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- Lannering, Christina
(author)
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Experiences and outcomes of systematic preventive work to reduce malnutrition, falls and pressure ulcers in nursing home residents
- 2018
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Doctoral thesis (other academic/artistic)abstract
- Background: Older people living in nursing homes are at a high risk of becoming malnourished, falling and developing pressure ulcers. In Sweden the national quality registry Senior Alert was developed to support prevention in these areas. Prevention according to Senior Alert follows a preventive care process of four steps, including risk assessment, analysis of the causes of risk, to determine and perform appropriate actions, and finally, to evaluate the care given.Aim: The overall aims of this thesis were to investigate how the preventive care process in Senior Alert functions as a tool for preventive work among older persons living in nursing homes, and to investigate the results of risk assessments and actions.Design: The thesis is based on three longitudinal quantitative studies (I, III, and IV) and one qualitative study (II). In Studies I and III, process- and patient results were compared among different groups of nursing home residents, with a follow-up time of 6 months. In Study IV, associations between the assessment instruments and the outcomes of weight loss, falls and pressure ulcers were investigated. The qualitative study (II) was based on focus group interviews with healthcare professionals and was analyzed using content analysis.Results: The residents included in the registry during the later years (2013-2014) had a higher proportion of registered preventive actions in the three areas, and were followed up more frequently regarding weight and new assessments than residents included during the earlier years (2010-2012). Nevertheless, regardless of risk, only 30% were reassessed, and 44% of the residents at risk for malnutrition were followed up for body weight within 6 months. No difference in weight change was found between a group of residents included in Senior Alert and a second group receiving ‘care as usual’. Generally, the mobility variables in the risk assessment instruments had the strongest associations with the tested outcomes of weight loss, fall and pressure ulcers, albeit in different ways. Healthcare professionals described that Senior Alert stimulated better teamwork while at the same time they experienced the increased documentation and time constraints as aggravating circumstances. They also described a lack of reliability of the assessment instruments in that they overrated the risks compared to their own clinical judgement. Healthcare professional’s knowledge about the evaluation part of the process was low.Conclusion: The evaluation and follow-up step of the preventive care process was not sufficiently applied. This was expressed by the participants in the focus groups and was also reflected in registry data by the varying time to follow-up and the poor event registration. As a consequence, the sample to measure outcomes within 6 months became small. Therefore, larger samples are needed to study longitudinal outcomes, if a fixed system-mandatory time point for follow-up is not implemented. A committed leadership is important to improve the preventive work and to stimulate follow-up of results.
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| 2. |
- Petersson Bloom, Linda
(author)
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Equity in education for autistic students : professional learning to accommodate inclusive education
- 2022
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Doctoral thesis (other academic/artistic)abstract
- Purpose: This thesis aims to explore if and how professionals’ participation in professional development enhances the quality of education for autistic students, including the perspectives of autistic students, their parents, and professionals in pre- and primary school. Furthermore, the thesis directs attention to how professional development may lead to the development of accommodations in the learning environment to support autistic students. Four studies have been conducted to fulfil the aim, which in combination answer the research questions addressed in this thesis. The four studies comprise one systematic review and three empirical studies. Study I, the systematic research review, explored adaptations and modification strategies. Study II investigated how a professional development intervention designed as a lesson study changed attitudes and practices amongst preschool professionals. Studies III–IV were developed from study II, and used professional development to explore changes in the preschool (study III) and primaryschool (study IV) practice. In these studies, multiple stakeholders were included; professionals (teachers, pre- and school management), autistic students, and their parents.Theoretical frameworks: Pragmatism is used as the umbrella framework capturing the methodology and methods, in combination with Communities of Practice (CoP) and Landscapes of Practice (LoP), are used to explain and discuss the results of the thesis.Design/Approach/Methods: A multilevel mixed methods research design was applied in this thesis. Following the concept of mixed methods, the integration was applied in three phases: research design, methods, interpretation and reporting. In the three empirical sub-studies, variants of mixed methods were alsoused in the designs. The results of the sub-studies are synthesized with a narrative synthesis.Findings: The results from the synthesized sub-studies indicate that professional development contributes to changes in professionals’ attitudes, increased knowledge, and strategies to accommodate, the latter more vaguely. Professionals could identify more changes than parents and autistic students. Barriers to implementation were found, such as lack of resources and physical environment. Enabling factors were identified as participation (collaborative aspects). Discrepancies were detected across participants and contexts.Conclusions: Based on the results of the included studies and the synthesized result, it is possible to conclude that professional development can contribute to changes, most prominent when exploring professionals’ views. The more distinct changes resided in changes and development in attitudes contributing to changes in mindset and increased knowledge. Furthermore, a lack of prerequisites, such as resources, may hinder the sustainability of professional development and, on a larger scale, inclusive education, which needs to be addressed further. To conclude equity for autistic students is a challenging issue for the Swedish school context, and is not yet fulfilled for this student group.Originality/Value: This thesis offers insights into a complex area, includes multiple stakeholders and provides a comprehensive understanding of the phenomena. Including young autistic students as active participants could be considered to be of great value. The findings could be of interest to both the research community and school practice.
