| 1. |
- Walla, Maria
(författare)
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Matematik i förskoleklass : En studie om bedömning och matematikundervisning vid skolstart
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis is about assessment and education in early mathematics. The aim is to develop knowledge about mathematics assessment in the Swedish preschool class and about how an equal mathematics education based on this assessment can be designed.In Sweden, children begin preschool class at the age of six. In 2019, national assessment of mathematics was made mandatory in preschool class with the aim of assessing the mathematical thinking of all six-year-olds as they start school. To address the aim of the thesis, three studies were conducted: a document study, a focus group study, and an educational design research study. In the document study, assessment material for six-year-olds in Sweden and Norway was analysed. In the focus group study, four focus group interviews about early assessment with a total of 12 preschool class teachers were conducted. In the educational design research, four cycles of planning, implementation, and evaluation of mathematics education were conducted in a classroom with 18 preschool class students. Two theories were used: discourse analysis by Gee in study one and study two, and communities of practice by Wenger in study three. The findings of study one show a diversity of discourses both between and within the assessment materials of Sweden and Norway, indicating different views on when to assess, on what knowledge to assess, and on how and why to assess. The findings of study two show a diversity of discourses with different meanings ascribed to early mathematics education and equity. The findings of study three show that it is possible to develop mathematics education in a way that contributes to equity in mathematics, based on the assessment. Together, the findings of these studies indicate that teachers’ views on equity may affect the extent to which assessment may contribute to equity in early mathematics education. Furthermore, the results show that mathematics education in preschool class can be understood as unique, where the uniqueness is about how and why the mathematics education is carried out the way it is. However, mathematics education in preschool class can also be understood as changing as a result of challenges that come with the new national assessment for preschool class.
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| 2. |
- Cruz, Igor, 1986-
(författare)
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Evaluating the utilisation of industrial excess heat from an energy systems perspective
- 2022
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Sweden aims to achieve climate neutrality by 2045. The need to immediately reduce greenhouse gas emissions in order to achieve climate targets affects industry directly. The pulp and paper sector is responsible for more than 50% of industrial energy use in Sweden. Increased energy efficiency is expected to contribute significantly to the reduction of primary energy use. The recovery and utilisation of industrial excess heat (IEH) has been identified as an important potential contribution to energy efficiency in industry. Previous research based on top-down studies has estimated the availability of IEH for entire sectors, and bottom-up results for many case studies are available. While top-down studies lack detailed information on the profile of the excess heat available, bottom-up studies have limited coverage. Detailed information about excess heat amounts and temperature levels is required for the assessment of the potential of the various heat recovery technologies that are available. The aim of this thesis is to present, in a series of steps, methods to systematically analyse an industrial process to obtain a detailed profile of the excess heat available under various process conditions, to aggregate results that can be generalised to whole industrial sectors, and to obtain IEH recovery potentials using different technologies. The assessment of the utilisation options for IEH recovery is complemented with an analysis of system aspects that could affect profitability and global greenhouse gas (GHG) emissions. An energy-targeting procedure combined with optimisation has been applied to six case studies of kraft pulp and paper mills in Sweden. This method obtained IEH profiles that were used in a regression analysis to estimate the IEH availability and electricity generation potentials from low and medium temperature IEH using organic Rankine cycles (ORC). A comparison of profitability and global GHG emissions between ORC electricity generation using IEH and small-scale combined heat and electricity (CHP) production is presented for three energy markets.The results show that there is a potential to increase electricity generation from low and medium temperature IEH by 7–9% in the kraft mills in Sweden, depending on the level of process integration considered. The utilisation of low and medium temperature IEH for electricity generation has the potential to reduce global GHG emissions in all the energy-market scenarios considered, but if biomass is considered a limited resource, district heating (DH) deliveries can achieve higher global GHG reductions. ORC electricity generation from low and medium temperature IEH is economically viable and showed overall better profitability and GHG emissions reductions than small-scale CHP using ORCs. The economic feasibility of ORC electricity generation is less affected by external conditions and uncertainties than direct DH deliveries.
