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Sökning: hsvkat:504 mat:dok (lärosäte:(gu) OR lärosäte:(du) OR lärosäte:(kau) OR lärosäte:(lnu) OR lärosäte:(ltu) OR lärosäte:(lu) OR lärosäte:(miun) OR lärosäte:(mdh) OR lärosäte:(su) OR lärosäte:(umu) OR lärosäte:(uu) OR lärosäte:(oru)) > (2015-2018) > Medicin och hälsovetenskap

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1.
  • Pedersson, Anders, 1981 (författare)
  • En fängslande vetenskap?: Kriminologi i Sverige, 1885–1965
  • 2017
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The purpose of this dissertation is to write a history of criminology in Sweden 1885– 1965. It is an investigation of how criminology was established as a science – as an acknowledged field of scientific knowledge – not as a broader discursive formation. The aim is to put criminological theories and practices in relation to political movements, media, the state and its institutions, such as the prison, the asylum and the university, and through that analyze Swedish criminology from the point of view of history of science. I mobilize the theoretical concepts of “hybrid management” and “boundary movement” to investigate how the borders between science and politics were negotiated and upheld. The study is divided into three parts which relate to each other both chronological and thematically. I argue that criminological theories and practices were established by being connected to different actors, different modes of thinking and different types of political aims. By analyzing criminology as a public science as well as tool for political administration and reform and as an academic discipline, I investigate not only the criminological text and ideas but also the infrastructure and political and cultural context of the science of crime. For this purpose I utilize diverse source material, including, but not limited to, popular scientific texts, state committee reports, the daily press and documents from a range of archives. I argue that criminology as a historical phenomenon is best understood as a social science which tries to mobilize a scientific way of thinking, talking and acting with the purpose of changing society in one way or another. Rather than focusing on which different criminological perspectives dominated at different times I focus on continuity and investigate criminology in Sweden as a project in which criminologists and their allies tried to achieve their goals of 1) production of knowledge, 2) securing the conditions for production of knowledge and 3) implementation of that knowledge in social and penal political reform. The dissertation shows that the political dimension of criminology should be described as shifting and multifaceted. Criminology did not represent repression or emancipation. Rather, as a science of the welfare state it was mobilized for both purposes and it needs to be understood in a complex process of conflicting interests. I conclude that a fundamental aspect of the establishing of criminology as a science in Sweden 1885– 1965 was its proponents’ ability to balance between scientific and political interests in their endeavor to produce criminological knowledge and promote a criminological rationality.
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2.
  • Bergmark, Magnus, 1975- (författare)
  • Integrerade psykosociala insatser : Policy, implementering och praktik i ett komplext verksamhetsfält
  • 2017
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • InledningAlltsedan psykiatrins avinstitutionalisering tog fart under 1980- och 1990-talen har en utveckling av samhällsbaserade psykosociala insatser förespråkats för att erbjuda vård och stöd till personer med psykisk funktionsnedsättning. Insatserna förväntas bidra till att brukarna får tillgång till effektiv vård och stöd, samtidigt som de inkluderas i samhället. Vidare förutsätts insatserna baseras på kunskap och evidens, samt bygga på brukarens delaktighet och stödja dennes återhämtning. En annan målsättning är att vissa insatser ges i form av integrerade modeller, så att personer ur målgruppen får tillgång till sammanhållet stöd från inblandade myndigheter. Även om Sverige räknas som ett resursstarkt land som har kommit långt på området, så förekommer kritik mot utvecklingen. Kritiken har berört både planering och styrning på politisk nivå, men även utförandet av de insatser som erbjuds till brukarna. Kritiken har bland annat handlat om bristande samverkan mellan landsting och kommuner, och om stora lokala variationer i den erbjudna servicens kvalitet. I den här avhandlingen studeras dels utformningen av policy på området, dels implementering av specifika insatser. Syftet med avhandlingen är att undersöka hur svenska policymakare på nationell nivå har hanterat utvecklingen av psykosociala insatser för personer med psykisk funktionsnedsättning, samt att analysera möjligheter och svårigheter för organisationer och personal när det gäller att implementera de insatser som förespråkas av beslutsfattare. De frågeställningar som avhandlingen söker besvara är följande:Hur formuleras policy som syftar till att införa samhällsbaserade psykosociala insatser, och vad kan policyns egenskaper innebära för genomförandet av den?Vilka styrstrategier uttrycks i statliga policydokument?Vad hämmar respektive underlättar implementeringen av föreslagna integrerade psykosociala insatser?Hur kan vi förstå vad som påverkar möjligheten att erbjuda integrerade psykosociala insatser, i termer av