| 1. |
- Johansson, Anna, 1965-
(författare)
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Sleep-Wake-Activity and Health-Related Quality of Life in Patients with Coronary Artery Disease and evaluation of an individualized non-pharmacological programme to promote self-care in sleep
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Sleep is a basic need, important to physical and psychological recovery. Insomnia implies sleep-related complaints, such as difficulty falling asleep, difficulty staying asleep, early awakening, or non-restorative sleep (NRS) in an individual who has adequate circumstances and opportunity to sleep. Insomnia is also related to impairment of daytime functions. The prevalence of reported sleep disturbances varies between 15% and 60% in patients with coronary artery disease (CAD) up to five years after intervention. Disturbed sleep may have a negative impact on self-care capacity and behaviours. Little attention has been given to evaluation of sleep promotion through individualized non-pharmacological interventions among CAD patients.The overall aim of this thesis was to describe the impact of sleep quality and disrupted sleep on health-related quality of life (HRQoL) in patients with stable CAD, in comparison to a population-based group. The objective was also to evaluate an individualized non-pharmacological programme to promote self-care in sleep.Four studies were conducted during seven years, starting in 2001. Patients from six hospitals in the south of Sweden were invited to participate. In addition, an age and gender matched population-based group was randomly selected during the same period as the patients and was used for comparison with the CAD patients in two of the studies. Data was collected through interviews, self-reported questionnaires, a study specific sleep diary and actigraphy registrations. A pretest-posttest control design was used to evaluate whether an individualized non-pharmacological intervention programme could promote self-care in sleep-activity in CAD patients.The results showed a high prevalence of insomniac CAD patients out of whom a large proportion were non-rested insomniacs. This showed that NRS is one of the core symptoms of insomnia. On the other hand there were weak or non-significant gender differences with increasing insomnia severity. Severe insomniac CAD patients displayed a two or threefold higher presleep arousal or anxiety score and were more limited in taking physical exercise than the general population. Generally low sleep efficiency (SE%) was revealed in the studies, particularly among severe non-rested insomniac CAD patients.Among CAD patients, the individualized non-pharmacological programme to promote self-care in sleep-activity indicated improvements in sleep and HRQoL.This thesis elucidates the importance of focusing on the individual’s perception of their sleep-activity and health in their local context and supporting self-care management. Furthermore, it is of importance that nurses set individual goals together with the patient in order to increase self-efficacy to promote HRQoL.
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| 2. |
- Coello Midence Balthasar, Zairis Aida
(författare)
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Insufficient water supply in an urban area - case study : Tegucigalpa, Honduras
- 2011
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Tegucigalpa, the capital of Honduras, has experienced an unsatisfied water demand during the last three decades. The state owned water utility in charge of the water supply of the country, SANAA, has faced this deficit by providing an intermittent water supply. The intermittent water supply has increased the gap between the rich and the poor, who cannot afford water storage facilities. Theories explain water scarcity either by low precipitation or by lack of investment in water structures. This thesis investigates the applicability of both explanations by quantifying the annual precipitation in the sub catchments with water supply potential for Tegucigalpa, and identifying the problems which caused the lack of investment into the water infrastructure. The analysis concluded that even if the annual precipitation is abundant, it is not evenly distributed in time and in space. Furthermore, it is argued that the financial limitations which hindered the lack of investment in water structures originated in the low tariffs imposed, and to the practices of the patronage system.
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| 3. |
- Elmi Mohamed, Abdullahi, 1965-
(författare)
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Sharing Water in Africa : Comparative Analysis of the Limpopo and Orange-Senqu River Basins in SADC and the Juba and Shabelle River Basins in the Horn of Africa
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- As water resources management becomes increasingly critical and many countries in the arid and semi-arid regions are increasingly forced to consider the possibilities of utilizing the water that is available in international rivers. Thus, the concerns relating to the use of international waters in shared rivers are becoming more important. The increasing competition over shared waters may have to lead either to more joint management and cooperation or to conflicts between basin countries.The purpose of the thesis work has been to analyze management of shared waters in international river basins with case studies from the Limpopo and the Orange River Basins in Southern African Development Community (SADC) region and the Juba and Shabelle River Basins in the Horn of Africa (HoA) region, focusing on river cooperation. The methodology employed was a comparative case study analysis through literature review, document analysis, interviews, focus groups and study visits.While similarities in climatic conditions and population growth stand out when comparing the basins in the two regions, the rivers differ primarily in terms of physical development of the water resources and institutional building for cross-border river cooperation. The Limpopo and Orange-Senqu river basins in the SADC region became reason for cooperation and catalyst of regional integration while the Juba and Shabelle river basins in the HoA has the potential to lead its riparian to conflict. The river basins in SADC established and operationalized functional system of river cooperation with both bilateral and multilateral basin-wide frameworks.The analysis concludes that management of water resources in internationally shared river basins is effectively affected by issues other than water. Sharing benefits from the shared waters in international rivers require basin-wide river cooperation. There are variety sets of factors that are of great importance for initiating, establishing and operationalizing river basin cooperation.
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| 4. |
- Strömbäck Hjärne, Marcus, 1979-
(författare)
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A fair score? : group independent validity arguments for college admission tests
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis aims to investigate fair use of test scores for admission to higher education. In this thesis, fairness is narrowed down to an instrumental definition relating to a fair interpretation of test scores. The focus is on the use of the Swedish Scholastic Aptitude Test (SweSAT) for admission decisions. The main questions targeted are whether the scores generated from an adaptation with extended time for test takers with dyslexia are fair and whether the SweSAT-scores may disadvantage students with an immigrant background.The thesis is based on validity theory and an established argument-based validity concept is used to link the results to crucial aspects of fairness. This thesis adds explicit fairness-related issues in some detail to this already established framework used for validity research related to the SweSAT. This approach involves some propositions about fairness, each of which can be investigated empirically which, to some extent, has been conducted in separate studies in this thesis.The individual studies contain a variety of results. In the first study, sub-scores of the SweSAT was found to have differential values for certain groups of test takers. This could cause unfairness if the sub-scores are used for admission decisions, but it also indicates that the internal structure of the test is inconsistent across groups. In the second article, the SweSAT was found to be speeded, meaning that the time limit is affecting the test score, and that test takers with dyslexia generally benefit from being given extra time to complete the test. It could not be ruled out that the extra time causes a beneficial experience of lower speededness compared to the rest of the test population, who take the test with no extra time. In the third article, we discover, to our surprise, that immigrant groups generally perform worse than expected in higher education when the expectations are based on their SweSAT and upper secondary school grades. In other words, the instruments used does not create an unintentional obstacle for immigrants in general since the ability of these groups to complete higher education is overestimated when grades and SweSAT-Scores are used for selection. However, in the final article, test items that may cause an unfair disadvantage for immigrant students was identified.In summary, the results contribute to expanding and, to some extent, strengthening the validity of using the SweSAT for admission. However, certain fairness issues have been noted.
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