| 1. |
- Ahlström, Monica, et al.
(författare)
-
Ett praktiskt försök : nationell prioriteringsmodell tillämpad i Landstinget i Kalmar Län
- 2008
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Idag finns en nationell modell för hur öppna vertikala prioriteringar kan genomföras. Den är resultatet av de samlade erfarenheterna av att omsätta riksdagens riktlinjer för prioriteringar i praktiskt prioriteringsarbete. Modellen är framtagen av Socialstyrelsen, PrioriteringsCentrum samt flera vårdförbund och landsting gemensamt. Också FSA och LSR har ställt sig bakom den. Fram tills nu har det dock saknats praktisk erfarenhet av att tillämpa modellen inom arbetsterapi och sjukgymnastik. Men sedan drygt två år tillbaka har de båda rehabiliteringsenheterna Samrehab och Rehab Söder i Landstinget i Kalmar län med stöd av PrioriteringsCentrum bedrivit ett prioriteringsarbete i enlighet med modellen. Det är deras erfarenheter denna rapport handlar om.Prioriteringsarbetet har med nära stöd av verksamhetsledningarna letts av en projektgrupp bestående av arbetsterapeuter och sjukgymnaster från de båda enheterna som fungerat som handledare, ansvarat för metodutveckling och utbildning samt kontinuerligt utvärderat arbetet. Själva tillämpningen av den nationella modellen har ett antal utvecklingsgrupper inom olika specialistområden stått för. De har valt ut och rangordnat tillstånd och olika åtgärder som de ansett angelägna att ta fram prioriteringar för.Ett av syftena med prioriteringsarbetet i Samrehab och Rehab Söder var att få till stånd länsövergripande prioriteringar inom vissa verksamheter och/eller för vissa sjukdomstillstånd för en mer likvärdig vård. Idag finns elva sådana prioriteringsordningar presenterade på landstingets intranät och ytterligare ett tiotal är under bearbetning. Utöver vinsterna med det förbättrade samarbetet mellan länsdelarna har alltså den interna öppenheten i prioriteringarna ökat. Alla anställda kan lätt få fram prioriteringsordningarna via basenheternas hemsidor när man behöver det. Andra vinster av prioriteringsarbetet är att kännedomen och kunskapen om riksdagens riktlinjer för prioriteringar har ökat, att en större del av basenheternas verksamhet idag är faktabaserad än innan prioriteringsarbetet startade samt att den kliniska erfarenheten har tillvaratagits och dokumenterats på ett mer systematiskt sätt än tidigare. Det har dessutom skett en utveckling av den nationella modellen som har blivit mer konkret vad det gäller svårighetsgrad och nytta. En majoritet av deltagarna i utvecklingsgrupperna har haft en positiv inställning till att arbeta med prioriteringar utifrån modellen och upplever också att de erhållit ett språk som gör det möjligt att kommunicera prioriteringar med politiker och landstingsledning.I rapporten presenteras också de frågor kring modellens olika steg som dykt upp under arbetets gång. Tre frågor har dominerat; syftet med prioriteringsarbetet, tolkningen av modellen samt dokumentationen av prioriteringsarbetet. Syftet har inte alltid upplevts som helt klart och sambandet mellan prioriteringsarbetet och annat kvalitetsarbete som t ex framtagande av behandlingsriktlinjer har varit otydligt. När det gäller tolkningen av modellen har t ex graderingen av svårighetsgrad och patientnytta gett upphov till frustration. Också den skriftliga presentationen av prioriteringsordningarna har stundtals upplevts som krånglig och svår att förmedla till övriga medarbetare på ett användbart sätt.Alla de åtgärder som projektgruppen vidtagit för att underlätta de svårigheter som dykt upp delar de här med sig av i rapporten. Likaså pekar de ut viktiga förutsättningar för ett prioriteringsarbete (som t ex tid, kompetens, kontinuitet och legitima deltagare). Syftet med att pröva om den nationella modellen för öppna vertikala prioriteringar är användbar i Samrehabs och Rehab Söders prioriteringsarbete är uppnådd och det har inte framkommit något som ger anledning att ifrågasätta modellens grundstruktur. Förslag har dock givits bl a avseende bedömning av svårighetsgrad och patientnytta för att ytterligare underlätta tillämpningen.Nu planerar enheterna att gå vidare med sitt prioriteringsarbete, dels genom att fortsätta att ta fram behandlingsriktlinjer som kombineras med prioriteringar men också genom att ytterligare utveckla prioriteringsstödet för de enskilda medarbetarna i deras dagliga patientarbete. Om andra verksamheter i Sverige följer efter detta exempel från Kalmar län med att öppet redovisa hur de hanterar prioriteringar i sin verksamhet kommer ytterligare nya erfarenheter att hjälpa metodutvecklingen på traven.
