrated that profitability was considered as the most prioritized interest in the companies (I), and that trade-offs between productivity and safety is an obstacle to working safely (III). Managers generally perceived their companies to prioritize work environment factors more than the safety delegates did (I & IV). Perceptions of work environment priority did, however, not differ depending on company size (II & IV). Responsibility for safety was perceived to rest on the individual to the largest extent, and risk-taking was believed to originate from a combination of individual factors and external circumstances in the work environment (III). Larger company size, positive safety culture, and low risk in creditworthiness were found to be associated with better OHS management practices in companies (IV). Correspondingly, smaller company size, negative safety culture, and high risk in creditworthiness were found to be associated with worse OHS management practices.In summary, structural, social, and financial aspects seem to be important in companies’ possibilities for prioritizing and managing OHS. Recommendations for industry and future research are discussed.
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| 6. |
- Liu, Yuanhua, 1971
(författare)
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Usability Evaluation of Medical Technology: Investigating the Effect of User Background and Users' Expertise
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Medical devices play a major role in diagnosis and therapeutics in the healthcare systems. The basic features of medical devices concern safety and efficient clinical performance. Nowadays, usability evaluation is an important part of the design process of medical devices. The aims of this thesis work were to investigate the effect of user profiles on usability evaluation results and to provide practical advice on choice of users as test subjects when conducting usability evaluations of medical devices. Five studies, with analytical and empirical evaluation approaches with different foci, were included in the work. In the studies, consideration was given to user background and users’ expertise as well as to user interfaces of different levels of complexity. The user background aspect was taken as the focus for the analytical evaluation approach, while users’ expertise was taken as the focus for the empirical evaluation approach. Cognitive Walkthrough was employed as an example of an analytical evaluation method to investigate user background, while usability tests were used as an example of empirical evaluation method to investigate users’ expertise. The results showed that medical device user background settings can influence the outcome of an analytical evaluation results, i.e. when more ergonomic factors were included in the user background settings, a wider range of usability problems were detected. User expertise is an important factor for the results of empirical usability tests. Users’ familiarity with tasks can be used as an important criterion for classification of user expertise. The quantitative analysis of the empirical evaluations implies that the effect of users’ expertise may be invisible when interacting with a simple user interface, but visible when interacting with a more complex user interface. Expert users outperformed novice users when interacting with a complex interface but not when interacting with a simple interface.The qualitative analysis of verbal explanations and statements, causes of errors and redesign proposals stressed the differences between novice and expert users in terms of decision-making, presentation and judgment, which implied that expert users’ use experience and novice users’ interaction experience differ in contributing to product design and development. Insufficient domain and interaction knowledge were consistently identified as typical causes of errors for novice users. The differences of information organization between previously experienced user interfaces and the interfaces interacted in the usability tests affected expert users’ task completion. Expert users made task-related errors due to terminology issues and interaction-related errors due to their ‘old’ mental model of how to interact with the user interface. Based on the results, different strategies are suggested to be used when choosing test subjects for usability evaluations in different interaction situations. A guideline and some practical advices were proposed as well to medical industrial companies about how to conduct usability evaluations on medical devices.
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| 7. |
- Puthoopparambil, Soorej Jose, 1985-
(författare)
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Life in Immigration Detention Centers : An exploration of health of immigrant detainees in Sweden and three other EU member states
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Governments around the world use immigration detention to detain and deport irregular immigrants, which negatively affects their health. The aim of this thesis was to explore, describe and identify factors that could mitigate the effect of immigration detention on the health of detainees. This was a mixed method study using qualitative methods (Papers I and II), quantitative methods (Paper III) and descriptive case comparison (Paper IV) comparing the Swedish system to the system in the Benelux countries (Belgium, the Netherlands and Luxembourg). The study design was strengthened by triangulation of methods and data sources.Detainees experienced lack of control over their own lives due to lack of information in a language they can understand, inadequate responses from detention staff and restrictions within detention centers further limiting their liberty. Duration of detention was negatively associated with satisfaction of services provided in detention and the detainees’ Quality of Life (QOL). Detainees had low QOL domain scores with the psychological domain having the lowest score (41.9/100). The most significant factor positively associated with the QOL of detainees was the support received from detention staff. A sense of fear was present among detainees and staff. Detainees’ fear was due to their inadequate interaction with authorities, perceiving it as threatening, and due to their worry of facing repercussions of being involved in incidents caused by others. The potential for physical threat from detainees created a sense of fear among the staff. The detention staff expressed the need for more support to manage their emotional dilemma and role conflict of being a civil servant, simultaneously enabling the deportation process while providing humane care to detainees as fellow human beings. Detention centers in the Benelux countries had more categories of staff providing different services to detainees. Compared to the Benelux countries, healthcare services at the Swedish detention centers were limited. Detainees were offered no medical screening on arrival and no regular access to mental healthcare professionals.Detaining authorities have the obligation to safeguard the health of detainees. Challenges faced by the detention staff and detainees must be addressed to create a supportive environment and fulfill that obligation.