lokala förutsättningar och strategier för implementering?MetodPolicy på området studerades genom en studie av tre av de övergripande dokument som beslutats på regeringsnivå de senaste 20 åren. Riktade kvalitativa innehållsanalyser baserade på relevant litteratur genomfördes. Implementering av insatser studerades genom att 15 program följdes under 3 års tid. 14 av dessa arbetade med att implementera arbetsrehabiliteringsprogram utifrån modellen Individual Placement and Support (IPS). Under samma tidsperiod följdes ett team som implementerade den intensiva samordnings-, vård- och stödmodellen Assertive Community Treatment (ACT). För att bedöma verksamheternas följsamhet till modellerna genomfördes programtrohetsskattningar av samtliga program. Data avseende programmens målgrupp samlades också in. Tre IPS-program deltog i en fördjupningsstudie där kvalitativa intervjuer genomfördes med ledare, personal och samverkanspartners. Implementeringen av dessa program analyserades utifrån implementeringsramverket the Consolidated Framework for Implementation Research. Implementeringen av samtliga 14 IPS-program studerades med hjälp av skattningsskalan the Sustainable Implementation Scale (SIS). När det gäller ACT-teamet genomfördes dels kvalitativa innehållsanalyser av djupintervjuer, och dels skattningar av implementeringskomponenter med hjälp av SIS.ResultatPolicy på området har innehållit stora mått av otydlighet och konflikt, både gällande de mål och medel som har formulerats. Regeringen har främst förespråkat så kallade mjuka styrstrategier, vanligen i form av statliga stimulansbidrag. Vissa förtydliganden och konkretioner har skett under tid, vilka ibland går i linje med de internationella rörelserna New Public Management och evidensbaserad praktik. Exempel på försök att strama upp styrningen är målformuleringar som förespråkar riktade och prestationsbaserade stimulansbidrag, samt nationella riktlinjer för att styra utvecklingen mot utvalda specificerade insatser. Trots detta är det fortfarande de berörda myndigheterna som är ansvariga för att välja ut, utforma och implementera psykosociala insatser. På verksamhetsnivå leder detta till att många otydligheter består, vilka ibland är relaterade till svårigheter att avgränsa ansvarsområden och att förändra hindrande regelverk och traditioner. Dessutom förekommer konflikter, exempelvis i form av konkurrerande målsättningar och ojämn resurstilldelning.Studierna av de integrerade modellerna IPS och ACT visar att implementering av dessa är möjlig, även i en sektoriserad välfärdskontext som den svenska. Det finns dock en rad faktorer på såväl organisationsnivå som teamnivå, som försvårar implementeringen. Exempel på dessa är de involverade organisationernas varierande målsättningar och traditioner, regelverkens utformning, samt svårigheter att erhålla långsiktig finansiering. I en del fall beskrivs de arbetssätt som modellerna förespråkar som försvårande, då de upplevs som annorlunda och utmanande för existerande rutiner och uppfattningar om stöd till målgruppen. Ett stort hinder för effektiv implementering är svårigheter att samverka, främst mellan, men även inom inblandade organisationer. De flesta program som lyckades genomföra en hållbar implementering hade personal som var duktiga på att navigera förbi de hinder som orsakades av ogynnsamma regler, och de lyckades även hitta vägar för att etablera samverkan, både horisontellt (med samarbetspartners på samma hierarkiska nivå) och vertikalt (mellan ledning och personal). En verksamhetsledare som har möjlighet att påverka samverkansrelationer i både horisontell och vertikal riktning är gynnande för implementeringen. Andra betydelsefulla komponenter som underlättar implementering är en noggrann planering innan ett program startas, medveten rekrytering av personal, formering av ändamålsenliga styrgrupper, samt att tidigt i processen arbeta strategiskt för att lösa finansieringsfrågan. Även programtrohetsskattningar var betydelsefulla, då de både fungerade som instrument för att identifiera förbättringsområden för programmen, men också hade en legitimerande funktion vid återkoppling till ledningen.SlutsatserDet råder en samstämmighet i övergripande målsättningar som syftar till att utveckla området integrerade psykosociala insatser. På en mer konkret nivå är läget betydligt oklarare, både gällande målsättningar i policy och av vem och hur insatserna ska implementeras. Även om vissa förändringar skett, står regeringen fortsatt för en mjuk styrning vilken lämnar ett stort ansvar till de myndigheter som ska implementera valda insatser. Detta innebär en rad svårigheter för frontlinjepersonalen, vilket leder till att de ofta behöver lägga mycket tid och energi på att hitta vägar för att överkomma dessa svårigheter.I många fall har ledare och personal goda möjligheter att uppnå en hög programtrohet på teamnivå, men för en hållbar implementering krävs det att ett program är väl förankrat både vertikalt och horisontellt. Därför finns ett behov av att forskare och beslutsfattare tar ett tydligare helhetsgrepp, både på området policy och implementering av specifika insatser. Skattningar av programtrohet och implementering kan vara ett stöd i att identifiera vad som fungerar samt vad som behöver förändras i och mellan organisationer. Men för att programmen ska lyckas med en effektiv implementering på organisationsnivå behöver deras legitimitet stärkas vertikalt, och planering för långsiktig lokal finansiering behöver göras i ett tidigt skede.
