| 1. |
- Rigato, Cristina, 1989
(författare)
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Direct Drive Bone Conduction Stimulation: Experimental Studies on Functionality and Transmission with Focus on the Bone Conduction Implant
- 2017
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Sound is conducted to the inner ear in two ways: by air and by bone. Air conduction (AC) hearing consists of sound waves entering the ear canal and reaching the cochlea, the main hearing organ, via the middle ear. In bone conduction (BC) hearing, instead, the transmission is through soft tissues and bone. These two pathways coexist and complement each other, although innormal hearing subjects the AC part is prevalent over the BC part in most of the ordinary hearing situations.BC hearing can represent an effective way to rehabilitate hearing impaired patients who would not benet from conventional AC hearing aids. This is the case when the hearing impairment is located in the outer or middle ear, or if the patients have chronic infections or malformations preventing them from wearing earmolds. The key idea in bone conduction devices (BCDs) isto generate vibrations with a transducer and transmit them via the skull bone to the inner ear.At present, the most common BCD is probably the bone anchored hearing aid (BAHA), consisting of a single-unit device attached to a skin penetrating screw in the parietal bone. To overcome the issues related to the skin penetration, the development of BCDs is recently focusing on so-called active transcutaneous devices, whose main feature is to have the bone transducer implanted under intact skin.In this thesis, the novel active transcutaneous bone conduction implant (BCI), currently in advanced clinical trial phase, was compared to BAHAs in terms of audiological tests and perceived rehabilitation effect. The outcomes showed that the BCI can be a valid alternative to BAHAs for indicated patients. Preliminary investigations were also performed on how the transmission of vibrations is affected by different ways of attaching the transducer to the skull bone. It was found that the relation varies substantially with frequency, with a general trend of improved transmission when the contact area between transducer and bone is limited.Finally, a new verication method of the implant functionality was evaluated intra- and post- operatively. The method, consisting in the measurement of the sound pressure in the nostril, seems promising and the implant to bone transmission was found stable over time.
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| 2. |
- Persson, Urban, 1961-
(författare)
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Realise the Potential! : Cost Effective and Energy Efficient District Heating in European Urban Areas
- 2011
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The Member States of EU27 need to accelerate the integration of energy efficient technology solutions to reach the 20% energy efficiency target set for 2020. At current pace, projections indicate that only half of expected primary energy reductions will be reached. To meet the energy demands of growing populations and a vibrant economy, while simultaneously reducing primary energy supplies, the European continent faces a new kind of challenge never previously encountered. The identification and application of feasible, competitive, and comprehensive solutions to this problem are of highest priority if the remaining gap is to be closed in time. How is this multi-dimensional and complex dilemma to be dissolved? In this work, expanded use of district heating technology is conceived as a possible solution to substantially reduce future primary energy demands in Europe. By extended recovery and utilisation of vast volumes of currently disregarded excess heat from energy and industry sector fuel transformation processes, district heating systems and combined generation of heat and power can improve the general efficiency of the European energy balance. To investigate the possible range of this solution, this thesis introduces a set of methodologies, theoretical concepts, and model tools, by which a plausible future excess heat utilisation potential, by means of district heat deliveries to residential and service sectors, is estimated. At current conditions and compared to current levels, this potential correspond to a threefold expansion possibility for directly feasible district heating systems in European urban areas and a fourfold increase of European excess heat utilisation.
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| 3. |
- Söderquist, Fanny, 1985-
(författare)
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Melatonin and its receptors in the normal human gastrointestinal tract, pancreas and in small intestinal neuroendocrine tumours
- 2017
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Melatonin, “the hormone of darkness” is well known to regulate sleep and circadian rhythm. However, melatonin is also present in numerous peripheral tissues and the number of actions assigned to this neurohormone is growing steadily. Based on animal studies, it has been proposed that gastrointestinal melatonin is produced in enterochromaffin cells.The aims were to characterise the expression of melatonin and its receptors MT1 and MT2 in normal human gastrointestinal tract and pancreas as well as in tumours derived from enterochromaffin cells, small intestinal neuroendocrine tumours (SI-NET), using immunohistochemistry. Melatonin and receptor expression was furthermore compared to clinical symptoms, tumour prognostic factors and treatment response.In enterochromaffin cells from normal gastrointestinal tissue and in SI-NETs a strong immunoreactivity (IR) for melatonin and MT2 was found, while MT1 IR was low or absent. Melatonin, MT1 and MT2 IR was also seen in the large intestinal epithelium of normal gastrointestinal tract and in pancreatic islets, although the expression of MT1 in pancreatic tissue varied. Analyses of mRNA data confirmed the expression of the enzymes needed for melatonin synthesis as well as MT1 and MT2 in small intestine and pancreas.The intensity of melatonin IR in SI-NETs correlated to lower proliferation index and less symptoms of diarrhoea, which is well in line with the proposed actions of melatonin described in nimal studies. The intensity of MT2 IR was generally lower in metastases than in primary tumours. Plasma levels of melatonin in patients with SI-NETs and disease stabilisation/remission were reduced after treatment and higher levels were associated with nausea.In conclusion, melatonin and its receptors are present in the normal human gastrointestinal tract, pancreas and in SI-NETs. Melatonin IR intensity in tumours correlated significantly to less diarrhoea and to lower proliferation index. Plasma levels of melatonin in patients with SI-NETs were reduced with treatment response, indicating a possible tumour-derived origin of circulating melatonin levels.These results are in agreement with the suggested actions of melatonin on gastrointestinal motility and tumour growth.
