| 1. |
- Hjalmarsson, Anna, 1976-
(författare)
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Being provided with a safe haven : Care-dependent older persons' participation in prehospital emergency care
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Participation in care is a key concept in many welfare societies and serves to guide clinical practice and adapt care to personal preferences and needs in order to promote well-being and quality of life. Previous research has shown that practicing participation in care is complex due to the concept not being clearly defined. A significant risk is, therefore, that participation in care is practiced based on the professional caregivers' own definitions, which might be inconsistent with the cared-for persons' perceptions of what participation is.Older persons can continue to live in their own homes with the support of municipal home care services that meet everyday care needs. Care-dependent older persons are known to have increased emergency care needs, which in Sweden require inter-organizational and inter-professional collaboration involving a care transfer between welfare levels. This thesis aimed to deepen the understanding of care-dependent older persons' participation in prehospital emergency care from lifeworld and welfare perspectives. The inductive design was based on a lifeworld approach and included triangulation of the phenomenon of participation in care using descriptive, interpretative, and comparative methods.From the perspective of care-dependent older persons, participation in prehospital emergency care means a forced transfer of life responsibility to professional caregivers when being existentially unsafe and incapacitated due to acute illness. Through authorized representation, the professional caregivers act for the older person, with the power to bring about change and create opportunities for existence. Care-dependent older persons' participation in prehospital emergency care involves a deepened dependence that necessitates coexistence and being provided with a 'safe haven' through the entire emergency care chain. A 'safe haven' can be understood as an unconditional, calm, and sheltered interpersonal space for emotional rest that is provided to the older person during an existentially challenging situation. From the perspective of care-dependent older persons, the emergency care chain transcends organizational boundaries and includes mobile safety alarm services and emergency department attendance.The involved professionals must be supported in practicing participation in care based on a comprehensive understanding of the concept, and emergency care options must be aligned with the care-dependent older persons' need for coordinated and continuous care. Collaborative challenges related to unstructured collaboration and professional hierarchy need to be addressed to support well-functioning collaboration in situations involving acutely ill older persons. The involved organizations need to recognize care-dependent older persons' deepened dependence when acutely ill, as well as their extended view of the prehospital emergency care chain.
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| 2. |
- Holmberg, Rurik, 1967-
(författare)
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Survival of the Unfit : Path Dependence and the Estonian Oil Shale Industry
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Estonia is the only country in the world, which is totally dependent on oil shale in its energy system. Although this fossil fuel exists in enormous quantities around the world, it has so far not been utilized on a larger scale. The reasons for this have been both economic and, in recent times, ecological. It can therefore be argued that in most cases, oil shale represents an inferior solution compared to other energy sources.This work examines why a technology utilizing oil shale has developed in Estonia and why Estonia appears not to be in a position to switch to other energy sources. In this work it is claimed that oil shale actually has been an appropriate solution to short-term concerns, despite the fact that its long-term drawbacks have been identified. These circumstances led to path dependence. Once the technology was in place, it advanced along its learning curve producing a satisfactory outcome, but not an optimal one. However, this situation has been accepted due to the extremely turbulent institutional environment Estonia has undergone in the 20th century.In Sweden, a somewhat similar (but smaller) oil shale industry was shut down in the 1960s because of poor economic performance, but also because of the competition from other energy sources. Such competition did not take place in Estonia, in part due to the specific institutional set-up of the Soviet Union. This made it possible for the Estonian oil shale industry to develop further, causing the present lock-in. Today the existing infrastructure, the knowledge-base, and the particular socio-political circumstances of Estonia effectively prevent change.Furthermore, it is argued that because there was only little oil shale-related technology developed outside Estonia, most technology had to be developed domestically. This in turn has forced the Estonian oil shale industry to make several highly inconvenient alliances in order to gain room to manoeuvre. Partially as a result of this, there is today wide-spread scepticism towards the industry, but no exit in sight in the foreseeable future.One purpose of this work is to contribute to a broader understanding why human societies have become dependent on fossil fuels and to extend our knowledge on where to search for an exit.