|
|
| 2. |
- Bejnö, Hampus, 1984-
(författare)
-
Early intervention and autism : Improving preschool program quality for children with autism spectrum disorder receiving Early Intensive Behavioral Intervention using the Autism Program Environment Rating Scale (APERS)
- 2021
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The quality of the learning environment in preschool is of significant importance for children with autism spectrum disorder (ASD). However, very limited research has addressed how this environment can be improved. In regard to early intervention, most previous studies have primarily focused on child characteristics, and intervention content and quantity, rather than the broader learning environment in which interventions are delivered. Thus, the overall aim of this thesis was to study the quality of the learning environment for children with ASD. In particular, the focus was on children who receive Early Intensive Behavioral Intervention (EIBI) in community-based Swedish preschools, using the Autism Program Environment Rating Scale (APERS). Within this framework, three studies were conducted.In study 1, we translated, culturally adapted, and systematically assessed the content validity of APERS, a rating scale designed to assess the program quality for children with ASD in educational settings. In the process, the scale was modified to make the instrument as relevant as possible for the Swedish preschool context, and re-named APERS-P-SE. Nine experts rated the clarity and comprehensiveness of the individual items, as well as the relevance of the scale in its entirety. In study 2, we evaluated APERS-P-SE as the foundation for professional development for preschool staff working with children with ASD receiving EIBI, to promote preschool learning environment quality (primary outcome), and outcomes for autistic children, and preschool staff (secondary outcomes). Using a quasi-experimental design, preschool staff either implemented EIBI enriched by in-service training and on-site coaching based on APERS-P-SE assessments (k = 9), or EIBI only (k = 8) during 8 months. A total of 17 children and 35 preschool staff participated, across 17 preschools. In study 3, individual interviews and focus-group interviews were conducted with preschool staff, preschool principals, habilitation supervisors, and parents to children with ASD who had participated in study 2 and received the APERS-P-SE-based intervention. Through these interviews, the different groups of stakeholders provided their thoughts about what they found to be the most important aspects of preschool programs for autistic children who receive EIBI, and their opinions and experiences of participating in study 2. Study 1 demonstrated a high level of content validity for the Swedish version of the APERS. In study 2, the EIBI/APERS-P-SE preschools significantly improved their learning environment, compared to the preschools that received EIBI only. Outcomes for autistic children and preschool staff did not differ significantly between the groups, despite positive descriptive findings. In study 3, four themes were identified as being key aspects of preschool programs with high quality to promote optimal development of children with ASD: (1) staff’s competence, (2) children’s inclusion and participation, (3) collaboration, and (4) learning environment. Overall, the stakeholders described the APERS-P-SE-based model as helpful in improving children’s participation, preschool staff’s engagement with the child, and optimizing child outcomes.Taken together, the results indicate that APERS-P-SE is an instrument with a high level of content validity, and that it can be used in combination with in-service training and on-site coaching to improve preschool program quality for children with ASD.
