| 1. |
- Grundberg, Åke
(författare)
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Mental health promotion among community-dwelling seniors with multimorbidity : perspectives of seniors, district nurses and home care assistants
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The prevalence of mental illness is increasing among the older population in Sweden. One of the most vulnerable groups for mental health problems is older persons with multimorbidity, i.e. seniors with multiple chronic conditions. Many of them remain in their own homes with a comprehensive and complex need of support and healthcare, mainly provided by home care assistants (HCAs) and district nurses (DNs). However, the detection of mental health problems for adequate treatment or to promote mental health among community-dwelling seniors with multimorbidity, calls for skills and competences in this area.This thesis aimed to gain a deeper understanding of how mental health may be promoted among community-dwelling seniors with multiple chronic conditions. Four studies have been included in this thesis (I-IV). All studies had a qualitative descriptive design with either a phenomenographic approach or latent and manifest qualitative content analysis technique. The aim of study I was to describe the variations in how community-dwelling seniors with multimorbidity perceived the concept of mental health and what may influence it. The findings showed the participants conceptualised mental health as having both positive and negative facets. The participants further conceived that social contact, physical activity and optimism may improve mental health, while social isolation, ageing, and chronic pain may worsen it. Study II aimed to describe the experience of health-promoting dialogues from the perspective of community-dwelling seniors with multimorbidity, and what these seniors believed to be important for achieving a dialogue that may promote their mental health. The main finding was the necessity of being seen as a unique individual by an accessible and competent person. Further, the participants missed having friends and relatives to talk to and they especially lacked healthcare or social service providers for health-promoting dialogues that may promote mental health. The aim of study III was to describe DNs’ perspectives on detecting mental health problems and promoting mental health among community-dwelling seniors with multimorbidity. Findings revealed that the DNs’ focus was on assessment, collaboration and social support as a way of detecting mental health problems and promoting mental health. Study IV described HCAs’ perspectives on detecting mental health problems and promoting mental health among the seniors in focus. The findings revealed that continuity of care and the seniors’ own thoughts and perceptions were regarded as essential for the detection of mental health problems. Further, observation, collaboration, and social support emerged as important means of detecting mental health problems and promoting mental health.Conclusions: The results of this thesis are based on interviews and show that: 1) Seniors with multimorbidity should have an opportunity to describe how multiple chronic conditions may affect their life situation; 2) An optimal level of care can be achieved through continuity, involvement, and by providing a health-promoting dialogue based on the person’s wishes and needs; 3) Even if DNs seemed engaged in primary mental healthcare, there were no expressed goals set in the improvement of mental health, and it seemed that these DNs could not bear the primary responsibility for early detection of mental health problems and early interventions to improve mental health; 4) HCAs had knowledge about risk factors for mental health problems and it appears that they were dependent on care managers’ decision-making in granted support, as well as supervision from DNs in the detection of mental health problems and to promote mental health.In summary, the finding in the present thesis demonstrates that managing mental health problems is still an ongoing challenge for those organisations providing continuity in home care and home healthcare for homebound elderly persons with complex chronic conditions. The finding in the thesis also shows that DNs and HCAs seem to be dependent on each other in this area. Mental health promotion was expressed as an important assignment among DNs and HCAs, even though they describe different prerequisites and factors which could be seen as barriers in the detection of common mental health problems such as depression, anxiety and sleep problems. These personnel further described difficulties in collaboration and transmission of information between care- and healthcare providers from the community and primary care context. Social and physical interventions - as well as social contacts and social support to break social isolation - seemed important according to all the informants, with their different perspectives of how mental health may be promoted.