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| 3. |
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| 4. |
- Hälleberg-Nyman, Maria, 1968-
(författare)
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Urinary catheter policies for short-term bladder drainage in hip surgery patients
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to evaluate methods for urinary catheter handling in patients undergoing hip surgery. The intention was to gain knowledge in order to provide optimal and cost- effective care regarding urinary catheterisation in this group of patients.In Study I , 45 of the 86 catheterised patients (52%) contracted nosocomial urinary tract infections (UTIs). Diabetes was a risk factor for developing UTI, and cloxacillin as a perioperative antibiotic prophylaxis seemed to offer a certain protection. Study II was a randomised controlled trial on the effect of clamping (n = 55) or not (n = 58) of the indwelling urinary catheter before removal. No significant differences were found between the groups with respect to time to normal bladder function, need for recatheterisation, or length of hospital stay. Study III was a randomised controlled trial among patients with hip fracture and hip arthroplasty, in which the patients were randomised to intermittent (n = 85) or indwelling (n = 85) urinary catheterisation. No significant differences in nosocomial UTIs (9% vs. 12%) or cost-effectiveness were shown. The patients in the intermittent group regained normal bladder function significantly sooner after surgery. Fourteen percent of the patients in the intermittent group did not need any catheterisation. In Study IV , 30 patients were interviewed about their experiences of bladder emptying and urinary catheterisation. The patients’ views were described through the main category ‘An issue but of varying impact’. Both bladder emptying through micturition and bladder emptying through catheterisation were described as convenient, but also as uncomfortable and an intrusion on dignity. The patients were aware of risks and complications of urinary catheterisation.In conclusion, this thesis indicates that UTI is common in hip surgery patients. Clamping of indwelling catheters seems not necessary. There is no preference for either intermittent or indwelling urinary catheterisation according to the results of this thesis, either for the development of nosocomial UTI or, for cost-effectiveness, or from the patient perspective. Nurses should be aware that catheterisation might make the patients feel exposed, and it is essential that their practice reflect the best available evidence.
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| 5. |
- Pettersson, Sara, 1976-
(författare)
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Supporting Self-care in Migrants with Type 2 Diabetes
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Diabetes Mellitus, specifically type 2 diabetes, represents a growing global health concern, with a prevalence predicted to reach 783 million by 2045. Type 2 diabetes leads to personal suffering, reduced productivity and significant health care cost. Selfcare is the most important cornerstone in the treatment of type 2 diabetes and patient education is a prerequsite for performing adequate self-care. Migrants show a risk of uncontrolled diabetes and the prevalence of type 2 diabetes in migrants, living in European countries, poses challenges as cultural and language barriers might affect health care outcomes Culturally appropriate diabetes education is important for improving glycaemic control and health outcomes in migrant populations. In the Swedish health care setting, diabetes care follows national guidelines and is predominantly provided in primary health care centers. However, criticism has arisen regarding the lack of tailored care for migrants, leading to less effective health care. This thesis explores patients’ competence and health providers’ cultural competence influencing patient’s self-care.Aim: The overall aim of this thesis was to gain knowledge that can contribute to optimising support of self-care in migrants with type 2 diabetes. The aim in study I was to compare foreign‐ and Swedish‐born persons, diagnosed with type 2 diabetes, to study whether there are dissimilarities in knowledge about diabetes mellitus and to study determinants of knowledge. The aim in study II was to describe the cultural competence of primary health care professionals that specialize in diabetes care and to examine related factors that affect cultural competence. In study III the aim was to describe the process of developing a culturally appropriate tool to support self-care in migrants with type 2 diabetes and in study IV the aim was to evaluate the feasibility of a culturally appropriate website, supporting self-care in migrants with type 2 diabetes.Methods: This thesis includes four studies with two cross-sectional descriptive studies one co-design study, and one feasibility study. In study I where knowledge and glycaemic control were assessed, patients diagnosed with type 2 diabetes, receiving care at a primary health care center, participated. The data was collected with validated questionnaire and described by numbers and percentage, mean (SD) and median (range). Comparisons between groups were made by tests of statistical significance where p < 0.05 was considered statistically significant. For analytical statistics, to identify any independent associations between knowledge and socio‐demographic variables and diabetes related characteristics, multiple logistic regression analysis was performed. Data was collected between September 2014 and March 2016. Study II was also a cross-sectional study and aimed to measure perceived cultural competence in health care providers. Data was collected by a questionnaire from January to July 2020. Data was analysed by descriptive statistics and to analyse sociodemographic factors associated with the three domains, univariate analyses with bivariate correlations, independent Student t-tests, or one-way ANOVA were employed, as appropriate. Linear regression analyses were conducted, including sociodemographic factors. The third study used a co-design process, involving fourteen migrant patients, ten health care providers in diabetes care, and four researchers with data collection between February 2021 to December 2022. In the fourth study feasibility of the developed culturally appropriate