| 1. |
- Syrén, Eva-Lena
(författare)
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Risk factors for and Strategies to Prevent Complications of Endoscopic Retrograde Cholangiopancreatography
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of this thesis was to study risk factors for and strategies to prevent complications of Endoscopic Retrograde Cholangiopancreatography (ERCP). Methods: Prospectively registered data from the Swedish National Quality Register for Gallstone Surgery and ERCP (GallRiks) 2006-2018 were retrospectively retrieved and reviewed. In Study I, ERCP procedures performed for common bile duct stones (CBDS), were analysed and cross-checked with the National Patient Register (NPR) in order to assess risk factors for post-ERCP pancreatitis (PEP). In Study II, different techniques for CBDS clearance over time at different hospital levels and the effectiveness and safety of postoperative rendezvous ERCP compared to intraoperative rendezvous ERCP were studied. In Study III, the rate of postoperative cardiovascular events in CBDS-patients treated with ERCP only, cholecystectomy only, cholecystectomy followed by delayed ERCP, cholecystectomy together with ERCP, or ERCP followed by delayed cholecystectomy were analysed. In Study IV, associations between ERCP success and complications, and endoscopist- and centre case-volumes regarding procedures for CBDS, and suspected or confirmed malignancy were analysed. Results: Women, patients<65 years, patients with hyperlipidaemia, and those with a previous history of recent acute pancreatitis had a higher risk for PEP, while patients with diabetes had a lower risk (all p<0.05). Intraoperative ERCP increased during the period of the study, whereas preparation for postoperative ERCP decreased. CBDS management differed between different hospital levels. Total rate of intra- and postoperative complications as well as intraoperative bleeding, postoperative bile leakage, and postoperative infection with abscess were higher in the postoperative rendezvous ERCP group (all p<0.05). However, PEP, postoperative bleeding, cholangitis, percutaneous drainage, antibiotic treatment, ICU stay, readmission/reoperation within 30 days, and 30-day mortality did not differ between the groups. Nor did risk for cardiovascular complication or death within 30 days differ between patients treated for CBDS by cholecystectomy and/or ERCP. A high endoscopist case-volume was associated with higher successful cannulation rate and lower PEP rate (p<0.05). Centres with a high annual case-volume were associated with higher successful cannulation rates (p<0.05). Conclusions: Age, sex, hyperlipidaemia, and previous history of recent acute pancreatitis all increased the risk for PEP while diabetes reduced the risk. Techniques for management of CBDS discovered at cholecystectomy have changed over time and differ between hospitals levels. Though intraoperative rendezvous ERCP is the method of choice, postoperative rendezvous ERCP is an acceptable alternative when adequate ERCP resources are lacking or limited. Primary ERCP as well as cholecystectomy for CBDS may be performed with acceptable safety. Higher endoscopist- and centre case-volumes lead to safer and more successful ERCP.
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| 2. |
- Bolin, Malin, 1974-
(författare)
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The importance of organizational characteristics for psychosocial working conditions and health
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The importance of organizations for understanding differences in the working conditions and health of employees is often emphasized but rarely explored empirically. The general aim of this thesis is to describe organizational characteristics of workplaces, and to assess their impact on the psychosocial working conditions and health of employees. In modern working life, it is assumed that employees' working conditions and health are affected by a general transformation of workplaces from bureaucracy to post-bureaucracy. The organizational data used are based on structured interviews with managers at workplaces in different types of operations in mid-Sweden, whereas the individual data consist of a questionnaire to all employees working in the participating workplaces, resulting in a dataset of 90 workplaces and 4306 individuals. Descriptive analysis was carried out for comparison of organizational characteristics in different types of operations, while multilevel analysis was applied to investigate the magnitude of the organizational impact on psychosocial working conditions, and to analyze associations between organizational characteristics, psychosocial working conditions and health. The results showed that the workplaces were mainly displayed by a combination of bureaucratic and post-bureaucratic characteristics, and these were unequally distributed between types of operations. A systematic variation in the psychosocial working conditions and health of employees was found between workplaces, and the variation in psychosocial working conditions was attributed to several organizational levels. The variation between workplaces was explained by both organizational characteristics of the workplaces and individual characteristics of the employees. Formalization, centralization, job enrichment, individual responsibility, soft control systems, and performance control were associated with psychosocial working conditions when controlled for occupational class, gender and age of employees, and a high degree of customer adaptation was associated with increased sickness absence of employees. It is concluded that bureaucracy and post-bureaucracy should not be regarded as dichotomies. Organizational characteristics of workplaces have an impact on the psychosocial working conditions and health of employees beyond occupational class. This has implications for both the theory and the practice of occupational health research.