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3.
  • Björquist, Elisabet, 1959- (författare)
  • Mind the gap : transition to adulthood – youths' with disabilities and their caregivers' perspectives
  • 2016
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Transition to adulthood, referring to the process of moving from childhood to adulthood, can be a complex period for youths with disabilities who might need special support transitioning into an independent life as adults. Caregivers are significant persons for the youths, which is why their own health and wellbeing is important. Therefore the overall aim of this thesis was to gain a deeper understanding of health and wellbeing, challenges, preferences and needs during the transition from childhood to adulthood in youths with disabilities and their caregivers. The thesis is comprised of two studies, study A focusing on the perspectives of youths with CP (Paper I) and of their caregivers (Paper II) and Study B focusing on the perspectives of immigrant youths with disabilities and caregivers from Middle Eastern countries residing in Sweden (Paper III and IV). Study A had a qualitative approach and involved focus groups and individual interviews with 12 male and female youths, 17-18 years of age, with CP and various physical and cognitive levels of disabilities (Paper I), as well as 15 mothers and fathers (Paper II). The interviews were analysed using qualitative content analysis. In Study B, a combination of qualitative and quantitative methods was used. Based on structured and semi-structured questionnaires in combination with open ended questions interviews were conducted in Swedish or Arabic with 17 male and female youths, 13-24 years of age with various disabilities and 10 mothers, five fathers and one sibling. The families were all immigrants with Middle Eastern origin and most of them had lived in Sweden for more than five years. The questionnaires Family Need Survey (FNS), Rotterdam Transition Profile (RTP) and Canadian Occupational Performance Measure (COPM) were all translated and adapted to Swedish except for COPM where there already was a Swedish version. The results were analysed using mainly descriptive statistics and based on the framework of International Classification of Functioning, Disability and Health – Children & Youth Version (ICF-CY). The findings from study A showed that the experiences of youths and caregivers mostly concerned mental health and wellbeing described as both positive and negative experiences. Their family life was experienced as important, secure and convenient, which made the youths feel safe and gave parents a sense of meaningfulness. Youths described participation, socialising and love as being important, but also challenging and worrying. Caregivers experienced sorrow and anger and together with demanding logistics, planning and worrying, their health was affected negatively during their children's transition to adulthood. The findings from study B showed that youths were dependent on their caregivers for transportations, participating in leisure activities and socialising with friends. They were also dependent on their caregivers for the demanding of support and health care. The youths had few or no experiences of intimate relationships but felt that they were expected to get married in the future which worried them and their caregivers. Caregivers were uncomfortable with using the term intellectual disability. Caregivers needed help to understand their child's condition and to explain the child's condition to their wives/husbands. A significant difference was found in what problems youths identified with and what their caregivers identified as their youth's problems. The youths experienced problems with handling finances, transportations and seeking employment or daily activities whilst their caregiver thought their youth's primary problems involved self-care. The overall finding showed that to strengthen health and wellbeing in youths with disabilities and their caregivers and to meet challenges, preferences and needs during transition from childhood to adulthood both youths and caregivers need information and support. Both youths and caregivers expressed a desire for individualised support given by one person who could facilitate the transition period by coordinating information and give support based on individual preferences and needs. During the recruiting process in both studies, great challenges were experienced in finding participants. Collaboration with professionals in schools and leisure activities was found to be the most effective way to get in contact with immigrant youths and thereby also their caregivers. The findings from this thesis may enable professionals to develop and improve best practice guidelines for support, habilitation and health care in youths' transition. To facilitate for the youth to transfer from services with a family-centred approach to person-centred adult services, their autonomy must be strengthened by involving them in their own transition planning early on. Immigrant youths need special information and support about love and the freedom of choice to get married. The COPM and RTP are suggested to be used as tools in person-centred transition planning given they are used customized and applied with cultural sensibility. To enable those with communication limitations to give their independent voice the use of communication tools is necessary. Furthermore, the transition to person-centred adult support and health care should be flexible and not determined by biological age. However, youths need support by their caregivers who in turn might both need, and want, support for themselves and occasionally hands-on support. Guidance by a specially designated navigator aimed to support the whole family would be an option to meet individual needs. The information and support should be culturally sensitive with respect to various linguistic and cultural experiences. To close the gaps between systems of care collaboration was discussed to be necessary to facilitate the transition between support and health care for children and youths as well as services for adults. The use of ICF-CY as a framework for understanding needs and the standardised terminology in ICF-CY in documentation can facilitate this collaboration.