|
|
| 3. |
- Bergström, Ulrica, 1970-
(författare)
-
Fragility fractures in fragile people : epidemiology of the age quake
- 2009
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Osteoporosis-related fracture is already today a major public health problem and the number of hip fractures is expected to double to 2030. Sweden has one of the highest hip fracture incidences worldwide. This may be explained by several factors: e.g. age, genetic, climatologic, geographic and a relative vitamin D deficiency, secondary to the limited sunlight exposure especially during winter months. Intrinsic and extrinsic factors contribute to a fracture, although a prior low energy fracture is one of the strongest predictors for a subsequent one and this should be a target for secondary fracture prevention in an orthopaedic setting. Since 1993 all injured patients admitted to the emergency floor and all in-hospital fractures at Umeå University Hospital, Sweden, were registered according to the Injury Data Base, former EHLASS. There were 31,173 fracture events (one or more fractures at the same time), of which 13,931 were in patients’ ≥ 50 years old. The fracture database was co analyzed with the Northern Sweden Health and Disease Study cohort in a nested case-control study for investigations of associations between osteoporotic fracture and serum markers, lifestyle data, nutrition etc. We found that there were differences in fracture pattern depending on age and sex. Both injury mechanism and fracture site were strongly dependent of age. The most severe fragility fracture, hip fracture, had a decreasing incidence. However, the incidence curve was right-shifting leading to an increase, both in numbers and in incidence of hip fractures among the oldest female. To identify people at high risk for fractures, re-fracture patients are useful. No less than 21% of the fracture patients had suffered more than one fracture event, accounting for 38% of all fracture events. The total risk ratio for a subsequent fracture was 2.2 (2.1-2.3 95% CI). In males the highest risk for re fracture was in the age cohort 70-79 years (RR 2.7, 2.3-3.2 95% CI), in females > 90 years (RR 3.9, 3.2-4.8 95% CI). Another possible risk factor in this subarctic population is the lack of sunlight, leading to a vitamin D deficit. The overall adjusted risk of sustaining a hip fracture in this population was 2.7 (95%CI:1.3-5.4) in subjects with a serum 25 hydroxyvitamin D below 50 nmol/l. The association was, however, different according to age at baseline. Thus in subjects aged 60 years and above at baseline, the adjusted odds ratio of sustaining a hip fracture was 6.2 (1.2-32.5 95%CI) for the group of individuals with a serum 25OHD below 50 nmol/l, whereas no significant association was found in the youngest age group. In the next 30 years the ongoing demographic changes will accelerate. The World War II baby boomers will cause an age quake. We can already see signs heralding a new fracture pattern: an increasing cohort of mobile but fragile elderly, with considerable co-morbidity is now at risk for fragility fractures. In fracture patients, clinical information is sufficient to pinpoint patients with a high risk for re-fractures. It is therefore clinically important to use the information provided by the fracture event. We suggest that trauma units and primary care units should screen for risk factors and inform patients about the treatment options, and to organize fracture liaison services. This seems to be especially cost-efficient for our oldest and frailest patients. Secondary prophylaxis and follow-up treatment after cardiovascular disorders are now a matter of course worldwide, but the screening for risk factors, in order to prevent a second fracture, is often neglected. This is one of the most important issues of fracture care in the future in order to improve general health.
|
|
| 4. |
- Blomberg, Anders, 1956, et al.
(författare)
-
Establishing the barnacle Balanus improvisus as a potent invertebrate monitoring system in marine ecotoxicogenomics
- 2009
-
Ingår i: SETAC Europe 19th Annual Meeting Abstract Book, Göteborg 31 May - 4 June, 2009.
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- There is a need for potent invertebrate systems for assessing the impacts of environmental contaminants on marine ecosystems. Balanus improvisus, a marine athropod, has a number of promising characteristics that make it a good candidate in such efforts. We have conducted sequencing of a cDNA library from the cyprid larval stage and identified several detoxification systems as well as novel B. improvisus specific genes. To investigate the toxicological gene expression response in this organism, we performed a short-term exposure experiment of the cyprid larvae to two different biofouling substances. From a natural population of B. improvisus, 300 - 1000 cyprids were treated for 23 hours with 390nM CuO or with two different concentrations (10nM or 10μM) of meditomidine. Protein expression changes were studied by 2D-PAGE analysis after DIGE labelling. For gene expression analysis by DNA miroarrays total RNA was extracted and used for cDNA and cRNA/aRNA templates. Roughly 2000 B. improvisus genes were studied represented by 3000 different probes on the arrays (each in duplicates). Candidate genes were confirmed by qPCR. A number of protein expression changes were detected on the 2D gels as a result of the different treatments. Interestingly, the response to the different treatments clearly formed distinct groups in principle component analysis. The DNA microarray analysis revealed several genes as toxicity indicators, e.g. various heat shock proteins, some proteases and factors involved in regulatory processes (transcription factors). Our data indicate that B. improvisus may serve as a tool to evaluate the impacts of marine pollution, and thus to fill the niche as an important invertebrate marine model organism for ecotoxicology and environmental genomics.
