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- Lundgren, Marianne, 1951
(författare)
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Från barn till elev i riskzon : En analys av skolan som kategoriseringsarena
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The purpose of this doctoral thesis is to describe and analyse how school children are constructed into being pupils at risk. The research questions focus on what governing practices and techniques are used for and how power relations are expressed in a pedagogical practice.An ethnographic case study was conducted. Empirical data was collected during one year’s time comprising documents (pupils’ written material, teachers’ logbooks), classroom observations, and interviews with teachers as well as interviews with pupils and their mothers.For analytical purposes the material was divided into three main fields: What is said – speech, What is written – text and What is done – action. This was analysed by applying some central terms derived from Michel Foucault: governmentality, genealogy, pastoral power, regulation and examination processes. How pupils’ deviate behaviour is currently interpreted and dealt with in a pedagogical practice was of particular interest here.The outcome of this study suggests that teachers are part of a normalisation process, steering each other on the basis of conceptions and ideas rooted in the power and knowledge generally applied to the ”good school” of today. In Foucaultian terms this could be described as a process in which teachers constitute themselves as moral subjects. The teachers’ own conviction of governing ”the good school” can, however, be contrasted by their deeply rooted conceptions of pupils. Pupils are compared and categorised on the basis of judgments of what normality is. These normalising judgments can be understood in the light of the schools’ task and function in society. This task and schools’ function are not quite visible in the pedagogical practice and conceptions of deviance become more comprehensible. The predominant conception is that pupils should be responsible subjects equipped with internalised self-regulatory techniques. Whenever this does not appear to be the case, a need for various kinds of expert knowledge is created with the intention of directing pupils and parents towards what is conceived as normality. While schools’ and teachers’ failure is temporary, judgements of pupils’ deviance prevail throughout their school years. Pupils’ own strategies are not of relevance for the pedagogical practice. An ensuing effect of this is the construction of risk zones by the very pedagogical practice that considers children irresponsible objects. This doctoral thesis results in a suggestion as to how we could benefit from the challenging power constituted by pupils.
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| 2. |
- Nilsson Blom, Marcus, 1980-
(författare)
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Opioidberoende : en studie om beroendevården och det sociala sammanhangets betydelse
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Opioid dependence is highly associated with health problems relating to physical health (infectious diseases) as well as mental health (depression, anxiety, antisocial behavior). In addition, research has found an association between use of opioids and increased risk of premature death as a consequence of overdose or other circumstances, such as suicide. Furthermore, opioid dependent individuals experience a high level of social exclusion and problems with relationships, housing, income and livelihood. Overall, there is a connection between opioid dependence and physical, psychological and social vulnerability as well as premature death.The importance of social cohesion has rarely been the focus in research on opioid dependence. Therefore, there is a need to further explore whether differences in outcomes (medication assisted treatment, mortality and co-morbidity) in addition to individual characteristics, can be derived from social aspects of the opioid dependent individual’s life.The overall aim of the dissertation is to examine individual and social factors among individuals who are dependent on opioids and how they are associated with outcomes relating to: a) medication assisted treatment; and b) mortality and co-morbidity.This dissertation is based on data from four different registers. The first and second sub-studies use ASI data. The third uses DOK data from the National Board of Institutions (SiS) and the Death Registry (National Board of Health and Welfare). The fourth study is based on both DOKdata and data from the national patient registry (National Board of Health and Welfare).Overall, this dissertation confirms the understanding of opioid dependence as associated with a high level of vulnerability. This dissertation shows that opioid dependence is characterized by extensive care efforts, low levels of employment, and a high level of mental health and comorbidity.This dissertation shows that the characteristics related to the social network (parenting, work and education) are of significance for being in treatment, but also remaining in care (medication assisted treatment), which in turn promotes the individual's health and long-term health development. In that, this dissertation shows that for individuals dependent on opioids, there is an association between being part of a social network and favorable health development.