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| 3. |
- Privalov, Roman
(författare)
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After Space Utopia : Post-Soviet Russia and Futures in Space
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Since the early 2000s, new projects of space expansionism have emerged, including the commercial-, military-driven and scientific projects to colonize the Moon and Mars. The new space expansionism followed a period of comparatively lower attention to space in international politics, and it is sometimes called the New Space Race by analogy to the 20th century Space Race between the USSR and the US. With the first Space Race, outer space became explicitly politicized and served as a locus of futuristic utopian social and political imagination, not least in the USSR and the socialist bloc. In this dissertation, I investigate the possible ways of constructing alternative social and political futures in and through space in post-Soviet Russia. Drawing theoretically on postcolonial critique of space expansionism, the concepts of biopolitical production and of assemblage, and methodologically on narrative analysis, I argue that social and political futurism in and through space today presupposes changing attitudes to space and time in a way that challenges analyses from the angles of political science and IR. In this thesis, I highlight socially and politically futuristic practices which exist on the margins of political power and have greater autonomy from official discourse, arguing for the understanding of utopia in postmodernity as an assemblage.
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| 4. |
- Ahlberg, Mats Steinholtz, 1979-
(författare)
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Surveillance and follow-up of early prostate cancer
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Active surveillance (AS) for prostate cancer was introduced to address overtreatment resulting from prostate-specific antigen (PSA) testing. Despite advancements such as Magnetic Resonance Imaging (MRI) and targeted biopsies, PSA remains crucial in prostate cancer diagnostics, leading to ongoing challenges of overdiagnosis and overtreatment. This thesis aimed to investigate different aspects of AS and follow-up of early prostate cancer and provide new insights to reduce overtreatment and enhance surveillance and follow-up. In Paper I, the rationale and methodology of a randomized controlled trial, the Prostate Cancer Active Surveillance Trigger trial/Scandinavian Prostate Cancer Group study no. 17 (PCASTt/SPCG17), were outlined. This trial's objective is to evaluate the safety of an AS protocol based on MRI and standardized triggers for repeat biopsies and transition to radical treatment. Patient recruitment is anticipated to conclude in 2024. Paper II investigated the risks of biochemical recurrence, metastatic disease, and prostate cancer-related death in patients following radical prostatectomy. The analysis was conditioned on time after radical prostatectomy without biochemical recurrence. For patients with favourable histopathology in prostatectomy specimens and no biochemical recurrence five years post-prostatectomy, the probability of developing metastatic disease or dying from prostate cancer within 20 years after surgery was very low. This suggests shorter follow-up for selected patients. Paper III compared outcomes of AS for men from different healthcare regions in Sweden with varying traditions of AS. Regions with lower uptake in AS demonstrated a higher probability of transitioning from AS to radical treatment, but no difference in AS failure. The results suggest overtreatment in regions with low uptake in AS. Paper IV explored the associations between potential triggers for transitioning from AS to radical treatment and the transition to treatment. We analysed how this association changed with the introduction of prostate MRI. We found an increasingly strong association between triggers, particularly histopathological progression, and transition. However, most treated men had not experienced histopathological progression. The introduction of MRI did not contribute much to the change. In conclusion, this thesis outlines an ongoing study on defined triggers for transitioning from AS to radical treatment, suggests shorter follow-up after radical prostatectomy for selected patients, reveals overtreatment in regions with low uptake in AS, and shows an increasing use of histopathological progression as a trigger for transition to radical treatment.
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| 5. |
- Hjalmarsson, Anna, 1976-, et al.
