| 1. |
- Kirvalidze, Mariam, et al.
(författare)
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Effectiveness of integrated person-centered interventions for older people's care: Review of Swedish experiences and experts’ perspective
- 2024
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Ingår i: Journal of Internal Medicine. - : John Wiley & Sons. - 1365-2796 .- 0954-6820. ; 295:6, s. 804-824
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Tidskriftsartikel (refereegranskat)abstract
- Older adults have multiple medical and social care needs, requiring a shift toward an integrated person-centered model of care. Our objective was to describe and summarize Swedish experiences of integrated person-centered care by reviewing studies published between 2000 and 2023, and to identify the main challenges and scientific gaps through expert discussions. Seventy-three publications were identified by searching MEDLINE and contacting experts. Interventions were categorized using two World Health Organization frameworks: (1) Integrated Care for Older People (ICOPE), and (2) Integrated People-Centered Health Services (IPCHS). The included 73 publications were derived from 31 unique and heterogeneous interventions pertaining mainly to the micro- and meso-levels. Among publications measuring mortality, 15% were effective. Subjective health outcomes showed improvement in 24% of publications, morbidity outcomes in 42%, disability outcomes in 48%, and service utilization outcomes in 58%. Workshop discussions in Stockholm (Sweden), March 2023, were recorded, transcribed, and summarized. Experts emphasized: (1) lack of rigorous evaluation methods, (2) need for participatory designs, (3) scarcity of macro-level interventions, and (4) importance of transitioning from person- to people-centered integrated care. These challenges could explain the unexpected weak beneficial effects of the interventions on health outcomes, whereas service utilization outcomes were more positively impacted. Finally, we derived a list of recommendations, including the need to engage care organizations in interventions from their inception and to leverage researchers’ scientific expertise. Although this review provides a comprehensive snapshot of interventions in the context of Sweden, the findings offer transferable perspectives on the real-world challenges encountered in this field.
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| 2. |
- Barber, R. M., et al.
(författare)
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Healthcare access and quality index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015 : A novel analysis from the global burden of disease study 2015
- 2017
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Ingår i: The Lancet. - : Lancet Publishing Group. - 0140-6736 .- 1474-547X. ; 390:10091, s. 231-266
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Tidskriftsartikel (refereegranskat)abstract
- Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0-42·8) in 1990 to 53·7 (52·2-55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Copyright © The Author(s). Published by Elsevier Ltd.
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| 3. |
- Samrani, George, et al.
(författare)
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Behavioral facilitation and increased brain responses from a high interference working memory context
- 2018
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Ingår i: Scientific Reports. - : Nature Publishing Group. - 2045-2322. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- Many real-life situations require flexible behavior in changing environments. Evidence suggests that anticipation of conflict or task difficulty results in behavioral and neural allocation of task-relevant resources. Here we used a high- and low-interference version of an item-recognition task to examine the neurobehavioral underpinnings of context-sensitive adjustment in working memory (WM). We hypothesized that task environments that included high-interference trials would require participants to allocate neurocognitive resources to adjust to the more demanding task context. The results of two independent behavioral experiments showed enhanced WM performance in the high-interference context, which indicated that a high-interference context improves performance on non-interference trials. A third behavioral experiment showed that when WM load was increased, this effect was no longer significant. Neuroimaging results further showed greater engagement of inferior frontal gyrus, striatum, parietal cortex, hippocampus, and midbrain in participants performing the task in the high- than in the low-interference context. This effect could arise from an active or dormant mode of anticipation that seems to engage fronto-striatal and midbrain regions to flexibly adjust resources to task demands. Our results extend the model of conflict adaptation beyond trial-to-trial adjustments by showing that a high interference context affects both behavioral and biological aspects of cognition.
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| 4. |
- Husdal, Rebecka, et al.