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| 3. |
- Grahn, Robert, 1972-
(författare)
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Treatment repeaters : re-entry in care for clients with substance use disorder within the Swedish addiction treatment system
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- According to the regulations contained in the Social Services Act (SFS 2001:453), Swedish social services have a legal responsibility to provide support, care, and treatment for individuals with substance use problems. This law mandate those who are responsible to provide treatment to motivate drug users to actively seek treatment on a voluntary basis, ensuring an end to their dependence on drugs. Studies have shown that although the treatment system largely focuses on promoting abstinence, about two-thirds of client’s relapse into substance use within one year after completing treatment. This dissertation focuses broadly on clients who repeatedly enter and use treatment for substance use disorders in the Swedish addiction treatment system. The aim of this thesis is to examine and identify the population groups who are repeated treatment users of the Swedish treatment system for substance use disorder, including both the voluntary treatment and compulsory care. This thesis was based on three national level databases. The results showed that clients with a higher degree of problems and problems in different areas of life also had an increased risk of having treatment for substance use disorder repeatedly. Clients who were older, men, reported more years of polydrug and alcohol use to intoxication, reported more compulsory care episodes for substance use, had ever been charged with crime, had ever been in inpatient mental health treatment, and had a higher ASI mental health symptom composite score, were significantly more likely to report more voluntary addiction treatment episodes. The strongest significant association with the number of treatment episodes was the number of compulsory treatment episodes for alcohol and drugs. Individuals who experienced prior compulsory care including mandatory treatment through LVU (law (1990:52)), been in prison, and had children mandated to out-of-home care, were more likely to have two or more entries in the compulsory care system for substance use disorder. In addition, this analysis showed that 59% of clients mandated to compulsory care dropped-out during their compulsory care episode, and that younger clients were significantly more likely to drop-out. Those who drop-out were significantly more likely to experience negative outcomes, i.e. additional sentence to compulsory care and higher risk of mortality. A hierarchal logistic regression model also identified that individuals with riskier childhood conditions were more likely to have had repeated entries to compulsory care for substance use disorder. The indirect effects showed that a family history of substance use disorder and psychiatric problems are both associated with higher probability of institutional care as a child i.e. LVU, and that in turn, mandated childhood institutional care is related to repeated compulsory care intakes as an adult. Individuals who use treatment for substance use disorder repeatedly have a higher degree of problems i.e. an exposed and problematic group of individuals characterized by problem in several different areas of life. Growing up in a home environment with unfavorable conditions, mandated care before the age of 18 (LVU), compulsory care for substance use disorder as an adult, children taken into out-of-home care, and crime are the factors that are primarily associated with repeated treatment for substance use. A change in the view of treatment for clients in need of repeated use of treatment seems important, and access to adapted continuous care efforts are crucial to counteract the risk of relapse after a treatment episode of voluntary or compulsory care. Further, it seems important to motivate the client to complete the compulsory care without any deviation, since this seems to have positive effects on their substance use disorder.
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| 4. |
- Jangland, Eva, 1964-
(författare)
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The Patient–Health-professional Interaction in a Hospital Setting
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the thesis was to describe patient−health-professional interactions in a hospital setting, with a specific focus on the surgical care unit. The thesis consists of four studies and includes both qualitative and quantitative studies. Content analysis and phenomenography were used in the qualitative studies; the quantitative study was an intervention study with a three-phase quasi-experimental design. The findings of study I showed that patient complaints to a local Patients’ Advisory Committee about negative interactions with health professionals most often concerned the perceived insufficiencies of information, respect, and empathy. The findings of study II showed that experiences of negative interactions with health professionals caused long-term consequences for individual patients and reduced patients’ confidence in upcoming consultations. The findings of the phenomenographic study (III) showed that surgical nurses understand an important part of their work in qualitatively different ways, which can be presented as a hierarchy of increasing complexity and comprehensiveness. In the most restricted understanding, surgical nurses focus on the work task, whereas in the others surgical nurses demonstrate increasing degrees of patient-centeredness. Finally, the results of study IV showed that an uncomplicated intervention that invited patients to express their daily questions and concerns in writing (using the ‘Tell-us card’) improved the patients’ perceptions of participation in their care in a surgical care unit. For further implementation of the Tell-us card to succeed, it needs to be prioritized and supported by leaders in ongoing quality improvement work. The value of a patient-focused interaction needs to be the subject of ongoing discussions in surgical care units. Patients’ stories of negative interactions could be used as a starting point for discussions in professional reflection sessions. It is important to discuss and become aware of different ways of understanding professional interactions and relationships with patients; these discussions could open up new areas of professional development. Providing patients an opportunity to ask their questions and express their concerns in writing, and using this information in the patient−health-professional interaction, could be an important step towards improved patient participation.
