| 1. |
- Finnbogadóttir, Hafrún
(författare)
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Exposure to domestic violence during pregnancy : impact on outcome, midwives’ awareness, women´sexperience and prevalence in the south of Sweden
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objective: The overall aim of this thesis was to investigate pregnant women’shistory of violence and experiences of domestic violence during pregnancy andto explore the possible association between such violence and various outcomemeasures as well as background factors. A further aim was to elucidate midwives’awareness of domestic violence among pregnant women as well as women’sexperiences and management of domestic violence during pregnancy.Design/Setting/Population: Paper I utilised material derived from a populationbasedmulti-centre cohort study. A total of 2652 nulliparous women at nineobstetric departments in Denmark answered a self-administrated questionnaireat 37 weeks of gestation. Among the total sample, 37.1% (985) women met theprotocol criteria for labour dystocia. In Paper II an inductive qualitative methodwas used, based on focus group interviews with sixteen midwives working inantenatal care in southern Sweden who were divided into four focus groups. InPaper III a grounded theory approach was used to develop a theoretical modelof ten women’s experiences of intimate partner violence during pregnancy. PaperIV was a cross-sectional study including a cohort of 1939 pregnant women whoanswered a self-administered questionnaire at their first visit to seventeen ANCsin south-west Scania in Sweden.Results: In paper I, 35.4 % (n = 940) of the total cohort of women reportedhistory of violence, and among these, 2.5 % (n = 66) reported exposure toviolence during their first pregnancy. Further, 39.5% (n = 26) of those had neverbeen exposed to violence before. No associations were found between historyof violence or experienced violence during pregnancy and labour dystocia atterm. However, among those women consuming alcoholic beverages during latepregnancy, women exposed to violence had increased odds of labour dystocia(crude OR 1.49, CI: 1.07 – 2.07) compared to women who were unexposedto violence. In Paper II, an overarching category ‘Failing both mother and theunborn baby’ highlighted the vulnerability of the unborn baby and the needto provide protection for the unborn baby by means of adequate care to thepregnant woman. Also, the analysis yielded five categories: 1) ‘Knowledge about‘the different faces’ of violence’ 2) ‘Identified and visible vulnerable groups’, 3)‘Barriers towards asking the right questions’, 4) ‘Handling the delicate situation’and 5) ‘The crucial role of the midwife’. In Paper III, the analysis of the empiricaldata formed a theoretical model, and the core category, ‘Struggling to survivefor the sake of the unborn baby’, constituted the main concerns of women whowere exposed to IPV during pregnancy. The core category also demonstratedhow the survivors handled their situation. Three sub-core categories wereidentified that were properties of the core category; these were: ‘Trapped inthe situation’, ‘Exposed to mastery’ and ‘Degradation processes’. In Paper IV,‘history of violence’ was reported by 39.5% (n = 761) of the women. Prevalenceof experience of domestic violence during pregnancy, regardless of type or levelof abuse, was 1.0 % (n = 18), and prevalence of history of physical abuse byactual intimate partner was 2.2 % (n = 42). The strongest factor associated withdomestic violence during pregnancy was history of violence (p < 0.001). Thepresence of several symptoms of depression was associated with a 7-fold risk ofdomestic violence during pregnancy (OR 7.0; 95% CI: 1.9-26.3).Conclusions: Our findings indicated that nulliparous women who have ahistory of violence or experienced violence during pregnancy do not appearto have a higher risk of labour dystocia at term, according to the definitionof labour dystocia used in this study. Additional research on this topic wouldbe beneficial, including further evaluation of the criteria for labour dystocia(Paper I). Avoidance of questions concerning the experience of violence duringpregnancy may be regarded as failing not only the pregnant woman but also theunprotected and unborn baby. Still, certain hindrances must be overcome beforethe implementation of routine enquiry concerning pregnant women’s experiencesof violence (Paper II). The theoretical model “Struggling to survive for the sakeof the unborn baby” highlights survival as the pregnant women’s main concernand explains their strategies for dealing with experiences of violence duringpregnancy. The findings may provide a deeper understanding of this complexmatter for midwives and other health care professionals (Paper III). The reportedprevalence of domestic violence during pregnancy in southwest Scania in Swedenis low. Both history of violence and the presence of several depressive symptomsdetected in early pregnancy may indicate that the woman also is exposed todomestic violence during pregnancy (Paper IV).