(författare)
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A matter of participation? : A critical incident study of municipal care personnel in situations involving care-dependent older persons and emergency medical services
- 2022
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis Group. - 1748-2623 .- 1748-2631. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: This study aimed at describing municipal care personnel’s experiences of and actions in situations when older persons need emergency medical services (EMS) at home. METHODS: An inductive descriptive design adhering to critical incident technique (CIT) was used. Data were collected through interviews and free text written questionnaires, analysed in accordance with CIT procedure. RESULTS: Experiences related to the main areas of Lifesaving competence and Collaborative care. Lifesaving competence involved having sufficient knowledge to guide older persons in emergencies without organizational support. The lack of care alternatives carries dependence on inter-organizational collaboration, as well as having to accept the collaborative conditions provided by the EMS. Actions meant Adjusting to situational needs and EMS authority, which involved safeguarding the person while being directed by the EMS. CONCLUSIONS: Lack of organizational support, care alternatives, and structured collaboration jeopardize care-dependent older persons’ health, and ability to influence care when emergency situations occur at home. Municipal care personnel’s actions as the older person’s representative support human agency, allowing older persons to become active participants in care despite acute suffering. This study underlines the importance of further developing welfare policies that facilitate and regulate inter-organizational responsibilities of health and social care to favour older people.
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| 6. |
- Hjalmarsson, Anna, 1976-, et al.
(författare)
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Balancing power : Ambulance personnel's lived experience of older persons' participation in care in the presence of municipal care personnel
- 2023
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Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 37:3, s. 766-776
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patient participation is considered to promote well- being and is, there-fore, central in care contexts. Care- dependent older persons living at home constitute a vulnerable population with increased ambulance care needs. Care transfers risk challenging participation in care, a challenge that can be accentuated in situations involving acute illness.Aim: To illuminate meanings of older persons' participation in ambulance care in the presence of municipal care personnel from the perspective of ambulance personnel.Method: A phenomenological hermeneutical method was used to analyse tran-scripts of narrative interviews with 11 ambulance personnel.Results: The ambulance personnel's lived experience of older persons' participa-tion includes passive and active dimensions and involves a balancing act between an exercise of power that impedes participation and equalisation of power that em-powers participation. The main theme ‘Balancing dignity in relation to manipulat-ing the body’ included the themes Providing a safe haven and Complying with bodily expressions, which means shouldering responsibility for existential well- being and being guided by reactions. The main theme ‘Balancing influence in relation to per-ceived health risks’ included the themes Agreeing on a common perspective, Directing decision- making mandate, and Sharing responsibility for well- being, which means shouldering responsibility for health focusing on risks. Influence is conditional and includes performance requirements for both the older person and municipal care personnel.Conclusion: Care- dependent older persons' participation in care from the per-spective of ambulance personnel means recognising passive and active dimensions involving human dignity, the ability to influence care, and optimising care efforts through collaboration. This study provides a deepened understanding of the balanc-ing of power involved in ambulance care determining participation, where power is equalised or exercised depending on personal engagement, health risks, and available care options. The knowledge provided holds the potential to improve am-bulance care to benefit older persons in critical life situations.
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| 7. |
- Hjalmarsson, Anna, 1976-, et al.
(författare)
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Characteristic patterns of emergency ambulance assignments for older adults compared with adults requiring emergency care at home in Sweden : a total population study
- 2020
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Ingår i: BMC Emergency Medicine. - : BioMed Central. - 1471-227X. ; 20, s. 1-12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Since the vast majority of older adults in Sweden live in their private homes throughout life, the emergency medical services need to adapt accordingly. Hence, we aimed to describe characteristic patterns of dyadic staffed emergency ambulance assignments for older adults aged > 70 years compared with adults aged 18– 69 years requiring emergency care at home in Sweden.Methods: A descriptive retrospective study was performed using anonymized registry data from the emergency medical services in a region of Sweden during 2017–2018. One-sample χ2 test, one-way analysis of variance, and binary logistic regression models were used for investigating group differences. Variables for analysis were age, gender, clinical assessments, on-scene time, priority levels, result of response, and temporal patterns.Results: Of all included emergency ambulance assignments (n = 28,533), 59.9% involved older adults, of which 53.8% were women. The probability for older adults to receive the highest priority was decreased for both dispatch (p < 0.001, odds ratio [OR] 0.63, 95% confidence interval [CI] 0.59–0.66), and transport priorities (p < 0.001, OR 0.74, 95% CI 0.68–0.80). Older adults were more likely to receive dispatch priority levels 2 (p < 0.001, OR 1.48, 95% CI 1.40–1.56), and 3 (p < 0.001, OR 1.73, 95% CI 1.46–2.06). The older adults were similarly more likely to receive transport priority level 3 (p < 0.001, OR 1.40, 95% CI 1.28–1.52) compared with adults. Age had a small but additive effect in relation to on-scene time (p < 0.001, R2 = 0.01, F = 53.82). Distinguishing initial clinical assessments for older adults were circulatory, respiratory, trauma, infection, and nonspecific assessments. Emergency ambulance assignments for older adults were more frequently occurring on Mondays (p < 0.001, χ2 = 232.56), and in the 08:00– 11:59 interval (p < 0.001, χ2 = 1224.08).Conclusion: The issues of the lower priority level preponderance, and the decreased probability for receiving the highest priority warrant further attention in future research and clinical practice.