|
|
| 5. |
- Eckersten, Sofia, 1989-
(författare)
-
New perspectives on Strategic Choice of Measures in Swedish Transport Planning
- 2022
-
Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Rapid changes in the global climate and declining biodiversity pronounces the need for adapting the transport system and transport infrastructure, which influence several sustainability issues and cause direct environmental impact through their use of land, as well as indirect impacts, for example, emissions of pollutants to air and water. The Swedish Transport Administration (STA) is responsible for and conducts a large part of the transport planning in Sweden and the STA endeavor to increase collaboration with other societal actors in transport planning. In 2013, the Strategic Choice of Measure (SCM) process was introduced by the STA to facilitate collaboration among multiple societal actors in the early stages of transport planning. In the SCM process many of the choices are made that will affect the development of the transport system as well as the future transport system's impact on the environment. Integrating environmental aspects at an early planning stage, such as in the SCM process, can help reduce and avoid the environmental impact of the transport system. Therefore, this licentiate thesis aims to explore the consideration of environmental aspects in the SCM process (Paper 1), and to analyze the SCM process from a systems perspective in order to illuminate the consequences of system boundaries on how environmental aspects are considered and what aspects are included or left out (Paper 2). In addition, proposals are being developed to strengthen practice (Papers 1 and 2).To achieve the aims of the thesis, interview studies, document studies and observational studies have been performed. Also, a case study of two SCM processes was conducted. This dissertation shows that there are several challenges associated with the consideration of environmental aspects in SCM processes. For example, the increased element of collaboration in the planning process implies that the coordination of the process will affect which environmental aspects are considered and in what way. Furthermore, land-use and transport planning are coordinated in the SCM process, which often leads to conflicting ideas about how an area should be developed. By finding solutions to transport and land-use related problems with synergetic effects, conflicts may be solved, and transport, land-use and environmental needs may be met simultaneously. To identify this type of measure and packages of measures in an SCM process, tools that enable the identification of links between transport, land-use and environmental aspects can be used as support.
|
|
| 6. |
- Englund, Undis, 1957-
(författare)
-
Physical activity, bone density, and fragility fractures in women
- 2009
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Scandinavia has among the highest incidence of fragility fractures in the world. The reasons for this are unknown, but might involve differences in genetic and/or environmental factors, such as sunlight exposure and levels of physical activity. Weight-bearing exercise is thought to have a beneficial effect on bone health in the young, but few studies have evaluated whether exercise in older subjects affects bone density and protects against fragility fractures. The initial objective of this thesis was to evaluate whether a combined weight-bearing training programme twice a week would be beneficial as regards bone mineral density (BMD) and neuromuscular function in older women. Forty-eight community living women with a mean age of 73 years were recruited for this 12-month prospective, randomised controlled trial, and were randomly assigned to an intervention group (n=24) or a control group (n=24). The intervention group displayed significant increments in BMD at the Ward’s triangle, maximum walking speed, and isometric grip strength compared to the control group. The second objective was to investigate if training effects were retained in older women five years after the cessation of training. The 40 women who completed the first study included in this thesis were invited to take part in a follow-up assessment five years later, and 34 women (~79 years) agreed to participate. During these five years both groups had sustained significant losses in hip BMD and in all neuromuscular function tests, and the previous exercise-induced intergroup differences were no longer seen. The third and fourth objective of this thesis was to investigate whether exercise and weight-bearing leisure activities in middle-aged women are associated with a decreased risk of sustaining hip or wrist fractures at a later stage. A cohort of women participating in the Umeå Fracture and Osteoporosis (UFO) study, a longitudinal, nested case-control study investigating associations between bone markers, lifestyle, and osteoporotic fractures, was used for the purpose of this investigation. Eighty-one hip fracture cases and 376 wrist fracture cases, which had reported lifestyle data before they sustained their fracture, were identified. These cases were compared with age-matched controls identified from the same cohort. Using conditional logistic regression analysis with adjustments for height, BMI, smoking, and menopausal status, results showed that moderate frequency of leisure physical activities such as gardening and berry/mushroom picking, were associated with reduced hip fracture risk (OR 0.28; 95% CI 0.12 – 0.67), whereas active commuting (especially walking) along with dancing and snow shoveling in leisure time, reduced the wrist fracture risk (OR 0.48; 95% CI 0.27 – 0.88, OR 0.42; 95% CI 0.22 – 0.80 and OR 0.50; 95% CI 0.32 – 0.79 respectively). In summary, this thesis suggests that weight-bearing physical activity is beneficial for BMD and neuromuscular functions such as muscle strength and gait in older women, and that a physically active lifestyle, with outdoor activities, in middle age is associated with reduced risk of both hip and wrist fractures. Possible mechanisms underlying this association include improved muscle strength, coordination, and balance, resulting in a decreased risk of falling and perhaps also direct skeletal benefits.