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| 4. |
- Andersson Järnberg, Linda, 1969-, et al.
(author)
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Willingness to pay for private and public improvements of vulnerable road users’ safety
- 2021
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Reports (other academic/artistic)abstract
- A frequent finding in the empirical literature on cost-benefit analysis of traffic safety measures is that valuations of public goods are lower than valuations of private goods, contrary to theory predictions. This study elicits the willingness to pay for publicly and privately provided safety improvement benefiting cyclists and pedestrians, a relatively neglected group in this literature. Our results suggest that there is no significant difference between valuations of a private good and three versions of a public good as long as the good itself is the same, in our case a mobile phone app. The public good versions differ in attributes such as mandatory or voluntary use and private or public provision institutions. This finding is consistent with the simultaneous presence of both financial altruism and safety altruism, or neither. Public institutions are preferred to private ones in the provision of the public goods, and voluntary participation is preferred to mandated regulation. We also find evidence that attitudes that favor using taxes to fund traffic safety projects, and public responsibility for traffic safety are associated with a higher willingness to pay.
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- Värja, Emelie, 1985-
(author)
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Local public expenditure : Equality, quality and growth
- 2016
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Doctoral thesis (other academic/artistic)abstract
- The focus of this dissertation is local government expenditure, where growth, quality, and equality is in the center of attention Essay 1: Sports and Local Growth in Sweden: Is a Sports Team Good for Local Economic Growth? The purpose of Essay 1 is to analyzethe effect of professional sports on the municipality’s tax base. I find no indications of a positive effect on the growth rate of per capita income from having a team in the top series. Essay 2: Equality of Quality of Day Activity Service Programs in Sweden. In this Essay we investigates the equality of the day activity service programs for people with intellectual disabilities provided by local governments in Sweden. The findings are that despite the Act concerning Support and Service for Persons with Certain Functional Impairments intended to secure equality in living conditions, the quality of day activity service programs seems to be dependent on the local government’s tax base as well as the political preferences. In Essay 3: Analysis of Cost and Quality Indicators of Day Activity Service Programs in Sweden, we analyze the distribution of observable quality indicators for daily activity service programs. We find that municipalities that conduct regular user surveys find reasons to spend more per user on average. Additionally, the probability for transitions to employment at a regular workplace is higher in municipalities where as a routine a review is made of whether each participant can be offered an internship or work. The objective of Essay 4: The Composition of Local Government Expenditure and Growth: Empirical Evidence from Sweden, is to analyze whether there is a possibility of enhancing the average income growth rate at the local level by redistributing expenditure between main functional areas of local governments, while keeping the budget restriction fixed. We find that devoting large shares of expenditure on areas that increase labor supply, such as child care are positively related to growth in income. Additionally we find that spending areas previously categorized as productive can have a non-linier relationship with growth.
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