website was evaluated through qualitative interviews with seven migrant patients and ten health care providers who had previously participated in study III. The interviews focused on four areas: Acceptability, Demand, Implementation, and Integration of the website. Data was analysed by directed content analysis.Result: The results show a significant gap in competence, including knowledge about diabetes and poor glycaemic control in migrants, particularly those born in the Middle East with type 2 diabetes. The thesis emphasizes the influence of cultural factors on selfcare, highlighting the need for cultural competence in health care providers working with diverse populations. A significant proportion of health care providers perceived themselves as open and aware regarding clients with other cultural backgrounds, but the health care providers perceived a lack of organizational support to improve cultural competence. In the third study, the need for a comprehensive tool providing culturally appropriate information was emphasized by both patients and health care providers. A prototype of a culturally appropriate website developed with the aim of improving the patients' competence and thereby supporting the self-care of migrants with type 2 diabetes. The website was then developed into a mobile-friendly website that patients and health care providers tested and evaluated. Both patients and health care providers experienced the website as culturally appropriate with information at a reasonably basic level, in patient's own language (Arabic) and with information provided in several different ways, such as written information, images, videos and thus accessible to those who cannot read. The participants expressed interest and demand for the website, and the planned strategy for implementation was considered reasonable. They also felt it was possible to integration the tool into existing primary health care infrastructure, as a complementary cultural appropriate tool.Conclusions: There are vulnerable groups in the society such as migrants born in the Middle East, with type 2 diabetes. This thesis highlights the importance of patient’s competence and health care providers‘ cultural competence and the influence of self-care. The development of a culturally appropriate tool, such as the website, is proposed as a practical solution to enhance patient’s competence and support health care providers in delivering culturally competent care.
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| 6. |
- Adamsson, Mathias
(författare)
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Non-image-forming effects of light : Implications for the design of living and working environments
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Seasonal variation in mood and subjective well-being are common at geographical locations further away from the equator. The 24-h light-dark cycle is the main time cue for synchronizing the human circadian clock to the external day and night.Nowadays, people spend more of their waking day indoors, with less exposure to the natural daylight cycle, relying on artificial lighting which differs to daylight in a number of aspects, including intensity, spectral composition and light exposure pattern.In parallel with the technology development that has been mainly driven by energy-saving reasons, it is important to investigate the non-image-forming effects of different properties of the daily and seasonal light exposure.The overall aim of the thesis was to identify characteristics of the daily light exposure that are important to support physiological and psychological needs of humans. To achieve this objective a number of research questions were posed concerning daily and seasonal light exposure, seasonal variation in physiological processes and psychological parameters, and evaluation of light exposure with respect to non-image-forming effects. The research questions were investigated in a longitudinal research design with measurements conducted each month during the year at a high latitude with large seasonal variation in day lengths.Self-report diaries and instruments for ambulatory- and static measurements were used to examine daily and seasonal light exposure in the working and living environments and for investigating the relationship between different parameters that can be used for evaluating light exposure according to non-image-forming effects of light. Seasonal variation in daily light exposure and regarding the pattern of light exposure was observed. Also, the results indicate a seasonal variation concerning the quality (i.e. spectral composition of the visible radiation) of the exposing light.Two biological markers, melatonin and cortisol, were used for investigating seasonal variation in physiological processes relating to the circadian clock. The results showed higher morning melatonin concentrations and peak level of melatonin during the winter although no seasonal change was observed concerning the phase position of the melatonin rhythm.Seasonal differences in mood and sleep-activity were studied by means of selfreport diaries and questionnaires. Seasonal variations were observed for both parameters. The results showed higher ratings of mood in the summer, particularly 6 in the evening, and a relationship between bedtime and evening light exposure and photoperiod length. Furthermore, longer sleep times was observed in the winter.Appraisal of lighting conditions in the offices during the year was rated by the use of a questionnaire. The results showed some seasonal differences concerning the perceived qualities of the light and some associations between characteristics of the lit environments and positive affect were found.Two methods, static- and ambulatory measurements, were used for recording lighting conditions in the working environments. Taken together, the results showed weak associations between the two methods.Research have demonstrated an increased need for taking non-image-forming effects into consideration when designing working and living environments, especially at geographical locations with large variations in day length where people are exposed to much of the daily light exposure at the workplace. Laboratory research has provided a good understanding of the basic concepts. However, more field research is needed. Also, current research has demonstrated that new methods of measuring and evaluating lighting conditions are needed.