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| 3. |
- Svensson, Birgitta, 1974-
(författare)
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Barn som riskerar att fara illa i sin hemmiljö : Utmaningar i ett förebyggande perspektiv
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BaksidestextBarnmisshandel är ett omfattande folkhälsoproblem med långsiktiga negativa konsekvenser för den enskilda individen och för samhället i stort. Förebyggande insatser kan vara livsavgörande för de utsatta barnen. Denna avhandlings övergripande syfte var att öka kunskapen om barn som riskerar att fara illa i sin hemmiljö samt att identifiera utmaningar i ett förebyggande perspektiv. Två områden har studerats:(1) Våld mot barn med långvarig sjukdom/funktionsnedsättning(2) Förskolan som upptäckande och stödjande arenaGemensamt för inriktningarna är att barn med långvarig sjukdom/funktionsnedsättning och barn i förskoleåldern utgör särskilt sårbara grupper, som löper ökad risk att fara illa i sin hemmiljö. De har också unik kontakt med professionella med möjlighet att upptäcka och agera vid oro.Avhandlingen bygger på fyra delstudier; en nationell kartläggning riktad till skolelever, en intervjustudie med föräldrar samt två förskolestudier. Resultaten från studierna diskuteras utifrån identifierade utmaningar i ett förebyggande perspektiv. Utmaningarna inkluderar emotionella hinder samt behov av ett mer nyanserat och proaktivt förhållningssätt för att kunna utveckla tidiga insatser till barn och föräldrar.
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| 4. |
- Arkkukangas, Marina
(författare)
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Evaluation of the Otago Exercise Programme with or without motivational interviewing : Feasibility, experiences, effects and adherence among older community-dwelling people
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Falls and injuries related to falls are one of the most common health problems among older people and are becoming increasingly more frequent. Regular exercise has been identified as one of the most effective fall-prevention activities for older people; however, awareness of the impact of exercise programmes and adherence to recommended exercise among the elderly population is generally low. Research examining how an exercise programme is administered to and experienced by elderly community-dwelling people is needed.The overall aim of this thesis was to investigate the feasibility, experiences and effects of and adherence to the fall-preventive Otago Exercise Programme (OEP) with or without motivational interviewing (MI) among community-dwelling people aged 75 years or older.Four studies were performed from October 2012 to May 2016 in a sample of 175 people. Both quantitative and qualitative research methods were used. The methods included the feasibility for conducting a randomized controlled trial (RCT) (I), individual face-to-face interviews (II), an RCT (III) and a prospective cohort study (IV). The intervention was given to two groups. The participants who received OEP with or without MI were compared with a control group that received standard care.The feasibility of performing an exercise intervention with or without MI was acceptable from the perspective of the participating physiotherapists. From the perspective of the older participants performing the exercise with behavioural change support, the inclusion of monitored exercises in everyday life and daily routines was important. The participants also expressed experiencing more strength, improved physical functioning and greater hope for an extended active life during old age.From the short-term perspective, there were significant improvements within the OEP combined with MI group in terms of physical performance, fall self-efficacy, activity level, and handgrip strength. Improved physical performance and fall self-efficacy were also found within the control group; however, corresponding differences did not occur in the OEP group without MI. There were no significant differences between the study groups after 12 weeks of regular exercise. Adherence to the exercises in the pooled exercise group was 81% at the 12-week follow-up.At the 52-week follow-up, the behavioural factors being physically active and obtaining behavioural support in terms of MI had a significant association with adherence to the exercise programme.These studies provide some support for the combination of OEP with MI as the addition of MI was valuable for achieving adherence to the exercise programme over time in older community-dwelling people.