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| 4. |
- Berggren, Elisabeth
(författare)
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Identity construction and memory after Subarachnoid Haemorrhage : Patients' accounts and relatives' and patients' statements in relation to memory tests
- 2010
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: A Subarachnoid haemorrhage (SAH) is a complex pathophysiological event and most patients have, before the onset, felt completely well. Being stricken by a SAH is a dramatic event, often followed by unconsciousness and memory problems. This may influence the adjustment to daily life. Supporting patients and relatives in nursing care therefore requires knowledge concerning patients' experience of the onset of the SAH event, and knowledge concerning patients' memory after a SAH.Aim: The general aim of this thesis was to study patients' experiences and reconstruction of the onset of, and events surrounding, a SAH and to study patients' and relatives' experience of patients' memory ability, in a long-term perspective.Specific aims:(I) The aim of this study was to analyse people's accounts of SAH, and to describe how they initiate and create meaning for the onset and events surrounding the SAH. The specific questions were : (i) What is highlighted in the accounts of SAH? (II) How is the illness reconstructed? (iii) How is meaning created through communicative interaction with others about SAH?(II) The aim was to describe memory after a SAH from the perspective of relatives and patients in two cohorts. In this study, the researchers also aimed to evaluate the application of relatives' statements as a tool in nursing care and rehabilitation, in order to support the patients. This was achieved by comparing: (i) Relatives' statements with patients' statements and (ii) Relatives' and patients' statements with the patients' memory test results.Methods: Both an inductive and a deductive approach were used. Nine open interviews were carried out in home settings, 1 year and 7 months (ranging 14-24 months) after the patients' onset and discourse analysis was used to interpret the data (I). Eleven relatives and 11 patients, 11 years and 15 relatives and 15 patients, 6 years after the onset participated in two studies. Interview questions and memory tests were used to collect data. Fischer's exact test was used for the statistical analysis (II).Findings:Patient with experience of a SAH were able to judge their own memory for what happened when they became ill. Both conscious irrational and rational actions were expressed in relation to experienced sensations. Critical events related to SAH were "existential insights" and "time as waiting and time as structuring meaning". The reconstruction of the illness event may be interpreted as an identity ceating process. The process of meaning-making is both a matter of understanding SAH as a pathological event, and a social and communicative matter, where the SAH is constructed into a meaningful life history, in order to make life complete (I). Memory problems were common according to relatives' and patients' statements and from memory test results. There was correspondence between relatives' and patients' statements regarding the patients' memory in general and long-term memory. Patients judged their own memory ability better than relatives, compared with results on memory tests. Both relatives and patients underestimated older patients' memory ability and underrated younger patients' memory problems, when compared with results on memory tests. Relatives stated that some patients had meta-memory problems (II). The episodic memory seemed to be well preserved, both concerning the onset (I) and in the long-term perspective (II).Conclusions: The reconstruction of the illness is a tool in nursing for understanding the patient's self-positioning and identity-construction. (I) Relatives' and patients' statements regarding patients' memory can also be used as tools in nursing care. However, the results showed: meta-memory problems (relatives' statements); that patients' judged their own memory ability better than relatives in comparison with results on memory tests. Consequently, memory tests and formalized dialogues, between the patient, the relative and a professional are required in order to prevent complications in the patient's mutual family relationships. However, professionals must assume that patients can judge their own memory (II). Dialogues between the patient, the relative and a professional, with focus on how to manage daily life in patients' home context, due to the patient's experience of the onset of the SAH and possible memory problems after the SAH, will probably improve the mutual family relationship in a positive way (I,II).