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| 7. |
- Afrell, Maria, 1953-
(författare)
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Att leva med en kropp som värker : samtal med fysioterapeuten
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and aim: Physiotherapists in primary care meet, assess and treat patients with long-standing benign musculoskeletal pain. As a clinical condition, long-standing pain is common but nonetheless it is quite complex. The aim of this thesis has been, from a bodily existential perspective, to investigate and conceptualise the experience of living with longstanding benign musculoskeletal pain, and from there, to work out a method for conversation and assessment within non-specialised physiotherapy.Methods: Our first study was an interview study where we applied a phenomenological approach and investigated the ways individuals suffering from long-standing pain experienced their body and their illness. Four aspects of body experience were described, and based on these aspects, four typologies of attitudes to pain were distinguished. In the second study, we made two group interviews with six physiotherapists about their experiences of using, in their clinical work, questions from the interview guide in study I that had given particularly rich responses. Transcripts were analysed using phenomenography. In the third study, patients’ verbal responses to the key questions, directed to them by physiotherapists in clinical situations, were investigated, and the four aspects of body experience from study I formed the concepts of a deductive analysis. In study IV, finally, the key questions and typologies were tried by a larger group (31), and their experiences and the possible applicability of the method were studied by qualitative content analysis combined with the counting of codes.Results: We created four typologies of attitudes to long-standing pain: “Surrendering to one’s fate”, “Accepting by an active process of change”, “Balancing between hope and resignation” and “Rejecting the body”. These typologies, in turn, were based on four aspects of body experience: “The body as an aspect of identity”. “Body reliance”, “Body awareness”, and “Ways of understanding pain”. In study II, by the aid of key questions, patient and physiotherapist managed to have a conversation on bodily existential matters. The physiotherapist learnt to know the patient as a person, a process appeared to be initiated in the patient, and their relation changed. The patient was willing to talk about her body in pain, and had the words to do this. In study III, the key questions opened ways to reflections on body, existence, and biography. The four aspects of body experience were central to the patients’ descriptions. In study IV, the participating physiotherapists reported by large positive experiences from applying key questions and typologies. The patients reflected, emotions were evoked, and the relation and the communication often improved. The typologies helped in giving a comprehensive perspective of the patient’s problem, and to grasp where in the process of rehabilitation the patient was to be found.Conclusions: The method, seven key questions combined with the tentative frame of interpretation of the answers, seemed to be easily applied by interested physiotherapists in non-specialised practice. The application of the method addresses the need of developing the professional role of the physiotherapist. The challenge is to face the whole person, who is her lived body as well as her identity crisis, carried by emotions such as grief and anger. This may inspire the use of the full potential of the physiotherapist’s professional role in the clinical encounter.