(författare)
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Organisation of primary diabetes care in people with type 2 diabetes in relation to all-cause mortality: A nationwide register-based cohort study
- 2020
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Ingår i: Diabetes Research and Clinical Practice. - : Elsevier BV. - 0168-8227 .- 1872-8227. ; 167
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To examine if personnel resources and organisational features in Swedish primary health-care centres (PHCCs) are associated to all-cause mortality (ACM) in people with type 2 diabetes mellitus (T2DM). Methods: A total of 187,570 people with T2DM registered in the Swedish National Diabetes Register (NDR) during 2013 were included in this nationwide cohort study. Individual NDR data were linked to data from a questionnaire addressing personnel resources and organisational features for 787 (68%) PHCCs as well as to individual data on socio-economic status and comorbidities. Furthermore, data on ACM were obtained and followed up until 30 January 2018. Hierarchical Cox regression analyses were applied. Results: After a median follow-up of 4.2 years, 27,136 (14.5%) participants had died. An association was found between number of whole-time-equivalent (WTE) general practitioner's (GP's) devoted to diabetes care/500 people with T2DM and lower risk of early death (hazard ratio 0.919 [95% confidence interval 0.895–0.945] per additional WTE GP; p = 0.002). No other personnel resources or organisational features were significantly associated with ACM. Conclusions: This nationwide register-based cohort study suggests that the number of WTE GPs devoted to diabetes care have an impact on the risk of early death in people with T2DM. © 2020 Elsevier B.V.
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| 5. |
- Bagger, Anette, 1974-, et al.
(författare)
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Digitalized national tests in mathematics : a way of increasing and securing equity?
- 2019
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Ingår i: Proceedings of the TenthInternational Mathematics Educationand Society Conference. - Hyderabad, India : International Mathematics Education and Society Co.
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Konferensbidrag (refereegranskat)abstract
- On one hand, the Swedish governing discourse on equity in the context of digitizing education portrays modernization, progress and democracy as a foundation in the equity work. On the other hand, in the context of digitized tests, equity is rather framed within a neoliberal logic while related to all individuals’ possibilities of choosing a ‘good life’, and to compete on equal terms. Not all disadvantaged groups are the target, though. It is mainly boys who are supposed be given better grades, and, in addition, students with disabilities who are supposed to (as far as possible) be able to have the opportunity to show their knowledge during the test. Language or socioeconomically diverse settings are not mentioned with regard to digitized national tests.
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| 6. |
- Bagger, Anette, 1974-, et al.
(författare)
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The governing of three researchers' technologies of the self
- 2018
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Ingår i: The Mathematics Enthusiast. - : Information Age Publishing. - 1551-3440. ; 15:1-2, s. 278-302
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Tidskriftsartikel (refereegranskat)abstract
- This article sheds light on a number of discursive conditions relating to being researchers in mathematics education and with an interest in diversity. The data derived from a self-reflective trialogue (dialogue of three people) between the three authors, three researchers. Two of Foucault’s governing technologies were adopted: technologies of power and technologies of the self. By exploring regularities between these in our trialogue we construed formations of governing technologies in relation to subjectification and subjectivation. We uncovered five formations: “Tensions between mathematics education (ME) researchers from different traditions through processes of normalization and othering”, “Limiting space between ME researchers within the socio- political through dismissal of knowledge”, “The socio-political tradition of a need for theory connects theory and ME researcher's’ self-cultivation”, “The researchers’ processes of self-cultivation connect theory and compassionate research practices”. and “Research on policy statements as resistance towards technologies of domination in society”.