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| 5. |
- Eriksson, Staffan, 1969-
(författare)
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Falls in people with dementia
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Falls and concomitant injuries are common problems among large groups of the elderly population, leading to immobility and mortality. These problems are even more pronounced among people suffering from dementia. This thesis targets fall risk factors for people with dementia in institutions. The overall aim of this thesis was to investigate risk factors for falls, predisposing as well as related to circumstances surrounding falls, and to do this as efficiently as possible. In a prospective cohort study including residents of residential care facilities with and without dementia, the fall rate was higher for those with dementia, the crude incidence rate ratio (IRR) was 2.55 (95% CI 1.60–4.08) and the adjusted IRR was 3.79 (95% CI 1.95–7.36). In the group of people suffering from dementia, including 103 residents, a total of 197 falls resulted in 11 fractures during the 6-months follow-up period. From the same baseline measurements 26% and 55%, respectively, of the variation in falls could be explained in the group of residents with and without dementia. Fall predictors significantly and independently associated with an increased risk of falls in the group of people suffering from dementia were the category “man walking with an aid” and the use of more than four drugs. In a prospective cohort study, including 204 patients in a psychogeriatric ward, a total of 244 falls resulted in 14 fractures. Fall predictors significantly and independently associated with an increased risk of falls were male sex, failure to copy a design, use of clomethiazole, and walking difficulties. Treatment with statins was associated with a reduced risk of falls. With these fall predictors in the negative binomial regression (Nbreg) model, 48% of the variation in falls was explained. The data from the psychogeriatric ward were also analysed with the use of partial least squares regression (PLS) and regression tree to be compared with the results of the Nbreg analysis. PLS and regression tree are techniques based on combinations of variables. They both showed similar patterns, that a combination of a more severe level of dementia, behavioral complications and medication related to these complications is associated with an increased fall rate. Thirty-two percent and 38%, respectively, of the variation in fall rate were explained in the PLS and regression tree analysis. The circumstances surrounding the falls in the psychogeriatric ward were analysed. It was found that the fall rate was equally high during the night and the day. A large proportion of the falls was sustained in the patients’ own room and a small proportion of the falls was witnessed by the staff. This pattern was even more pronounced during the night. The proportion of diurnal rhythm disturbances and activity disturbances was higher for falls at night than for falls during the day. Circumstances associated with an increased risk of falls, as shown by a short time to first fall, were anxiety, darkness, not wearing any shoes and, for women, urinary tract infection. The proportion of urinary tract infection was also higher in connection to falls sustained by women than to falls sustained by men. This thesis confirms that people suffering from dementia are prone to fall. Walking difficulties, male sex and impaired visual perception are factors that should be considered in the work of reducing falls among people suffering from dementia. Furthermore, falls at night, behavioral complications and medication related to these complications should also be considered in this work, especially as the dementia disease progresses. A larger portion of the variation of the outcome variable was explained by the Nbreg model than the regression tree and PLS. However, these statistical methods, based on combinations of variables, gave a complementary perspective on how the fall predictors were related to falls.
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| 6. |
- Eriksson, Ulla-Britt, 1949-
(författare)
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"Man är ju inte mer än människa" : Långtidssjukskrivning ur ett emotionellt, relationellt och strukturellt perspektiv
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The background to this thesis is the dramatic increase of the long-term sickness absence that took place in Sweden from the late 1990s. There was also a shift in the diagnostic pattern with rising mental diagnoses. The overall purpose was to describe and try to understand the process leading to long-term sickness absence from the perspective of the sickness absentees, in order to get a better knowledge base for preventive and rehabilitative actions. The thesis comprises four studies (I-IV). Research methods have been both qualitative and quantitative. In study I data from individual interviews with 32 persons on long-term sick leave due to burnout was analyzed using a grounded theory approach. In study II the study population comprised of 2064 employed sick-listed persons, a sub sample derived from the 2002 national Swedish survey on health, working conditions, life situation and sick-listing. It was analyzed if persons with