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4.
  • Holm, Marie-Louise (författare)
  • Fleshing out the self : Reimagining intersexed and trans embodied lives through (auto)biographical accounts of the past
  • 2017
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • This thesis explores how current ways of imagining possibilities for intersexed and trans embodied lives within medical contexts might be informed by and reimagined through the historical lived experiences of intersexed and trans individuals as they have been articulated in autobiographical accounts.Postmodern, queer, intersex, and trans researchers and activists have criticised existing standards of intersex and trans healthcare for limiting the possibilities for diverse embodied lives by articulating certain forms of embodiment and selfhood as more likely to enable a liveable life than others. This has often been done in a medico-legal context by referring to experiences in the past of the unliveability of corporealities and gendersexed situations that differ from privileged positions. With a point of departure in these critiques, this thesis reopens questions about how intersexed and trans people may be embodied and have relations with others by reflecting upon the period of the first three-quarters of the 20th century, when the present standards of care and diagnostic categories were emerging, but had not yet become established.Drawing upon a unique set of historical source material from the archives of the Danish Ministry of Justice and the Medico-Legal Council, intersexed and trans persons’ life stories are rearticulated from their own and medico-legal experts’ accounts written in relation to applications for change of legal gendersex status and medical transition. In this way, the process is traced through which these life stories have been repeatedly rearticulated in order to become a usable basis for diagnosis and decision-making. At the same time, the stories are unfolded once more in a rearticulation focusing on their complexity and diversity.
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5.
  • Lutz, Peter A. (författare)
  • Tinkering Care Moves : Senior Home Care in Practice
  • 2016
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • This dissertation builds on the current anthropological studies of care relations in practice. It draws inspiration from science and technology studies (STS) and postfeminist technoscience. A qualitative ethnographic approach grounds the empirical data collection and analysis. This entails ethnographic fieldwork with senior home care in the United States and Sweden during 2007–2008 and 2011–2012. Analytical attention centers on how movements situate various tensions of senior home care in practice. Four interrelated published works comprise the main thematic chapters. Each article exemplifies how human and nonhuman relations move and mediate care. They develop several heuristic terms that advance ideas about how older people, aging bodies, technologies, spaces, and times that tinker each other through movements of care in practice. The comprehensive summary frames these articles with an overview of the primary thematic orientations and methodological concerns. A discussion of the main contributions and implications of the dissertation concludes the work.
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6.
  • Wallroth, Veronika, 1978- (författare)
  • Men do care! : A gender-aware and masculinity-informed contribution to caregiving scholarship
  • 2016
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • In caregiving literature, it is often the female gender that has been the focus of attention, and in particular women’s unpaid labor. Studies also tend to make comparisons between men’s and women’s caregiving, using men’s caregiving experiences to show not only that women face greater burdens, but also that men’s needs can be minimized. This means that while gender analysis is not uncommon in the caregiving literature, gender tends to be equated with womanhood. This is impeding us from moving the debates on care and caregiving forward. The dissertation argues – through a phenomenological analysis of men’s motives, experiences and perceptions of care and caregiving – that much could be gained if we were to rectify the gender bias by bringing attention to caregiving men in the gender-aware and masculinity-informed way that is lacking in the family caregiving literature at present. For this dissertation, 19 caregiving adult sons and sons-in-law were interviewed. The aim of the study is twofold. Firstly, it attempts to contribute to the rectification of the gender bias found in the literature on family caregiving by focusing on men’s caregiving and answering the following research questions: What motivates men to provide care for their elderly parents? How do adult sons experience caregiving? What do adult sons think that care and caregiving are, i.e. what are their perspectives on care? Secondly, this dissertation also aims to explore whether a gender-aware and masculinity-informed perspective can be used to enhance our understanding of caregiving. This study discusses how motives, experiences and perspectives, which have so far been interpreted as unique to women, are also matters that men talk about and consider important in caregiving. Thus, this study shows that a gender-aware and masculinity-informed perspective on care can increase our understanding of family caregiving and contribute to rectify the gender bias that care research suffers from. The study suggests that caregiving men should not solely be regarded as empirically interesting. This is because they are an unexploited and theoretically profuse source of information about caregiving.
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