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| 2. |
- Afzelius, Maria
(författare)
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Families with parental mental illness : supporting children in psychiatric and social services
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Children living with a parent with a mental illness can face difficulties. Parentalmental illness may influence the parents’ ability to cope with family life, where theparents’ awareness of their illness plays an important role. Family interventionsprovided by psychiatric and children’s social care services can be a way to supportthese children, making them feel less burdened, and improving the relationshipswithin the family. The aim of this thesis was to illuminate how children infamilies with a parent with a mental illness are supported in psychiatric and socialservices, especially by means of family interventions, and how families experiencethe support. Study I explored how professionals in adult psychiatric outpatient servicesdeal with children and families when a parent has a mental illness. The findingsshowed that professionals balanced between establishing, and maintaining,a relationship with the patient and fulfilling the legal obligations towards thepatient’s children. Asking the patient about their children could be experiencedas intrusive, and involving the patient’s family in the treatment could be seen asa dilemma, in relation to the patient. Efforts were made to enhance the familyperspective, and when the patient’s family and children joined the treatment thisrequired flexibility from the professional. Study II examined how professionals in children’s social care services experienceworking with children and families when a parent has a mental illness. The socialworkers’ objective was to identify the needs of the children. No specific attentionwas paid to families with parental mental illness; they were supported in thesame way as other families. When the parental mental illness became difficult tohandle both for the parent and the social worker, the latter had to set the child’sneeds aside in order to support the parent. Interagency collaboration seemed likea successful way to support these families, but difficult to achieve. Study III investigated if patients in psychiatric services that are also parentsof underage children, are provided with child-focused interventions or involvedin interagency collaboration between psychiatric and social services and childand adolescent psychiatry. The findings showed that only 12.9% of the patientsregistered as parents in Psykiatri Skåne had registered children under the ageof 18 years. One fourth of these patients had been provided with child-focusedinterventions in psychiatric service, and 13% of them were involved in interagencycollaboration. If a patient received child-focused interventions from the psychiatricservices, the likelihood of being involved in interagency collaboration was fivetimes greater as compared to patients receiving no child-focused intervention.Study IV explored how parents and their underage children who were supportedwith family interventions experienced these interventions. The results showedthat parents experiencing mental illness were eager to find support in explainingto and talking with their children about their mental illness, although the supportfrom the psychiatric service varied. Both children and other family membersappreciated being invited to family interventions. After such an intervention, theyexperienced the atmosphere in the family as less strained and found it easier tocommunicate with each other about difficulties. Unfortunately, the participatingpartners felt that they were left without support specifically targeted at them. The thesis showed that there is a gap between how professionals deal withquestions concerning these families and their support, and the parents’ and thefamilies’ needs to receive support in handling the parental mental illness in thefamily. The psychiatric and social services need to expand their approach andwork with the whole family, in order to meet the needs of the child and otherfamily members involved.