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| 2. |
- Bäckström, Ingela, 1963-
(författare)
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Quality Management for Sustainable Health : Methodologies, Values and Practices taken from Swedish Organizations
- 2006
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In many Western countries today, not least in Sweden, there are a lot of organizations that have great problems with sickness absence. The costs connected to the high rates of sickness absence have also risen to alarming levels. Healthy co-workers and healthy organizations are obvious goals for many leaders, but this is not always so easy to establish. Work practices and leadership that are beneficial to co-worker health are thus vital to identify. Studies have shown relationships between company-wide implementation of quality programs and improved co-worker satisfaction along with low co-worker turn over; in other words, co-worker health along with improved customer satisfaction and financial results. Despite the great problems concerning sickness absence, there are organizations that have been awarded prizes for excellence in leadership, internal partnership, working environment, and profitability. The overall purposes of the research described in this thesis are to examine and describe how management and leadership can establish sustainable health among the co-workers and examine how the leadership for sustainable health is related to Quality Management. The in-depth purpose is to examine which aspects within the values derived from the quality movement are those that primarily influence the co-workers’ perceived health. The results presented can be described in three parts and are results from four case studies carried out in five different organizations. Three of the organizations have received awards for establishing good working environment, good financial results, and low sick leaves among their co-workers; the fourth received an award for the successful implementation of quality programs. The first part consists of results from case studies in three different organizations and describes how organizations can work to achieve sustainable health among their co-workers, with practical examples. The results are methodologies, values and organizational structure, which it is considered possible for other organizations to adopt in their efforts to achieve good working conditions resulting in fewer sick leaves. The second part is an attempt to investigate if leadership for sustainable health is related to Quality Management. Methodologies, leadership values, organizational structure, and general values found in organizations which have achieved sustainable health are analyzed in the light of Deming’s 14 points, and a correlation is indicated. There is also correlation found between the TQM values and the co-workers’ perception of their health. The third part examines which of the aspects within the values grown from the quality movement are those that influence the co-workers perceived health. The results show significant correlation between the values and the co-workers’ perception of their health. Aspects found within the value “Top management commitment” were named; Empathy, Presence and Communication, Integrity, and Continuity. Within the value “Let everybody be committed” the aspects; Development, Influence and Being informed were found. These aspects are described in more detail and also in one model per value. The result implies that the TQM values; “Top management commitment”, “Improve continuously” “Let everybody be Committed” and “Focus on customers” are important for achieving healthy organizations and sustainable health among co-workers.
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| 3. |
- Hansson, Johan, 1974-
(författare)
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Historieintresse och historieundervisning : Elevers och lärares uppfattning om historieämnet
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis studies teachers’ and students’ conceptions of history and history teaching and aims to explain the importance of an interest in history among teachers and students of the subject. Research on teachers’ conceptions (e.g. Martin 2005) shows that the didactical question “Why?” influences the “How?” and “Why?” questions and that teachers’ thinking about their own practice is mainly influenced by their background and their experiences from teaching. Research on students’ opinions (e.g. Youth and History, 1997) shows that they enjoy history shown in films, that they appreciate museums, and that the preferred topic is 20th century history. In this thesis learning is envisaged as something individual but it is the learners’ social context that defines what is important, meaningful and interesting to learn. The research methods consist of a survey study concerning the pupils’ attitudes towards history and history education, and an interview study with their teachers about their teaching and their opinions about history in general. Nine teachers and their 217 pupils participated.It is mainly topics from 20th century that are described as interesting by both students and teachers. The teachers had different views on the didactical whyquestion, which they described either as student oriented or subject oriented. Their views on why history is important influenced their teaching methods. The student oriented teachers stated that their pupils’ needs and wishes affect their methods while the subject oriented teachers said that they give varying lessons, and have a more student active teaching, but decide for themselves what teaching methods are to be used. The subject matter is influenced by the teachers’ personal interest in history, in most cases a Eurocentric political history. This choice of content, and the teachers own interest, are explained by the historical culture of Swedish society rather than the curriculum. The teachers state that exciting stories and dramatic events related in books or films were, and still are, important to their interest in history. Their individual interpretation of what is important and meaningful in their historical culture influences teachers’ personal interest, their knowledge, and the content of their history teaching. The students’ attitudes to history are also influenced by various factors, of which history education at school is merely one.