|
|
| 7. |
- Florin, Ulrika, 1964-
(författare)
-
Från idé till gestaltningsförslag : fallstudie från Projekt Konstpaus
- 2010
-
Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Populär sammanfattning I vårt samhälle finns många offentliga konstverk. Dessa verk har kommit till på olika sätt men gemensamt är att konstverken i de allra flesta fall upphandlats med utgångspunkt i någon form av skiss. Skissen föregår det kommande konstverket och tjänar som underlag för beslut om upphandling av verket i full skala. Kunskapen om hur skisser kan tydas varierar och dessutom förekommer flera typer av skisser som var för sig fordrar olika sorters insikter av betraktaren (beslutsfattaren) för att kunna tolkas. Det övergripande temat för avhandlingen är kommunikationsprocesserna i relation till utvecklingen av 12 konstnärers gestaltningsförslag, tävlingsbidrag, samt hur juryns bedömning av dessa ser ut. Studien är baserad på material insamlat från de deltagande konstnärernas processer i Projekt Konstpaus, ett projekt delfinansierat av EU. Syftet med studien är att öka förståelsen för hur konstnärer utformar sina gestaltningsförslag, samt hur dessa förslag används och värderas. För att göra detta har tävlingsbidragen analyserats och konstnärerna intervjuats. Konstnärliga gestaltningsprocesser har synliggjorts liksom kommunikationen mellan beställare och konstnär.Bland annat har det framkommit att det finns en större potential att förmedla ett komplext gestaltningsinnehåll till en jury med stöd av digitala skisser, än vid användande av traditionella skisser. Det har visat sig att det kommande konstverkets kvaliteter blir synliga, men också att de brister som finns i gestaltningen tydliggörs i 3D- skisserna. Liksom teknologier tidigare i historien haft sin påverkan på bildutvecklingen, tolkningen och seendet har också övergången till digitala skisstekniker denna inverkan. Det har också visat sig att den text som tillhör respektive tävlingsbidrag haft avgörande betydelse för utfallet av jurybedömningen. Muntliga och skriftliga presentationer, bilagor och brev har påverkat juryn i sina beslut.Studien har också visat hur konstnärer kan tolka och förmedla resultat av en inventering och genom sina skisser förmedla dessa tolkningar. Konsten som tolkare av miljö, tid och tanke, kan gestalta information om en plats och i och med detta också fungera värnande för ett samhälles identitet i olika faser av en utveckling.Studien har bidragit med en djupare inblick i konstnärliga gestaltningsprocesser och hur de kan beskrivas samt i och med detta också en fördjupad förståelse i allmänhet av kreativa processer.
|
|
| 8. |
- Hampus, Bejnö, et al.