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| 3. |
- Albèr, Cathrine
(författare)
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Humectants and skin : effects of hydration from molecule to man
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Humectants belong to a group of hydrophilic compounds frequently used in skin care products with the aim to diminish the clinical symptom of skin dryness. The biochemical and biophysical mechanisms by which humectants interact with the skin barrier are far from fully understood. Increased understanding of such mechanisms can enhance the possibilities to tailor skin care products for various skin abnormalities.The work presented in this thesis centres on one high (hyaluronan) and two low (urea and glycerol) molecular weight humectants and their interactions with water, as well as their effect on the barrier properties of the outermost layer of the skin, i.e. the stratum corneum (SC). We explore the effect of hydration on thermodynamic properties of humectants, in particular hyaluronan, by using isothermal sorption calorimetry, differential scanning calorimetry and small- and wide-angle X-ray scattering. By combining data from several methods, a binary phase diagram of the hyaluronan - water system was constructed.We also investigate the effect of hydration and presence of humectants on the SC permeability in vitro by using an experimental set-up that allows for control of the boundary conditions in terms of water activity. In contrast to low molecular weight humectants, like urea and glycerol, it was concluded that hyaluronan (17 kDa) does not penetrate the skin barrier due to size exclusion. Addition of urea, glycerol or hyaluronan to aqueous formulations inevitably lowers the water activity of the formulation, which in tum affects the SC permeability when being applied. Moreover, it was shown that skin permeability of a model drug metronidazole decreases upon addition of hyaluronan to the formulation, while high skin permeability was maintained with addition of urea or glycerol. In addition, skin membrane electrical resistance, which normally increases at dehydrating skin conditions, remained low in presence of urea and glycerol.Excised skin hydrated at different hydration levels were examined with confocal Raman microspectroscopy. Large water inclusions were observed in fully hydrated SC after 24h exposure to a buffer solution. Addition of urea was shown to promote the formation of these inclusions. Urea and glycerol were also shown to improve the hydration capacity of isolated comeocytes.Similar approach as used in vitro was employed in vivo to explore the effect of hydration and humectants on skin permeability. It was shown that the water activity of the applied formulations have a marked effect on the barrier properties and urea and glycerol was shown to improve skin hydration even at reduced water activity of the applied formulation.
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| 4. |
- Aleksejeva, Olga
(författare)
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Blue copper proteins as bioelements for bioelectronic devices
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis is focused on bioelements for biological electric power sources,specifically, on blue copper proteins with and without an intrinsic biocatalyticactivity, i.e. ability to reduce oxygen directly to water. These proteins, viz. differentlaccases, ceruloplasmin, and rusticyanin, were characterised in detailand employed for the construction of both self-charging and conventional biosupercapacitors.First, similarities and particularities of oxygen electroreductionvs. bioelectroreduction were reviewed. Moreover, being a promising candidatefor the construction of autotolerant implantable biocathodes, the electrochemistryof human ceruloplasmin was revisited. For the first time, a clearbioelectrocatalytic reduction of oxygen on ceruloplasmin modified electrodeswas shown. Second, computational design combined with directed evolutionresulted in a high redox potential mutated laccase, GreeDo, with increased redoxpotential of the T1 site, increased activity towards high redox potentialmediators, as well as enhanced stability. Third, GreeDo was electrochemicallycharacterised in detail. The mutant exhibited higher open circuit potentialvalues and onset potentials for oxygen bioelectroreduction compared to the parental laccase, OB-1. Moreover, the operational stability of GreeDo modifiedgraphite electrodes was found to be more than 2 h in a decidedly acidicelectrolyte, in agreement with the extended operational and storage stabilitiesof the enzyme in acidic solutions. Fourth, multi-cell single-electrolyte glucose/oxygen biodevices with adjustable open-circuit and operating voltages,which are independent on the difference in equilibrium redox potentials of thetwo redox couples, gluconolactone/glucose and oxygen/water, viz. 1.18 V, butdependent on the number of half-cells in the biodevice construction, were designedand tested. The biodevices were made from tubular graphite electrodeswith electropolymerised poly(3,4-ethylenedioxythiophene) modified withTrametes hirsuta laccase and Neurospora crassa cellobiose dehydrogenase as the cathodic and anodic biocatalysts, respectively. Due to the interplay betweenfaradaic and non-faradaic electrochemical processes, as well as betweenionic and electronic conductivities, the open-circuit voltage of the self-chargedbiodevice is extraordinarily high, reaching 3 V, when seven biosupercapacitorsoperating in a common electrolyte were connected in series. Moreover,glucose/oxygen biodevices could be externally discharged at an operatingvoltage exceeding the maximal limiting open-circuit value of 1.24 V for thecomplete glucose oxidation. Last but not least, a conventional biosupercapacitor,i.e. a biodevice lacking self-charging ability, was composed of Acidithiobacillusferrooxidans rusticyanin modified gold electrodes. The complete biodevicesas well as separate electrodes were thoroughly characterised electrochemically.The symmetrical biosupercapacitor based on two identical goldelectrodes modified with rusticyanin is able to capacitively store electricityand deliver electric power, accumulated mostly in the form of biopseudocapacitance,when charged and discharged externally.