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| 4. |
- Hansson, Per, 1980-
(författare)
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First Determination of the Electric Charge of the Top Quark and Studies of the Top Quark Pair Background to New Physics
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis is concerned with experimental investigations of properties of the top quark and processes involving this particle. In the first part of the thesis, the first determination of the electric charge of the top quark is presented. The measurement was made using top quark pair events produced in proton-antiproton collisions recorded by the D0 detector at the Fermilab Tevatron. It is based on the reconstruction of the charge of the top quarks decay products from the dominant decay to a W boson and a b-quark. The method uses a jet charge algorithm, calibrated with data, to discriminate between b- and antib-quark jets. A constrained kinematic fit is also performed to resolve the ambiguities of the pairing of the top quark decay products and to extract the top quark electric charge. The result is in good agreement with the Standard Model top quark electric charge of 2e/3 and an upper limit of 0.8 at 90\% confidence level on the fraction of exotic quarks with charge 4e/3 in the data sample is obtained. The second part of the thesis concerns the estimation of the top quark pair background to searches for new physics, such as supersymmetry, with the ATLAS experiment at the CERN Large Hadron Collider. These searches will require a robust estimation of standard model backgrounds in order to make any claims of discovery or to exclude models of new physics. For searches with a final state signature characterized by two isolated charged leptons, multiple jets and large missing transverse energy the largest source of background is expected to be top quark pairs with leptonic decay of the two W bosons from the top quarks in the event. A data-driven method to estimate this contribution based on full kinematic reconstruction of the top quark pair events is studied using simulated proton-proton collisions. It is shown that the method is capable of estimating the top quark pair background to within 12% using data corresponding to approximately 1fb-1. The systematic uncertainty is of the order of 20% and, depending on the model, the contamination of signal events can potentially be large.
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| 5. |
- Jormfeldt, Henrika
(författare)
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Dimensions of Health among Patients in Mental Health Services
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Empirical studies focusing on the subjective experience of health among patients in contact with the mental health services are rare and most questionnaires are based on a medical model that emphasizes objectively observed disease-oriented health indicators. In studies I and II perceptions of the concept of health among patients and nurses in mental health services were explored and described using a phenomenographic approach. The perceptions and description categories that emerged from these studies were transformed into a number of items forming a questionnaire intended to measure subjectively experienced health among patients in mental health services. In study III, a randomly selected sample was used to test the psychometric properties of the new Health Questionnaire. A factor analysis revealed three factors labelled Autonomy, Social Involvement and Comprehensibility. The purpose of study IV was to examine the construct validity of the Health Questionnaire. The hypothesis was that subjectively experienced health would be positively associated to self-esteem, empowerment and quality of life, and negatively associated to psychiatric symptoms, perceived stigmatization experiences and perceived attitudes of devaluation and discrimination. This hypothesis was mainly confirmed insofar that overall health was positively correlated to self-esteem, empowerment and quality of life and negatively correlated to symptoms, attitudes of devaluation and discrimination and rejection experiences. The results of this thesis show that health is more than just an absence of disease and support a focus on health promotion interventions in mental health care.
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| 6. |
- Odelstad, Jan
(författare)
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Many-Sorted Implicative Conceptual Systems
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A theory of many-sorted implicative conceptual systems (abbreviated msic-systems) is presented. Examples of msic-systems include legal systems, normative systems, systems of rules and instructions, and systems expressing policies and various kinds of scientific theories. In computer science, msic-systems can be used in, for instance, legal information systems, decision support systems, and multi-agent systems. In the thesis, msic-systems are studied from a logical and algebraic perspective aiming at clarifying their structure and developing effective methods for representing them. Of special interest are the most narrow links or joinings between different strata in a system, that is between subsystems of different sorts of concepts, and the intermediate concepts intervening between such strata. Special emphasis is put on normative systems, and the role that intermediate concepts play in such systems, with an eye on knowledge representation issues. Normative concepts are constructed out of descriptive concepts using operators based on the Kanger-Lindahl theory of normative positions. An abstract architecture for a norm-regulated multi-agent system is suggested, containing a scheme for how normative positions will restrict the set of actions that the agents are permitted to choose from. Technical results inlude a characterization of an msic-system in terms of the most narrow joinings between different strata, characterization of the structure of the most narrow joinings between two strata, conditions for the extendability of intermediate concepts, and finally, a specification of the conditions such that the Boolean operations on intermediate concepts will result in intermediate concepts and characterization of most narrow joinings in terms of weakest grounds and strongest consequences.