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| 5. |
- Johansson, Anna, 1980-
(författare)
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Självskada : En etnologisk studie av mening och identitet i berättelser om skärande
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This doctoral thesis is about people who write about their self-harm on Internet message boards. The aim of the study is to understand how meaning is produced in relation to self-harm, and how this involves particular constructions of self-harmer identity. The empirical material consists of written dialogues from seven Swedish message boards, as well as interviews with their members and a selection of published texts. This body of material is analysed using a poststructuralist discourse theoretical approach. In order to outline a context for the study, the thesis traces the constitution of self-harm in Swedish public debate since the 1990s. It is suggested that several discourses interact when cutting is represented in media, literature and governmental reports. Most noticeable, a psychiatric discourse, a dystopian discourse of contemporary society, a discourse of alternative youth culture, and a discourse of vulnerable girls are drawn on here. These discourses are regarded as resources for the production of meaning and the acts of identification in message board discussions and interviews. The analysis of this material is concerned with four empirical themes: the practice of cutting; the importance of talking as cure; distinctions between authentic and inauthentic cutters; and the paradoxical and antagonistic relationship between self-harming patients and psychiatry. Issues of normality/deviance and victimhood/agency are of great importance throughout the thesis, as the informants constantly negotiate these dichotomies. The thesis demonstrates that cutting is framed on the one hand as a deliberate strategy for managing emotions and demonstrating self-control, and on the other hand as the ultimate sign of helplessness, self-hatred and lack of control. Although the informants have different reasons for cutting, their diverse accounts and approaches are linked together on the message boards through their shared identification with the position of ‘feeling bad’. The thesis further argues that cutter identity in this empirical material is defined through the construction of different constitutive outsides or ‘enemies’. On the one hand, cutters who ‘feel bad’ are posited against less ‘real’ or authentic ones. On the other hand, cutters are also posited against psychiatry and psychiatric care staff. Psychiatry is constituted in particularly contradictory ways and the informants tend to vacillate between the positions of autonomous, rebellious patient and docile victim of disease. I argue that this can be seen as ways of dealing with certain problematics inherent in the asymmetrical power relationship between patient and psychiatry, at the same time as the construction of psychiatry as an antagonist is also essential for the assertion of solidarity and mutual support on the message boards.
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| 6. |
- Lundgren, Oskar, 1979-
(författare)
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Psychological Resources and Risk Factors in Coronary Heart Disease : Assessment, Impact and the Influence of Mindfulness Training
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- There is strong evidence for the observation that psychological risk factors, such as depressive symptoms, hopelessness, and anxiety are associated with higher risk of developing coronary heart disease (CHD), and also contribute to a worse prognosis among CHD patients. Much less is known about psychological resources, such as Mastery, and their role in cardiovascular medicine. Although the current state of science about the importance of psychological factors has advanced during the last decades, the mental health status of patients is often neglected in clinical practice. The reason behind this gap is multifaceted, including unawareness of the current state of science among professionals and a lack of clear guideline, which in turn, results from a lack of evidence-based ways to address the issues. Furthermore, the measurement of psychological resources is complex and a debated topic in psychology. The aim of this thesis was to investigate: 1) If the use of inverted items in three questionnaires that measure psychological resources and risk factors represent a validity risk in the context of CHD. 2) If psychological resources and risk factors are independently associated with incidence in CHD. 3) If an eight-week course in Mindfulness-Based Stress Reduction (MBSR) is a feasible psychological intervention, as an addition to cardiac rehabilitation. 4) How CHD patients experience the practices of mindfulness and yoga in MBSR.In Study I and II, data from 1007 participants randomly selected from a Swedish community sample, aged 45-69 at baseline (50 % women), were analysed. To study the validity of the self-report instruments Mastery, Self-esteem and Centre for Epidemiological Studies Depression scale (CESD), subscales with only positive and negative items were created. The new subscales were evaluated against three criterion measures; cross-sectional against each other and the circulatory marker of inflammation interleukine-6 (IL-6) (concurrent construct validity); prospectively against 8-year incidence in CHD (predictive validity), and in addition, a factor analysis was used to investigate construct dimensionality. The instruments seemed to be valid measures of psychological resources and risk factors in the context of CHD risk. The new subscales showed the same associations as the original scales, except for the positive items in CES-D. However, this did not have a major influence on the full scale. In Study II a prospective analysis of the impact of psychological factors on 8-year incidence in CHD was performed. The psychological resources Mastery and Self-esteem were negatively associated with CHD, also after adjustment for nine traditional cardiovascular risk factors in Cox proportional hazard models. The protective effect of the two resources, and the increased risk of Hopelessness, remained after adjustment for depressive symptoms. In Study III and IV, a group of CHD patients with depressive symptoms (n=79) was invited to participate in MBSR as a complement to cardiac rehabilitation. Twenty-four patients started MBSR and 16 completed it. The results were compared with a reference group (n=108) of patients from the same clinic, which showed stability in psychological variables over 12 months. MBSR was appreciated by the patients and improvements in psychological risk factors (e.g., depressive symptoms), and an increase in Mastery were observed. Study IV made use of a qualitative content analysis of diary entries written by patients immediately after practice sessions throughout MBSR. Participants described difficulties, both physical and psychological, during the whole course, but as the weeks passed they more frequently described an enhanced ability to concentrate, relax and deal with distractions. From the combined findings in Study III and IV, we conclude that MBSR could be a promising complement to cardiac rehabilitation for a selection of patients.The overall picture, emerging from this thesis, strengthens the argument that psychological factors should be recognized and addressed in clinical practice. It also encourages further studies of how psychological resources could be built, which could inform the development of effective prevention and treatment strategies for CHD patients with psychological distress and also contribute to improved public health interventions.
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