burnout had higher probability of having experienced the steps in the burnout staircase compared to other diagnostic groups in accordance with the previously suggested hypothesis of "the burnout staircase". Study III comprised of 2521 employed persons, a sub sample derived from the same national survey as in study II. It was analyzed if psychosocial work environment and conflicts and losses in private life independently or in combination were more strongly associated to sickness absence with mental diagnoses as compared to a healthy population. In study IV individual interviews with 25 professional rehabilitation actors and 14 unemployed sick-listed persons were conducted. Data were analyzed according to grounded theory method. The process that led to sicknes absence can be described as an emotional deprivation process, illustrated as a flight of stairs (the burnout staircase) describing a sequence of steps toward sickness absence (I). In accordance with the tested hypothesis persons with burnout to a noticeable higher extent reported expereince of being in the different steps in the burnout staircase compared to sickness absentees with other diagnoses. The model seemed to be valid also for persons with other mental diagnoses (II). Reorganization and conflicts at work as well as adding adverse private life events were associated with increased risk for sickness absence with mental diagnosis (III). Three significant factors behind the weak co-operation between local social insurance and employment agencies were identified: indistinct regulation of co-operation, shifting political goals over time and conflicting goals between agencies (IV). In this thesis it has been suggested that the course of events preceding sickness absence might be understood as a process of emotional deprivation, where the individual is gradually emptied of the life-giving emotional energy revealed in joy, commitment, and empathy. This life-giving force finds its nourishment in safe and secure social relations with others and in a social structure that promotes this type of social relations. The profound changes in the Swedish labour market during the 1990s influenced not just the psychosocial work climate but also the rehabilitation efforts for unemployed sick-listed persons. When the political goal of reducing the unemployment level came to the forefront the indistinct regulation and the conflicting goals in addition were factors that impaired co-ordinated rehabilitation. In this process also the physicians were involved. A labour market problem was turned into a medical problem.
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| 7. |
- Hersi, Abdi-Fatah, 1989-
(författare)
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Superparamagnetic iron oxide nanoparticles, a novel tracer in breast cancer surgery
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The most common surgical choice of treatment in breast cancer is breast-conserving surgery (BCS) together with sentinel lymph node biopsy (SNB). Around 10% of breast cancer diagnosis are ductal carcinoma in situ (DCIS). Superparamagnetic iron oxide nanoparticles (SPIO) are a novel tracer for sentinel lymph node (SN) detection. The aim of this thesis was to investigate the unique applications and functionality of a magnetic approach in breast cancer surgery.Paper I was a two-centre pilot study of 32 patients with non-palpable breast cancer who were scheduled for BCS together with SNB. They received SPIO for SNB and a magnetic seed (Magseed®) for localization of the breast tumour. All 32 patients underwent microscopically radical resection and SNB was successfully performed in all included patients.Paper II was a multicentre prospective single-cohort study. It was a pre-planned interim analysis of 189 patients with “high-risk” DCIS who received SPIO at primary surgery but without performing SNB. If an invasive breast cancer was shown by the final histopathology report, the patient was scheduled for second surgery to undergo SNB. Because SPIO has a much longer half-life than the radioisotope, the magnetic signal at the second surgery was sufficient for detecting SNs; in fact, in patients with DCIS, it reduced from around 50% to 22%. Paper III was a multicentre prospective trial. Two consecutive cohorts of patients with breast cancer scheduled for SNB (n = 328) were included. Lower doses of a refined SPIO suspension were tested in different time frames and injection sites. Analyses were performed as a one-step individual patient-level meta-analysis using patient-level data from a similar previous cohort (n = 206) as a third reference group. In 534 patients, the SPIO SN detection rates were comparable (97.5% vs. 100% vs. 97.6%, p = 0.11) and were noninferior to the dual technique. Paper IV was a multicentre randomized pilot trial aimed to compare tumour localization in nonpalpable breast cancers using either Magseed® or guidewire in patients scheduled for BCS + SNB. All patients received SPIO for the SNB preoperatively. Patients who were randomized to the magnetic seed cohort received their Magseed® at the same time as the SPIO injection preoperatively while the guidewire placement was performed on the same day as surgery. In 207 patients, there were no significant differences in reoperation rate (3% in the magnetic seed cohort vs 7% in the guidewire cohort, p = 0.35).