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| 7. |
- Sundström, Johan, Professor, 1971-, et al.
(författare)
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Risk factors for subarachnoid haemorrhage : a nationwide cohort of 950 000 adults
- 2019
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Ingår i: International Journal of Epidemiology. - : Oxford University Press. - 0300-5771 .- 1464-3685. ; 48:6, s. 2018-2025
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Subarachnoid haemorrhage (SAH) is a devastating disease, with high mortality rate and substantial disability among survivors. Its causes are poorly understood. We aimed to investigate risk factors for SAH using a novel nationwide cohort consortium.METHODS: We obtained individual participant data of 949 683 persons (330 334 women) between 25 and 90 years old, with no history of SAH at baseline, from 21 population-based cohorts. Outcomes were obtained from the Swedish Patient and Causes of Death Registries.RESULTS: During 13 704 959 person-years of follow-up, 2659 cases of first-ever fatal or non-fatal SAH occurred, with an age-standardized incidence rate of 9.0 [95% confidence interval (CI) (7.4-10.6)/100 000 person-years] in men and 13.8 [(11.4-16.2)/100 000 person-years] in women. The incidence rate increased exponentially with higher age. In multivariable-adjusted Poisson models, marked sex interactions for current smoking and body mass index (BMI) were observed. Current smoking conferred a rate ratio (RR) of 2.24 (95% CI 1.95-2.57) in women and 1.62 (1.47-1.79) in men. One standard deviation higher BMI was associated with an RR of 0.86 (0.81-0.92) in women and 1.02 (0.96-1.08) in men. Higher blood pressure and lower education level were also associated with higher risk of SAH.CONCLUSIONS: The risk of SAH is 45% higher in women than in men, with substantial sex differences in risk factor strengths. In particular, a markedly stronger adverse effect of smoking in women may motivate targeted public health initiatives.
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| 8. |
- Yazdi, Homa Papoli, 1988-
(författare)
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The evolution of sex chromosomes and sex-linked sequences in birds
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Identifying the processes involved in the evolution of suppressed recombination between sex chromosomes and understanding their consequences for the evolutionary dynamics of sex-linked loci have been major topics of research during the last century. In this thesis, I used the avian ZW system, where females are the heterogametic sex, to investigate the underlying processes in sex chromosome evolution in birds. I identified the gametologous genes between the largely recombining Z and W chromosomes of ostrich and dated the timing of the cessation of recombination to prior to the split of modern birds. I then constructed a genetic map of the ostrich Z chromosome and corrected its assembly in order to obtain the ancestral organization of the Z chromosome in a basal clade of birds. By analyzing the inversion events across the avian phylogeny, I concluded that a combination of Z- and possibly W-linked inversions might have been responsible for the evolution of suppressed recombination in avian sex chromosomes. To understand the determinants of levels of genetic diversity on Z chromosome compared to autosomes, I calculated Z to autosome (Z:A) genetic diversity across 32 avian species. This revealed a broad range of Z:A genetic diversity, between 0.278 – 1.27. Lineage-specific estimates of the nonsynonymous to synonymous substitution rate ratio (dN:dS) for autosomal and Z-linked genes further revealed a Fast-Z effect in the majority of birds. The lack of a significant correlation between Z:A dN:dS and Z:A genetic diversity indicated that genetic drift might not be sufficient to explain faster evolution of Z-linked genes, suggesting that positive selection might also contribute to the observed values. Finally, I calculated genetic diversity and linkage disequilibrium (LD) along the pseudoautosomal region (PAR) of the Z chromosome using population genomics data of ostrich. In contrast to theoretical expectation, levels of diversity on the PAR were not significantly higher close to the sex-determining region (SDR) compared to autosomal values. Additionally, I observed a lower level of LD on the PAR compared to the average for the Z chromosome and no significant level of LD across the PAR boundary was detected, indicating recombination allows the boundary-proximal region of PAR to behave independently of SDR. Considered together with a higher level of recombination rate in females in the proximity of the SDR, this observation might help explain the maintenance of a long PAR in ostriches and other ratites. Altogether, the results of this thesis make a modest contribution to our understanding of sex chromosome evolution in birds.
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