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| 5. |
- Ali, Abdullah, 1985-
(författare)
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Topical formulations, design and drug delivery : "A dive into water"
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Water is a vital component regulating the properties of topical formulations and their interaction with biological barriers, such as skin and mucosa. Changing the watercontent within the frame of the pharmaceutical triangle will have a huge impact on which type of formulation, such as a cream, ointment, gel, or lotion, is formed, as well as the physical properties of the formulation. The composition of a formulation, and the subsequent reformulation after application, will govern the features of the residual film. This will in turn affect the barrier properties of the underlying tissue and consequently the penetration of various substances across skin or mucosa.The primary aim of this thesis has been to provide further understanding on differences between traditional surfactant-based formulations and particle-stabilized, Pickering, formulations and how specific excipients, like alcohols, emollients, and thickeners can affect their physical and/or sensorial properties. The secondary aim has been to gain more knowledge on the role of water in topical formulations and how it affects the properties of the underlaying tissue on application.By combining a portfolio of physicochemical techniques combined with sensory science, we have been able to identify differences between Pickering and surfactantstabilized formulations. Starch-based Pickering emulsions were perceived as less greasy and sticky than traditional creams, even at high oil content. Moreover, we were able develop a novel type of alcohol-based Pickering emulsion with combined moisturizing and antiseptic properties. We have also been able to link sensory attributes, evaluated by human volunteers, with physicochemical characterizations. Furthermore, the in vitro ForceBoard™ method was developed further and we evaluated its potential to be used as an ex vivo method using excised skin. In addition, we have shown that that the water gradient over a biological barrier has a general relevance with respect to drug absorption and should be considered not only in dermaldrug delivery but also for buccal and nasal drug delivery.
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| 6. |
- Andersson, Frida
(författare)
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The female offender : patterning of antisocial and criminal behaviour over the life-course
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The studies included in the thesis illustrate the patterning of female offending over the life course. The overarching aim is to contribute to a better understanding of the female offender and of the heterogeneity in female criminal offending trajectories over the life course, and also of factors that differentiate between these trajectories. In order to extend the knowledge on individual predictors of female offending, the thesis analyses the correlations between offending and measures of crime propensity. Study I analyses sex differences in criminal career patterns using a group-based trajectory method. The overall conclusion is that the females in the study were much less predisposed to offend than the males, but when they did, they tended to follow a similar set of career trajectories. Four offending trajectories were identified for each sex, two sex-invariant and two sex-unique. Among both females and males, a group of Low Rate Desisters (LRD) and a group of High Level Chronics (HLC) were identified, which correspond with the groups commonly identified in earlier research focused on various cohorts. In addition, every sixth female offender was characterized as an Early Onset Desister (EOD). The offending pattern of this group was characterized by a very early onset of criminality, followed by almost no offending at all in the subsequent age categories. The second of the two female-unique patterns was denoted Adult Onset (AO). The offending pattern of this group was characterized by a late onset in crime followed by a high level of criminal activity over subsequent years. Studies II and III explore the within- and between-individual patterning of the different female offending trajectories identified in the Study I. Individual and social characteristics were investigated, along with the question of how such factors change and shape patterns of criminal involvement. Research has consistently shown that childhood risk factors appear to be important for distinguishing chronic from adolescent-limited offenders. Based on the data available to this thesis, the analyses confirm that this baseline assumption appears also to apply to females. The analyses show that it is possible on the basis of variables measuring different aspects of socio-demographic background and family functioning to separate offenders from non-offenders, and chronics from less severe offenders. Study III examines the AO group in more detail. Predictors in childhood and adolescence that are known to be related to chronic offending all produced significant effects in relation to memberships of the AO group. In addition, variables related to working class background, such as father’s occupation and coming from a family that had received social welfare payments during childhood, a low level of educational achievement and unemployment in adulthood, all seem to be related to the AO trajectory and indicate a need for further research. Studies I-III had provided indications of sex differences not only in criminal patterning but also in risk factors and life events and transitions. In Study IV, the aim was to try to identify and evaluate whether and how self-control and morality affect criminal activity for females and males respectively. Results from a split sample analysis showed that self-control was the strongest independent predictor for both sexes; further, self-control did not help explain the gender gap in offending. Overall, different aspects of morality also seemed to be powerful predictors of offending for both sexes. As regards the explanation of sex differences in offending, the impact of anticipated guilt appeared to be most important. No interaction effects were found between self-control and morality.