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| 8. |
- Bernhardsson, Susanne, 1958-
(författare)
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Advancing evidence-based practice in primary care physiotherapy : Guideline implementation, clinical practice, and patient preferences
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Research on physiotherapy treatment interventions has increased dramatically in the past 25 years and it is a challenge to transfer research findings into clinical practice, so that patients benefit from effective treatment. Development of clinical practice guidelines is a potentially useful strategy to implement research evidence into practice. However, the impact of guideline implementation in Swedish primary care physiotherapy is unknown. To achieve evidence-based practice (EBP), research evidence should be integrated with clinical expertise and patient preferences, but knowledge is limited about these factors in Swedish primary care physiotherapy.The overall aim of this thesis was to increase understanding of factors of importance for the implementation of EBP in Swedish primary care physiotherapy. Specific aims were: to translate and adapt a questionnaire for the measurement of EBP and guidelines; to investigate physiotherapists’ attitudes, knowledge and behaviour related to EBP and guidelines; to examine clinical practice patterns; to evaluate the effects of a tailored guideline implementation strategy; and to explore patients’ preferences for physiotherapy.The thesis comprises four studies (A-D), reported in five papers. In Study A, a questionnaire for the measurement of EBP and guidelines was translated, cross-culturally adapted, and tested for validity (n=10) and reliability (n=42). Study B was a cross-sectional study in which this questionnaire was used to survey primary care physiotherapists in the county council Region Västra Götaland (n=271). In Study C, a strategy for the implementation of guidelines was developed and evaluated, using the same questionnaire (n=271 at baseline, n=256 at follow-up), in a prospective controlled trial. The strategy was based on an implementation model, was tailored to address the determinants of guideline use identified in Study B, and comprised several components including an educational seminar. Study D was an exploratory qualitative study of patients with musculoskeletal disorders (n=20), using qualitative content analysis.The validity and reliability of the questionnaire was found to be satisfactory. Most physiotherapists have a positive regard for EBP and guidelines, although these attitudes are not fully reflected in the reported use of guidelines. The most important determinants of guideline use were considering guidelines important to facilitate practice and knowing how to integrate patient preferences with guidelines. The tailored, multi-component guideline implementation significantly affected awareness of, knowledge of, and access to guidelines. Use of guidelines was significantly affected among those who attended an implementation seminar. Clinical practice for common musculoskeletal conditions included interventions supported by evidence of various strengths as well as interventions with insufficient research evidence. The most frequently reported interventions were advice and exercise therapy. The interviewed patients expressed trust and confidence in the professionalism of physiotherapists and in the therapists’ ability to choose appropriate treatment, rendering treatment preferences subordinate. This trust seemed to foster active engagement in their physiotherapy.In conclusion: The adapted questionnaire can be used to reliably measure EBP in physiotherapy. The positive attitudes found do not necessarily translate to guideline use, due to several perceived barriers. The tailored guideline implementation strategy used can be effective to reduce barriers and contribute to increased use of guidelines. The clinical practice patterns identified suggest that physiotherapists rely both on research evidence and their clinical expertise when choosing treatment methods. Patients’ trust in their physiotherapist’s competence and preference for active engagement in their therapy need to be embraced by the clinician and, together with the therapist’s clinical expertise, integrated with guideline use in the clinical decision making. Further research is needed on how the EBP components and different knowledge sources can be integrated in physiotherapy practice, as well as on implementation effects on patient outcomes.