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| 5. |
- Bergström, Kamilla
(författare)
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Job satisfaction and emotional work tasks : dentists in Sweden and Denmark
- 2014
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Avhandlingen består av två studier som utgår från projektet ”Det goda arbetet”. Det överordnade syftet med projektet Det Goda Arbetet var att använda tandvård som ett exempel på ett arbete där relationerna med patienterna utgör arbetets kärna. Denna typ av arbete (även kallat människovårdande arbete) har speciella psykosociala arbetsmiljövillkor och känslomässiga krav som måste tas hänsyn till vid organisering av arbetet. Syftet med den första studien var att beskriva bakgrunden och utvecklingen av frågeformuläret ’Svenska och Danska tandläkares uppfattning av ’Det Goda Arbetet’ och att skapa ett mått för generell arbetstillfredsställelse, applicerat på fyra organisatoriska miljöer. Syftet med den andra studien var att introducera konceptet emotionellt arbete i tandvård genom att ge en teoretisk överblick av de emotionella aspekterna av arbetet, villkoren under vilka arbetet utförs och de potentiella effekterna på tandläkarnas välbefinnande. I kappan har kompletterande resultat från projektet Det Goda Arbetet inkluderats i syfte att ge en empirisk illustration av hur tandläkare upplever de emotionella faktorer som relaterar till patient-interaktionen och deras arbetsglädje. Data från 1226 danska och svenska verksamma tandläkare samlades in i November 2008 med en svarsprocent på 68 %. Ett additivt index skapades för att mäta generell arbetstillfredsställelse, och resultaten visade statistiska skillnader i tandläkarnas uppfattning mellan de olika organisatoriska miljöerna (Svenska offentliga/privata och Danska offentliga/privata). De danska offentliga tandläkarna hade den högsta graden av generell arbetstillfredsställelse medan de svenska offentliga hade den lägsta graden. En möjlig förklaring till detta kan vara att danska offentliga tandläkare skiljer sig från de andra tre grupperna i karakteristika vad gäller både tandläkare och patienter. Den låga graden av generell arbetstillfredsställelse hos de offentliga svenska tandläkarna kan möjligtvis vara en effekt av New Public Management-tänkande i sättet att organisera tandvård. Tilläggsresultaten visade att de svenska offentliga tandläkarna hade mycket mindre energi till sina privatliv i jämförelse med de andra tre grupperna och bara hälften av dem förväntade sig att fortsätta arbeta som nu fram till pensionen. Att arbeta med eller på människor handlar mycket om att skapa goda interaktioner och relationer mellan vårdgivaren och patienten. Goda patientrelationer kan vara ett primärt- och/eller sekundärt mål för att göra andra saker, som t.ex. den kliniska behandlingen, lättare. För många vårdgivare är relationerna med patienterna en arena där de kan leva ut sin potential som människor och kan upplevas som en bestående inre glädje av arbetet, kallat eudaimonia. I patientrelationen utför tandläkaren emotionellt arbete som ett sätt att intervenera med patienten för att vägleda denne i en bestämd riktning. Tandläkare har uttalade emotionella arbetsuppgifter i sina interaktioner med patienterna, emellertid har dessa emotionella aspekter av arbetet hitintills varit ett försummat forskningsområde inom odontologin. De emotionella arbetsuppgifterna är betingade eftersom att tandläkarens incitament inte är endimensionella och därför kräver de en hel del emotionell flexibilitet, uppmärksamhet och reflektion av tandläkaren. Påverkan från marknadskrafter och managerialism på de professionella värdena inom tandvård kan av tandläkaren uppfattas som motstridande och utmana villkoren för emotionellt arbete och tandläkarnas välbefinnande. Denna forskning syftar till att starka och uppmuntra olika nivåer av tandvård till att ytterligare undersöka, förstå och stötta dynamiken i de emotionella aspekterna av arbetet för att skapa en hållbar arbetsmiljö där värden och logik kan uppfattas som kompatibla med tandvårdens professionella värden.