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| 7. |
- Andersson, Linda
(författare)
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Endocytosis by human dendritic cells
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Dendritic cells (DCs) are specialized antigen-presenting cells with the ability to internalize antigen, and present antigen-derived peptides to T cells. The functions of DCs depend on the subset, as well as their location and activation state. Immature DCs act as sentinels by continuously sampling the antigenic environment through various endocytosing mechanisms. The aim of this thesis was to investigate the use of dealuminated zeolites as a delivery tool to study the early events during endocytosis, including recognition and uptake, in human DCs. In the first study, we showed that dealuminated zeoilte particles can be used to follow endosomal acidification and proteolysis in human peripheral blood DCs. In the following studies we further investigated zeolite particles, and showed that they have a unique capacity to adsorb various biomolecules, proteins as well as differently charged lipids. This feature makes zeolites an ideal tool to study receptor-mediated endocytosis. Using zeolites coated with different ligands, we could show major differences in the endocytic capacity in human blood plasmacytoid DCs (pDCs) and myeloid DCs (mDCs). The pDCs showed an almost complete lack of endocytosis whereas the mDCs had an efficient selective receptor-mediated endocytosis of IgG-, LTA-, and LPS-coated zeolite particles. Furthermore, capture was strongly dependent upon the density of the ligands adsorbed onto the zeolite particles. In the last study, we used zeolites to compare endocytosing capacity in mDC and MoDC (monocyte-derived DC). We could show that these cell populations differ considerably in their ability to capture particles, immune complexes and soluble molecules. Therefore, in vitro generated MoDCs does not seem to be an applicable model for peripheral blood mDCs when studying the early events of endocytosis. In conclusion, zeolite particles provide a valuable tool to gain more understanding of the endocytosing mechanisms not only in DCs but also in other endocytosing cell populations.
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| 8. |
- Andersson, Lisa
(författare)
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Problematisk opioidanvändning : om opioidrelaterade dödsfall och LARO i södra Sverige
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Problematic opioid use constitutes an extensive global problem. Correspondingly, opioid-related mortality is high and has increased in several Western countries, including Sweden, during the 2000s. In Sweden, the most effective treatment method, opioid substitution treatment (OST), was for a long time limited with respect to the number of patients. The treatment was also characterized by strict rules and conducted in a high-threshold manner, which has meant that it has not been fully appealing to people with problematic opioid use. Therefore, in Skåne County in southern Sweden, patient choice of treatment provider was introduced for OST in 2014 with the intention to increase the number of treatment places and strengthen patient empowerment. The overall aims of this thesis are (1) to investigate opioid-related deaths in Skåne with a focus on contact with care-providing authorities and in relation to increased access to OST, and (2) to examine patients’ and clinic managers’ attitudes towards the introduction of the patient choice reform for OST and their views of the reform's objectives of increased accessibility to OST and strengthening patients' empowerment and influence over their treatment.The four papers in this thesis are based on two research projects with various empiric material. Paper I and II are based on data on opioid overdose deaths from a period of two years before and two years following the introduction of the patient choice reform. Forensic data regarding the presence of various substances and which opioid caused the death, as well as demographic data and information on contact with care-providing authorities (health care, social services, and the Prison and Probation Service), were collected. Paper I examines clinical background and contact with care-providing authorities of opioid-related fatalities, as well as differences with regard to which opioid caused the death. Paper II examines the possible impact of the intervention on the development of opioid-related deaths in the region. National mortality data were also used in this study to investigate the development in Skåne compared to the rest of Sweden. The second research project focused on stakeholders’ views on the implementation of the patient choice reform. Paper III includes interviews with 33 OST patients, and paper IV consists of interviews with the managers of all OST clinics in Skåne. The results from paper I show that of the 180 deceased in opioid overdose included in the study, almost 90 per cent had been in contact with one of the examined care-providing authorities during the year prior to death. Few differences appeared with regard to which opioid contributed to the death. Paper II indicates that there has been no significant change in opioid-related deaths in Skåne after the patient choice reform and increased access to OST. An analysis on national mortality data however showed a significant yearly decrease in drug-related deaths in Skåne compared to other Swedish counties in the years following the reform (2015–2017). No change was noted in deaths related to methadone or buprenorphine in Skåne. The proportion of deaths among patients in OST increased after the introduction of the reform. The third paper indicates that patients in OST in Skåne have gained increased empowerment and influence over their treatment since the patient choice reform was introduced. Patients especially appreciated the knowledge that they could make an exit and change clinics if they so wished, even if they so far had chosen not to. In paper IV, the clinic managers were largely positive to the trend towards