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| 8. |
- Nystrand, Camilla
(författare)
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The value of social investments : A health economic approach to evaluating parenting interventions
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Child mental health problems are current welfare challenges and may be costly to the individual, the family and society at large. The problems may persist and result in adverse outcomes later in life, which also carries a large financial burden. Parenting interventions are effective strategies to prevent or reduce mental health problems in children and are potentially cost-effective and even cost-saving. This thesis sets out to fill the knowledge gaps regarding the social investment case for parenting interventions in Sweden. Study I evaluated five indicated parenting interventions compared to a waitlist control. Long-term projections of health-related quality-of-life and cost-offsets related to the reduction of externalising behaviour problems in children were made using an economic decision simulation model. Study II assessed the financial impact of the five parenting interventions, considering the child´s lifetime earnings. Study III assessed whether it was worth the extra spending to provide cognitive behavioural therapy for children, in addition to a parenting program, for the treatment of oppositional defiant disorder in children. A net benefit regression framework was employed to assess the willingness-to-pay needed for the intervention to become cost-effective. Study IV was a trial-based evaluation of a selective intervention delivered to Somali-born parents, valuing the health and economic impact on parents and children simultaneously, compared to a waitlist control. The evaluation merged impacts on parents and children to describe potential scenarios for cost-effectiveness. To provide an overview of the current evidence, Study V systematically reviewed the literature on the cost-effectiveness of parenting interventions, focusing on child outcomes. Results showed that the five indicated parenting interventions were highly cost-effective, and may yield substantial economic returns. Delivery of a parenting intervention in addition to an intervention for children yielded clinically relevant improvements but came at a cost exceeding estimates for the societal cost of children with oppositional defiant disorder. The delivery of a selective intervention generated significantly improved health outcomes, but cost-effectiveness depended on the willingness-to-pay, especially considering multiple effects concurrently. The systematic literature review suggested that parenting interventions were likely to be a cost-effective use of resources, particularly for the prevention of externalising and internalising problems. The findings suggest that parenting interventions may be a cost-effective approach for the prevention and treatment of child mental health problems, especially for externalising problems.
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| 9. |
- Sylwander, Charlotte, 1992-
(författare)
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Multiple perspectives on health promotion in individuals with knee pain
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Chronic musculoskeletal pain impacts the individual in multiple aspects of life (biological, psychological, and social). Individuals with knee pain have a higher risk of developingchronic widespread pain and knee osteoarthritis, compared to the general population, and the prevalence of chronic pain is estimated to rise. As a result, there is a global call for more health-promotive research in chronic pain. Hence, this thesis aimed to investigate multiple perspectives on health promotion by studying early factors associated with chronic pain and pain development as well as experiences of health-promoting activities and health literacy in individuals with knee pain. The studies are part of the Halland osteoarthritis (HALLOA) cohort, where 306 individuals with knee pain aged 30-65 years were included. Study I was a cross-sectional descriptive study (n=280), which aimed to investigate pain sensitivity and associations with radiographic knee osteoarthritis, chronic widespread pain, and overweight/obesity. Pain sensitivity was measured with pressure pain thresholds, and overweight was assessed using body mass index, visceral fat area and body fat percentage. Study II was a longitudinal study (n=251), aiming to examine whether or not health status and lifestyle habits have an impact on reporting chronic pain after two years. Lifestyle-related habits were overweight, physical activity, diet, alcohol intake, and tobacco use. Study III was an explorative qualitative study including 22 semi-structured interviews. The study aimed to explore health-promotive activities and was analysed with qualitative content analysis. Study IV had a convergent parallel mixed-methods design (n=221), including 19 interviews, and aimed to understand health literacy among individuals with knee pain. Quantitative variables were health literacy, health status, lifestyle habits, and pain distribution. The findings showed that higher pain sensitivity was associated with being female, having more pain sites, chronic widespread pain, higher body fat and visceral fat area (study I). Additionally, overweight/obesity and lower health status were associated with reporting chronic widespread pain after two years. Conversely, being normal-weighted and reporting better health status was associated with no chronic pain (study II). Striving for balance in everyday life was important to experiencing health among individuals with knee pain, and it was achieved by taking care of the body and managing life stressors (study III). Many reported sufficient health literacy, which was also associated with reporting better general health and less pain. How individuals found or received information, processed it, and took a stand based on trust and motivation, affected their decision-making processes (study IV). This thesis concludes that overweight/obesity and lower health status play an essential role in chronic pain. Health literacy and the everyday life of an individual are important when it comes to health promotion; and it is vital to consider what individuals with knee pain need in a given situation in order to prevent chronic pain.
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| 10. |
- Gisslevik, Emmalee, 1984
(författare)
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Education for sustainable food consumption in home and consumer studies : Lärande för hållbar matkonsumtion i hem- och konsumentkunskap
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Education as a means to enable sustainable food consumption has gained increasing recognition as a vital means to decrease current burdens upon both natural resources and human health. In response, the Swedish compulsory school subject of home and consumer studies, which positions education about food as core content, has been revised to incorporate in its national syllabus a perspective of sustainable development since 2011. However, because sustainable development remains an ambiguous, contested concept with a range of definitions and interpretations, it is necessary to gain better understanding of what incorporating its perspective can entail in home and consumer studies, particularly regarding the core food-related content knowledge that it teaches. Building upon four papers, this thesis reports research guided by an interpretive and exploratory approach that involved analysing data from syllabuses, observations, recordings of in-class lessons and interviews with practising teachers. The results reveal two ways of understanding what incorporating a perspective of sustainable development can entail in home and consumer studies in Sweden. The first understanding proposes an enriched and unified practice in which the curriculum prioritises embodied forms of knowledge about healthy, ethical and resource-efficient food consumption by allowing a multi-relational, systems thinking approach while focusing a homemade meal practice. By contrast, the second understanding proposes a practice riddled with inconsistencies and contradictions in providing teaching and learning opportunities to attain the intended goals. This ultimately results in fragmented learning opportunities focused more on informed reasoning than on informed actions. Taken together, both understandings pose theoretical, conceptual and practical implications, both for home and consumer studies in particular and in education for sustainable food consumption in general.
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