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| 6. |
- Folke, Solgun
(författare)
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Xerostomia : Views among health care professionals and the main concern among afflicted adults
- 2010
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aims of the two studies were to survey and describe views of xerostomia among health care professionals and to explore, among afflicted adults; the main concerns associated with xerostomia and attempted remedies. Two empirical studies with qualitative design were conducted. In Paper I, 16 participants were interviewed representing health care professionals with various exposures to patients with xerostomia. The data were subjected to qualitative content analysis. In Paper II, qualitative, conversational style interviews were conducted with 15 participants with subjective complaints of dry mouth. The grounded theory method was applied for data analysis. In the findings (Paper I), the latent content was formulated into a theme: Xerostomia is a well-known problem yet, there is inadequate management of patients with xerostomia. The findings identified three major categories expressing the manifest content: awareness of xerostomia, indifferent attitude, and insufficient support. Health care professionals recognised xerostomia as a common and escalating problem, particularly among elderly. Yet, the problem received little attention. In Paper II, a model was generated to elucidate the main concerns of xerostomia among afflicted individuals and how they handle various aspects of their condition. The core category was labelled: an aggravating misery, meaning that xerostomia has a devastating and debilitating impact on multiple domains of well-being. The model involves three different categories/remedial strategies, namely professional consultation, search for affirmation, and social withdrawal. All three categories express what the participants do to resolve their problems with xerostomia. In general, the participants perceived xerostomia as a burden and as a condition they were constantly reminded of. The participants also expressed a feeling of resignation due to lack of confirmation and support. The findings underscore that xerostomia is not a trivial condition for those afflicted. Oral impairment as well as physical and psychosocial consequences of xerostomia had negative impact on the participants´ qualitative of life. Health care professionals felt that xerostomia was an underestimated problem and that clinical symptoms and subsequent treatment were often ignored. The findings revealed that xerostomia is not only a predicament of the oral cavity but affects the individual as a whole. This is of particular concern among elderly as the occurrence of xerostomia increases with advancing age due to chronic diseases and adverse medications. In summary, it is essential to adopt a holistic view, and to provide additional education and improved interdisciplinary collaboration to manage and care for individuals suffering from xerostomia.
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| 7. |
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| 8. |
- Gillborg, Susanna
(författare)
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Orofacial pain and tooth wear in swedish adults : cross-sectional studies in southern Sweden
- 2019
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim. The present licentiate thesis investigated the prevalence of TMDpainand related factors, the prevalence and severity of tooth wear, andthe etiology and factors related to tooth wear in adults in southern Sweden.Methods. The methods used included a questionnaire, history, clinical examination,intraoral photographs, and saliva sample. In Paper I, twoscreening questions for TMD pain were used to query a study samplecomprising 6123 questionnaire participants about their pain experience.In Paper II, a clinical examination and intraoral photographs helped determinethe presence and severity of tooth wear. Information from a questionnaire,patient histories, and participant saliva samples were analyzedregarding tooth wear-related factors. The study sample comprised 831 individuals.Results. Paper I found a prevalence of TMD pain once a week or moreoften in 11% of the study sample. Related factors were female gender,subjects under 50 years of age, weekly headache, self-reports of poor generalhealth, impaired oral health-related quality of life, and tooth wear.Paper II showed tooth wear in all individuals. Attrition, the most commontooth wear, was found in over 90% of the study sample. Signs of erosionwere found in almost 80% of the individuals. Men had more tooth wearthan women, but none of the factors that were investigated as related factorsdiffered between the genders. Only some of the individuals, includingthe group with severe tooth wear reported having received information about tooth wear from their clinician. Participants reported receiving informationabout tooth wear due to extensive tooth brushing more thanabout erosion.Conclusions. Paper I found a prevalence of TMD pain in 11% of the studysample. In Paper II, attrition was found in over 90% of the study sample.Almost 80% of the individuals exhibited signs of erosion. Only a few reportedhaving received information about tooth wear due to erosion fromtheir clinician.
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| 9. |
- Granbom, Elin, 1986-
(författare)
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Respiratory tract infections in children with congenital heart disease
- 2016
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Respiratory Syncytial Virus (RSV) infection is common among young children. Congenital Heart Disease (CHD) is a risk factor of severe illness and hospitalization. Palivizumab prophylaxis reduces the severity of RSV infection and reduces the risk of hospitalization for children at high risk of severe illness, such as children born premature or with CHD.The aim of this thesis was to evaluate compliance with national guidelines for prophylactic treatment and to study the Relative Risk (RR) of hospitalization due to RSV and unspecified Respiratory Tract Infection (RTI) for children with CHD.In a prospective study, questionnaires were sent to all paediatric cardiology centres in Sweden with questions about prophylactic treatment. Hospitalization rates were retrieved from the national inpatient registry. Heart defects were grouped according to type and the relative risk of hospitalization was calculated for each group and for summer and winter seasons.Half of the patients received prophylactic treatment later than recommended in the guidelines. The risk of hospitalization due to RSV infection was increased (RR=2.06 95% CI 1.6-2.6; p < 0.0001) for children with CHD compared to children without CHD. The RR of hospitalization was also increased for all CHD subgroups, and was further increased during summer for children with the more severe CHD.We conclude that guidelines for prophylactic treatment were not followed and that the risk of hospitalization due to RSV and unspecified RTI was increased for all subgroups of CHD. The risk was increased both during winter and summer and we therefore argue that information to health personnel and parents should include that the risk of severe RTI is present all year round for children with CHD.
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| 10. |
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