increased influence for patients over their treatment situation. They were more critical of the fact that there was no major differentiation between treatment providers, and that the competition that arose after the patient choice reform mainly was related to prescribing benzodiazepines.Conclusions drawn from the papers in this thesis include that patient choice of treatment provider can be viewed as a means of empowerment for patients in OST, which was regarded as positive by both patients and treatment providers. The limitations of such a system for providing OST that emerged were lack of diversity between clinics and that the competition between treatment providers largely comprised of differing views on the prescription of benzodiazepines. Further, improved access to low-threshold OST in Skåne was not associated with an increased overdose death-rate. The result that people who died from opioid overdose to a very large extent are known to society’s care-providing authorities suggests that there are considerable opportunities to reach people with problematic opioid use for therapeutic and harm reducing measures such as low-threshold OST and take-home naloxone.
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| 9. |
- Andersson, Mika
(författare)
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Hate crime victimization : consequences and interpretations
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The field of hate crime studies is a young one and as such it is characterized by a high proportion of explorative and inductive studies. This methodological approach is well founded when a field is unfolding as they often generate theoretical conclusions or assumptions. Since I began working with the present dissertation in 2013, I have observed an increased tendency towards deductive studies testing the conclusions and assumptions made by field pioneers. The present dissertation is part of this branch and has two primary aims; 1) to test field assumptions and 2) develop present theoretical frameworks on causes and consequences of hate crime.In Article 1, me and my co-author examine the assumption that hate crime victimization result in higher levels of fear in comparison to non-bias crime. The assumption is tested by comparing fear of crime, behavioral adaptations and place-based worry among students with an immigrant and/or national minority background. The results show that hate crime victims reported significantly higher levels of fear of crime in comparison to non-victims and non-bias victims. However, there were few significant differences in behavioral adaptations and place-based worry. From interviews with hate crime victims we learned that place-based worry is not primarily associated with the physical characteristics of a certain area, but geographical concentrations of racist attitudes. Moreover, the behavioral adaptations that the interview participants used to avoid future victimization were often based upon de-identification. From these results we can conclude that traditional measures of place-based worry and behavioral adaptations does not adequately capture consequences of hate crime.In Article 2, me and my co-authors examine the assumption that police reporting is lower among victims of hate crime that target more than one of their identity categories. Contrarily to the assumption, we find that victims of hate crime with multiple motives report their experiences to the police to a higher extent in comparison to victims of hate crime with single motives. We also found that participants with several intersecting group identities endowed with stigma were more likely to be targets of hate crime with multiple motives, but not more likely to experience repeat victimization. These results support the branch of intersectional theory holding that group belongings primarily influence the expressions of violence rather than the risk of being subjected to violence.In Article 3, me and my co-authors examine the assumption that hate targets the identity of the victim and thereby attack the core of the victim’s self. We found that hate crime targets a negative stereotype associated with the perceived identity of the victim. Consequently, interview participants did not regard hate crime as a direct attack on their selves as they did not identify with the negative stereotype. However, hate crime remain a violation of the self as it denies the victims self-representation. The results also showed that the meaning-making regarding hate crime victimization is reflexive as the participants used earlier experiences when assigning meaning to incidents. This process was also recursive as new incidents lead to re-interpretations of previous experiences. In sum, the participants developed and negotiated their experiences of hate crime over time.In Article 4, me and my co-authors examine the assumption that vicarious victims respond in similar ways as direct victims since hate crime signal the presence of threat beyond the initial victim, sometimes referred to as the in terrorem effect. We examine the in terrorem effect by comparing fear of crime between non-victims, vicarious victims of hate crime, and direct victims of hate crime in three communities; women, Muslims and sexual minorities. The results showed that direct victims were generally more afraid of crime in comparison to non-victims in all communities. Though not all differences were significant, the reaction pattern among non-victims, vicarious victims and direct victims in the studies commu-nities showed the pattern of a stair, with the lowest rates among non-victims and the highest rates among direct victims. These results thereby contradict the proposed pattern of the in terrorem effect in which vicarious victims and direct victims are held to react in similar ways.In sum, the results of the present dissertation call for a more complex understanding of both individual and community effects of hate crime. The theoretical development and integration in Chapter 3 along with the results of Articles 1-4 results in hypotheses for future research on causes and consequences of hate crime in Chapter 6.