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| 8. |
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| 9. |
- Hjalmarsson, Anna, 1976-, et al.
(författare)
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Entrusting life to professionals : A phenomenological hermeneutical study of older persons' participation in prehospital emergency care involving municipal home care and ambulance services.
- 2023
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Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712.
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Tidskriftsartikel (refereegranskat)abstract
- Background: Participation in care is considered to promote safe and qualitative care. Care-dependent older persons ageing in place have increased emergency care needs, which initiate inter-organisational collaboration involving municipal home care and ambulance services. Previous research concludes that uncertainties exist regarding what participation in care means in clinical practice, which necessitates the need to illuminate the phenomenon for older persons in critical life situations.Aim: This study aimed to illuminate meanings of participation in prehospital emergency care from the perspective of care-dependent older persons experiencing acute illness at home.Design: This study has a qualitative design with a lifeworld approach.Method: A phenomenological hermeneutical method was used to analyse transcribed telephone interviews with eleven care-dependent persons aged 70–93 years.Results: Care-dependent older persons' participation in prehospital emergency care means ‘Entrusting life to professional caregivers’ when being in helpless solitude and existentially unsafe, which emphasises a deepened interpersonal dependence. Meanings of participation in care from the perspective of older persons involve Being reassured in togetherness, Being pliant in trust of emergency expertise, Being enabled through the agency of professional caregivers, and Encountering readiness in the emergency care chain.Conclusion: Care-dependent older persons' participation in prehospital emergency care is existential and involves interpersonal dependence. Togetherness brings reassurance, safety and opportunity for emotional rest while accessing the professional caregivers' power, competence and abilities which provide opportunities for existence and movement towards well-being and continued living.Implications for practice: Prehospital emergency care from the perspective of care-dependent older persons transcends organisational boundaries and includes the municipal mobile safety alarm service. The involved municipal and regional organisations need to provide support by implementing lifeworld-led care models and care alternatives that enable professionals to recognise the existential dimension of participation in care.
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| 10. |
- Hjalmarsson, Anna, 1976-, et al.
(författare)
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When older persons need Emergency Medical Services at home : a critical incident study on Swedish municipal care personnel
- 2021
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Older persons in Sweden can continue to live at home, assisted by the municipal home care services. Older age raises the risk of emergency situations that require involvement of the emergency medical services (EMS). Such situations intersect two different organizations, the municipal social care services and the regional EMS. The transfer of care between the organizations might impact the older persons´ health, and quality of life or death. Research question: How do municipal care personnel describe their experiences of and actions in situations when older persons are in need of EMS? Design: The study has a qualitative inductive design. Sample: Municipal care personnel (n=19) consisting of home care personnel and security alarm responders. Data collection and analysis: Data was collected through group interviews and free text written critical incidents analyzed according to critical incident technique. Results: Experiences related to the two main areas Lifesaving competence, and Collaborative care, which encompass the four categories Emergency knowledge, Companionship in a vulnerability, Limited caring options and Conditions for EMS collaboration. Actions related to the one main area Adjusting actions to actual conditions, which encompasses the three categories Adapting care to emergency needs, Safeguarding the person, and Adapting actions to EMS leadership.
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