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| 8. |
- Jazrawi, Allan
(författare)
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Optimizing the magnetic tracer technique for sentinel lymph node detection and tumour localization in breast cancer surgery
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Breast cancer is the most common form of cancer in women, and the primary treatment modalities are still breast-conserving surgery (BCS) and sentinel lymph node dissection (SLND) in most cases. Superparamagnetic iron oxide nanoparticles (SPIO) are gaining momentum as a tracer for sentinel lymph node detection. The aim of this thesis is to further refine the magnetic method and investigate its postoperative effects.Paper I: This feasibility study, involving 79 patients, explored the use of SPIO-guided Magnetic resonance imaging (MRI)-lymphography and magnetic-guided axillary ultrasound (MagUS) with core biopsy for sentinel lymph node (SLN) localization and SLN status. MagUS, outperformed baseline axillary ultrasound and successfully traced SLNs in all cases, detecting macro-metastases accurately and missed only one micro-metastasis. The findings suggest that the MagUS technique enables minimally invasive approach in axillary mapping that can meet tailored patient needs and reduce the need for diagnostic surgery. Paper II: This study aimed to compare skin staining incidence and size between different doses of SPIO and blue dye (BD), evaluating their persistence over time. Among 270 women receiving SPIO, 204 also received BD. At six months, 21.5% had SPIO stains and 25% had BD stains Incidence and size decreased reciprocally, with no significant difference between the tracers regarding skin staining after 24 months. Paper III: This study compared the magnetic technique using Magseed® for non-palpable breast tumor localization with guidewire localization and SPIO for sentinel lymph node detection. In a prospective analysis of 426 women, reoperation rates, resection ratios, and SLN detection were assessed. No significant differences were found between the techniques in terms of re-excisions, resection ratios, or SLN detection. However, the magnetic technique showed more successful localizations, shorter operation time, and better overall experience among surgeons, radiologists, and theater coordinators, making it a good alternative for BCS.Paper IV: In this prospective observational study, the impact of postoperative MRI outcome was explored in patients undergoing BCS with a peritumoral SPIO injection for SLN detection. The study affirms SPIO as a safe tracer for SLN detection without compromising MRI interpretation after BCS, ensuring reliable breast cancer recurrence assessment.
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| 9. |
- Lundberg, Martin, 1964-
(författare)
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Överläggningar om hållbar utveckling : En studie av studiecirkelsamtal
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Studiecirkeln är en pedagogisk praktik som tillskrivs en roll i den svenska demokratin. Studiecirkelns genomförande svarar väl mot en demokratisk praktik som framställs i deliberativ demokratiteori. Avhandlingens idé är att belysa deliberativ demokratiteori med empiri. Med studier av studiecirkelsamtal ges möjlighet att diskutera teorin med samtalsdata. Samtalsdata genererades genom analyser av ett videoinspelat cirkelsamtal som handlade om hållbar utveckling. Studiens teoretiska ram visar fyra olika bidraga till den deliberativa demokratiteorin. Dessa presenteras i en indelning som skiljer mellan något som i avhandlingen kallas för den rationella argumentationens överläggning och en retoriskt orienterade överläggning. Genom denna indelning ges fler möjligheter att tolka fenomen i samtalsempirin och vice versa. Beträffade åsiktsbildningen i studiecirkelsamtalet finner man att cirkeldeltagarna berör en mängd olika företeelser. I detta urskiljs deltagares egna åsikter samt föreställningar som är producerade i normativa sfärer. Samtalsprocessen kännetecknas att den varierar från en period till en annan. Det gör att tillgängligheten för deltagare att kunna bidra med och ta del av yttranden varierar. Resultaten reser frågor till teorin om tolkningen av vissa begrepp.
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| 10. |
- Andersson, Staffan, 1969-, et al.
(författare)
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Democracy and technocracy in Sweden's Experience of the COVID-19 Pandemic
- 2022
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Ingår i: Frontiers in Political Science. - : Frontiers Media S.A.. - 2673-3145. ; 4, s. 1-13
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Tidskriftsartikel (refereegranskat)abstract
- Sweden’s management of the coronavirus pandemic, beginning in early 2020, hasbeen much discussed because it deviated from other countries’ equivalents. Set inthe context of scholarly debate about the balance between politicians and experts inpolitical decision-making, we argue that a necessary condition for this case of Swedishexceptionalism was the manner of policy-making adopted by the Swedish authorities. Inthis article, we describe this policy-making procedure, which involved a radical form ofdelegation by elected politicians to appointed experts, and seek to explain how it cameabout. We focus on the 1st year of the pandemic, and use media reports and other publicdocuments, including parts of a public inquiry, as our empirical material.
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