(författare)
-
Cross-Cultural Content Validity of the Autism Program Environment Rating Scale in Sweden
- 2019
-
Ingår i: 12th Autism-Europe International Congress – September 13-15th 2019. ; , s. 94-95
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Increased diagnoses rates of autism and earlier identification pose new challenges to preschools and services delivering early intervention to children on the spectrum. A prerequisite for successful implementation of support is a high quality preschool learning environment. Here, we briefly describe the process of translating, culturally adapting and validating the contents of the Autism Program Environment Rating scale (APERS), originally designed for assessing the quality of the learning environment for children and adolescents with autism in the USA, to a European language and educational context.Methods: In an authorized step-wise procedure, the 59 item scale was translated by a PhD level clinician fluent in English with expertise in autism and psychometrics. Subsequently, following internal feedback from the research team, adaptions addressing translation and cultural adaption of the scale were made. Then, five Swedish external preschool and early intervention experts were invited to provide feedback on the cultural appropriateness of the adapted scale. Lastly, nine additional independent external experts within the field of autism, preschool and early intervention were invited to rate the content validity of the adapted scale. Relevance of subdomains and domains was assessed as well as clarity and comprehensiveness for all of the scale’s items. Experts also rated the practical relevance, need, usefulness, and feasibility of the scale as a whole, and provided anecdotal formative feedback.Results: All items, subdomains, and domains of the scale were estimated by the raters as showing sufficient content validity (Content validity index ≥,.79). Several Swedish experts highlighted the need for such a scale, and the usefulness of the scale as a means to assess and then support preschool staff to improve learning environment for children with autism. However, some concerns were raised about the comprehensiveness of the scale and the challenges preschools will meet in improving their learning environment. Discussion There seems to be a need for a rating scale to assess and improve the learning environment for children with autism in preschool settings. Although the usefulness and content validity of the translated and adapted scale was established, little is still known about other psychometric properties of the scale, and more work needs to be done to assess its usefulness as a tool for systematic improvement of preschool program quality.
|
|
| 9. |
- Muhrman, Karolina, 1976-, et al.
(författare)
-
Lärarstudenters övergång från lärarutbildning till arbete som lärare i skolan
- 2022
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Denna rapport handlar om övergången från lärarutbildning till arbete som lärare i skolan. Rapporten bygger på intervjuer med tjugo relativt nyutexaminerade lärare och en enkät som besvarats av 87 skolledare. Resultaten visar att förväntningarna på de nya lärarnas kunskaper och förmåga att klara alla delar av yrket efter utbildningen är hög hos skolledarna. Samtidigt beskriver de nya lärarna att de upplever många utmaningar med läraryrket och att det finns ett behov av en mentor som kan ge stöd under det första året. De flesta nya lärare får en mentor, men i många fall får varken mentorn eller den nya läraren någon tid avsatt för att träffas. Detta kan leda till att de nya lärarna trots att de har en mentor inte får det stöd de har behov av. I svaren från informanterna framkommer både tankar om hur mottagandet av nya lärare skulle kunna bli bättre och hur lärarutbildningen skulle kunna utvecklas för att det ska bli en bättre övergång. Resultaten från dessa svar är grunden till de förslag på implikationer som avslutar rapporten.
|
|
| 10. |
- Mustamäki, Noora, et al.
(författare)
-
Fjällbacka, Västerhavet, 1989–2019; Torhamn, södra Egentliga Östersjön, 2002–2019; Kvädöfjärden, Egentliga Östersjön, 1981–2019; Holmöarna, Bottniska viken, 1989–2019
- 2020
-
Ingår i: Faktablad från integrerad kustfiskövervakning.
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Inom den nationella miljöövervakningen av kust och hav bedrivs årligen sedan slutet av 1980-talet ett program för integrerad kustfiskövervakning i fyra nationella referensområden, ett vardera i Bottniska viken, Egentliga Östersjön, södra Egentliga Östersjön och Västerhavet. Syftet med programmet är att kartlägga fiskbeståndens status samt fiskens hälsotillstånd och miljögiftsbelastning för att upptäcka förändringar som indikerar storskalig påverkan av miljöhot som eutrofiering, miljögifter, klimatförändringar och andra miljöfaktorer. Detta faktablad sammanfattar resultaten från den integrerade kustfiskövervakningen i alla fyra områden under tidsperioden 1980–2019.
|
|