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| 9. |
- Fagerlind Ståhl, Anna-Carin, 1982-
(författare)
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Live long and prosper : Health-promoting conditions at work
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis is to contribute with knowledge concerning health-promoting conditions at work, and to investigate how individual, workplace and organisational conditions are interrelated. In the thesis, work-related flow, i.e. an experience of motivation, absorption and work enjoyment, is used as a holistic notion of occupational health. In Paper I, work-related flow is investigated in relation to decision latitude, social capital and an innovative learning climate at work. Paper II investigates whether the use of tools inspired by lean production, such as standardisation and value stream mapping, is positively associated with conditions for innovative learning in organisations. The aim of Paper III is to identify conditions for health and performance in organisation and at work; further, to investigate the association between work-related flow and performance. Paper IV reports on a longitudinal investigation of workrelated flow in relation to lean tool use and conditions at the workplace. The empirical material is based on data from 10 organisations, including 4442 employees. Papers I-III are cross-sectional, whereas Paper IV is longitudinal. Papers II-IV utilise multilevel analyses.The results show that decision latitude, social capital and an innovative learning climate are associated with an increase in work-related flow (Papers I, III & IV), and with performance (Paper III). Individuals’ decision latitude enables an increased benefit from the social capital and innovative learning climate at work (Paper I). The effect of tools inspired by lean production on work-related flow (Papers III & IV), and on conditions for innovative learning (Paper II) differs, depending on which tools are used, and on workplace conditions. These tools enable innovative learning mainly where decision latitude is low (Paper II), and it is primarily the lean tool value stream mapping which has the potential to create an arena for innovative learning (Paper II) and work-related flow (Paper IV).It is concluded that the individual is embedded in a social work context that has the potential to strengthen the ability to act with motivation, absorption and enjoyment. In order to utilise collective healthpromoting conditions at work, individuals need to have authority to make their own decisions and use their skills. The effect of tools inspired by lean production depends on the specific tools that are used, and on individuals’ decision latitude at work. Their potential to enable innovative learning is most evident for employees who have few opportunities for autonomous decision-making and skill use in their work. For those with a high degree of decision latitude, the use of lean tools has a smaller effect. Work-related flow may in itself serve as a resource that improves performance and increases engagement in health-promoting work conditions. In order to promote health as well as performance, work needsto be organised so that employees have opportunities to decide over their own work, and utilise their skills, individually and collectively within the workgroup.
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| 10. |
- Furberg, Maria, 1970-
(författare)
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Towards the Limits – Climate Change Aspects of Life and Health in Northern Sweden : studies of tularemia and regional experiences of changes in the environment
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundIndigenous peoples with traditional lifestyles worldwide are considered particularly vulnerable to climate change effects. Large climate change impacts on the spread of infectious vector-borne diseases are expected as a health outcome. The most rapid climate changes are occurring in the Arctic regions, and as a part of this region northernmost Sweden might experience early effects. In this thesis, climate change effects on the lives of Sami reindeer herders are described and 30 years of weather changes are quantified. Epidemiology of the climate sensitive human infection tularemia is assessed, baseline serologic prevalence of tularemia is investigated and the disease burden is quantified across inhabitants in the region.MethodsPerceptions and experiences of climate change effects among the indigenous Sami reindeer herders of northern Sweden were investigated through qualitative analyses of fourteen interviews. The results were then combined with instrumental weather data from ten meteorological stations in a mixed-methods design to further illustrate climate change effects in this region. In two following studies, tularemia ecology and epidemiology were investigated. A total of 4,792 reported cases of tularemia between 1984 and 2012 were analysed and correlated to ecological regions and presence of inland water using geographical mapping. The status of tularemia in the Swedish Arctic region was further investigated through risk factor analyses of a 2012 regional outbreak and a cross-sectional serological survey to estimate the burden of disease including unreported cases.ResultsThe reindeer herders described how the winters of northern Sweden have changed since the 1970s – warmer winters with shorter snow season and cold periods, and earlier spring. The adverse effects on the reindeer herders through the obstruction of their work, the stress induced and the threat to their lifestyle was demonstrated, forcing the reindeer herders towards the limit of resilience. Weather data supported the observations of winter changes; some stations displayed a more than two full months shorter snow cover season and winter temperatures increased significantly, most pronounced in the lowest temperatures. During the same time period a near tenfold increase in national incidence of tularemia was observed in Sweden (from 0.26 to 2.47/100,000 p<0.001) with a clear overrepresentation of cases in the north versus the south (4.52 vs. 0.56/100,000 p<0.001). The incidence was positively correlated with the presence of inland water (p<0.001) and higher than expected in the alpine and boreal ecologic regions (p<0.001). In the outbreak investigation a dose-response relationship to water was identified; distance from residence to water – less than 100 m, mOR 2.86 (95% CI 1.79–4.57) and 100 to 500 m, mOR 1.63 (95% CI 1.08–2.46). The prevalence of tularemia antibodies in the two northernmost counties was 2.9% corresponding to a 16 times higher number of cases than reported indicating that the reported numbers represent only a minute fraction of the true tularemia.ConclusionsThe extensive winter changes pose a threat to reindeer herding in this region. Tularemia is increasing in Sweden, it has a strong correlation to water and northern ecoregions, and unreported tularemia cases are quite common.
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