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| 7. |
- Johansson, Viktor, 1979-
(författare)
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Dissonant Voices : Philosophy, Children's Literature, and Perfectionist Education
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Dissonant Voices has a twofold aspiration. First, it is a philosophical treatment of everyday pedagogical interactions between children and their elders, between teachers and pupils. More specifically it is an exploration of the possibilities to go on with dissonant voices that interrupt established practices – our attunement – in behaviour, practice and thinking. Voices that are incomprehensible or expressions that are unacceptable, morally or otherwise. The text works on a tension between two inclinations: an inclination to wave off, discourage, or change an expression that is unacceptable or unintelligible; and an inclination to be tolerant and accept the dissonant expression as doing something worthwhile, but different.The second aspiration is a philosophical engagement with children’s literature. Reading children’s literature becomes a form of philosophising, a way to explore the complexity of a range of philosophical issues. This turn to literature marks a dissatisfaction with what philosophy can accomplish through argumentation and what philosophy can do with a particular and limited set of concepts for a subject, such as ethics. It is a way to go beyond philosophising as the founding of theories that justify particular responses. The philosophy of dissonance and children’s literature becomes a way to destabilise justifications of our established practices and ways of interacting.The philosophical investigations of dissonance are meant to make manifest the possibilities and risks of engaging in interactions beyond established agreement or attunements. Thinking of the dissonant voice as an expression beyond established practices calls for improvisation. Such improvisations become a perfectionist education where both the child and the elder, the teacher and the student, search for as yet unattained forms of interaction and take responsibility for every word and action of the interaction.The investigation goes through a number of picture books and novels for children such as Harry Potter, Garmann’s Summer, and books by Shaun Tan, Astrid Lindgren and Dr. Seuss as well narratives by J.R.R. Tolkien, Henrik Ibsen, Jane Austen and Henry David Thoreau. These works of fiction are read in conversation with philosophical works of, and inspired by, Ludwig Wittgenstein and Stanley Cavell, their moral perfectionism and ordinary language philosophy.
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| 8. |
- Johansson, Viktor, 1979-
(författare)
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Perfectionist Philosophy as a (an Untaken) Way of Life
- 2014
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Ingår i: The Journal of Aesthetic Education. - Champaign, USA : University of Illinois Press. - 0021-8510 .- 1543-7809. ; 48:3, s. 58-72
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Tidskriftsartikel (refereegranskat)
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| 9. |
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| 10. |
- Kankkunen, Tina Forsberg, et al.
(författare)
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New Public Management i kommunal praktik : En studie om chefers möjlighet att hantera styrning inom verksamheterna Vatten, Gymnasium och Äldreomsorg
- 2014
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Ingår i: ISM rapport. - Göteborg : Institutet för stressmedicin. - 1652-7089. ; 2014:15
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Denna studie belyser chefers möjligheter att hantera styrning inom olika kommunala verksamheter. Syftet med rapporten är att undersöka och jämföra hur styrning praktiseras inom den kvinnodominerade verksamheten ’Äldreboende’, den könsintegrerade verksamheten ’Gymnasium’, samt den mansdominerade tekniska verksamheten ’Vatten’. Analysen baseras på 30 intervjuer med linjechefer i fyra kommuner. För att förstå sammanhanget runt chefernas berättelser har även aktörer på kommunledningsnivå intervjuats. En utgångspunkt i studien är att jämförelser mellan olika organisatoriska sammanhang kan skapa lärande i arbetslivet.De deskriptiva resultat som presenteras i rapporten visar att styrning i linje med New Public Management har inneburit att cheferna upplever sig allt mer klämda mellan organisationens styrning och medarbetarnas och verksamhetens behov. Med New Public Management betonas styrning genom ekonomi, standardiserade processer, mål och uppföljning samt värderingar. De medverkande cheferna beskriver att detta har medfört målkonflikter som kan vara svåra att hantera. Det skiljer sig dock mellan verksamheterna hur målkonflikterna hanteras. Inom den mansdominerade verksamheten Vatten beskriver cheferna hur organisationen tar ansvar för målkonflikterna på ett sätt som möjliggör för cheferna att hantera dem. Inom Gymnasium och Äldreboende beskriver cheferna istället att de många gånger själva får hantera och ta konsekvenserna av målkonflikterna.Vi pekar sammanfattningsvis på fyra lärdomar kring chefens möjligheter att hantera målkonflikter. Dessa lärdomar handlar om hur arbetet organiseras, snarare än om chefernas individuella strategier. Vi talar om vikten av ett nära stöd, av att dela värld, av gemensamt språk och avgränsade mål och slutligen, vikten av tillit.
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