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| 10. |
- Annersten Gershater, Magdalena
(författare)
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Prevention of foot ulcers in patients with diabetes mellitus
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Amputation in patients with diabetes mellitus preceded by a foot ulcer is a serious complication. Patients with the highest risk of developing a foot ulcer are often found in home nursing settings. The overall aim was to focus on how registered nurses are working with prevention of foot ulcers in patients with diabetes mellitus in outpatient settings: - to identify factors related to short term outcome of foot ul-cers in patients treated in a multi-disciplinary system until healing was achieved. - to assess what was documented by registered nurses regarding diabetes care in a Swed-ish municipality’s home nursing service; to what extent nursing actions were planned for, performed and evaluated according to the goals of metabolic control, treatment and prevention of complications.- to explore registered nurses’ professional work with foot ulcer prevention in home nursing settings. - to explore whether participant driven group information has an impact on ulceration in a patient group with previ-ous diabetes foot ulcer. Study I used logistic regression analysis to identify factors related to outcome in a cohort of 2480 consecutive patients with diabetic foot ulcer at a multidisciplinary foot clinic. Results: Healed primarily: 65% (n=1617), 9% (n=250) after minor am-putation, 8% (n=193) after major amputation and 17% (n=420) died unhealed. Primary healing was related to co- morbidity, duration of diabetes, extent of periph-eral vascular disease and type of ulcer. In neuropathic ulcers, deep foot infection, site of ulcer and co-morbidity was related to amputation. In neuro-ischemic/ischemic ul-cers amputation was related to co morbidity, peripheral arterial disease and type of ulcer. Study II was a cross sectional assessment of all nursing records of patients with dia-betes (N=172) in a municipality’s home nursing setting and analyzed with manifest content analysis. Results: The overall standard of nursing records was insufficient. Evaluation of blood glucose was documented in 61% (n=105) of the records, weight was documented in 6% (n=10), blood pressure in 10% (n=17) and ongoing foot ul-cers were documented in 21% (n=36). Study III was a qualitative interview study of 15 registered nurses from four munici-palities, analyzed with manifest content analysis. Results: Registered nurses in home nursing settings worked mainly through health care assistants. The nurses used lead-ership and education as the main tools to enable the nursing process. They mainly relied on experience based competence. Study IV was a randomized controlled trial comparing participant driven education in group with standard information, in patients with diabetes and previous foot ul-cers. An interim analysis was made 6 months after intervention of 131 included pa-tients. Results: After 6 months follow up, 58% (n=57) of the 98 evaluated patients had not developed a new foot ulcer. There was no statistical difference between the two interventions. The most common reasons for ulceration were plantar stress ulcer and minor external trauma. Five patients had deceased and 10 had withdrawn con-sent to participate. Conclusion: Patients with diabetes and high risk of developing foot ulcer constitute a fragile group that needs special foot protective attention. This requires a well edu-cated staff in the home nursing organization. In the future patient education should target low risk patients.
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