| 1. |
- Kassymova, Gulnara, 1972-
(författare)
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The impact of postoperative telephone follow-up contacts on recovery after benign hysterectomy : with emphasis on health-related quality of life, postoperative symptoms, and health economics
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundThe course of a postoperative recovery is important for both patient and healthcare services. Efforts to expedite and improve recovery in a safe and cost-effective manner are therefore highly desirable from the perspective of both parties. Telephone follow-up (TFU) has been suggested as a way to improve postoperative recovery and reduce the burden of the healthcare service. This thesis intends to investigate these issues. The overall purpose of the thesis was twofold: to evaluate the effects of nurse-led TFU contacts on the recovery after benign hysterectomy, and to make a health economic analysis of TFU. The specific aims of the thesis were a) to evaluate whether TFU, particularly when combined with structured-oriented coaching, facilitated postoperative recovery in terms of health-related quality of life (HRQoL), the duration of sick leave, and the occurrence of unplanned telephone contacts (uTCs) and unplanned visits (uVs) in the postoperative period, b) to determine if the TFUs affected postoperative symptoms and the consumption of analgesics, c) to analyze whether symptoms of anxiety and depression, and low stress-coping capacity had an impact on the effect of TFU on recovery and the occurrence of uTCs and uVs, and d) to provide a health economic evaluation of the TFU from the healthcare and societal perspectives. By addressing these aims, the intention of the thesis was to contribute with important knowledge to the existing sparse body of science concerning clinical outcomes after nurse-led TFUs and their impact on recovery outcomes after benign hysterectomy. Material and methodsA four-armed, semi-blinded, randomized controlled trial was conducted at the departments of obstetrics and gynecology in five public hospitals in the southeast health region of Sweden from October 2011 to May 2017. The study comprised 487 women between 18 and 60 years old who underwent abdominal or vaginal hysterectomy for benign gynecological conditions. The treatments to be investigated were different nurse-led TFU models and consisted of four groups: Group A had no planned follow-up contact with the healthcare service after discharge (control group); Group B had one planned, structured TFU session with the research nurse (RN) on the day after discharge; Group C had a planned, structured TFU session with the RN on the day after discharge and then once weekly for six weeks; and Group D had a planned, structured, oriented coaching TFU session with the RN on the day after discharge and then once weekly for six weeks. The specific content of the TFUs in Groups B and C, as well as the oriented coaching TFU model in Group D, were outlined in the study. Demographic and clinical data relevant to the study were collected prospectively. Sick leave duration, analgesic consumption, uTC, and uV were recorded from discharge until the six-week follow-up visit with the RN. HRQoL was measured by means of the EuroQoL-5 Dimension with three levels and the Short Form Health Survey with 36 items. Psychological distress was evaluated using the Hospital Anxiety and Depression Scale and the Stress-Coping Inventory. Postoperative symptoms were assessed using the Swedish Postoperative Symptoms Questionnaire. The health economics were evaluated using a cost minimization analysis. The estimation of hospital costs was based on the principles of the Cost Per Patient (CPP) method and the prices from the CPP list for 2022 from the University Hospital in Linköping were applied. ResultsRegardless of the TFU model, women achieved baseline levels of HRQoL four weeks after surgery and no difference was seen between the intervention groups in the trajectory of recovery of HRQoL. The duration of sick leave was similar across all intervention groups, ranging from 26.8 to 28.1 days. There were no significant differences in the trajectory of the intensity of postoperative symptoms or analgesic consumption between the intervention groups. Approximately 46% of the women had uTC and 45% had uV. The oriented coaching TFU was associated with a 33% lower occurrence of uTC compared with other TFU models. Women who had uTC reported higher levels of pain intensity and sum scores of postoperative symptoms, especially when the uTC was followed by a uV. Symptoms of depression, anxiety, and low stress coping capacity did not affect the effects of the TFU models on recovery trajectories, although there were strong associations between symptoms of anxiety, depression and low stress-coping capacity and all recovery measures. In addition, uTCs were more frequent among women with anxiety. The total costs per patient more than doubled in the groups with repeated TFUs compared with the group with no TFU. The coaching TFU group had lower costs for informal care. ConclusionsNurse-led TFU after benign hysterectomy in the form used in the present study did not expedite or improve the postoperative recovery concerning HRQoL, sick leave duration postoperative symptoms, or analgesic consumption. However, nurse-led TFU with structured coaching reduced the occurrence of uTC to healthcare providers, but not uVs. Symptoms of anxiety increased the occurrence of uTC and pain seemed to be a significant cause of both uTCs and uVs, The effect of the TFU on the recovery did not seem to be affected by the psychological state of proneness to anxiety, depression, or low stress-coping capacity. Nurse-led TFUs were cost-driving for the healthcare systems and can be seen as an inefficient use of healthcare resources.
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| 2. |
- Andersson, Gunnel, 1958-
(författare)
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Urinary incontinence : prevalence, treatment seeking behaviour, experiences, and perceptions among persons with and without urinary leakage
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis is to describe urinary incontinence (UI) from a population perspective and to describe experiences and perceptions of UI from an individual perspective. This includes assessing the prevalence of urinary incontinence as well as describing treatment seeking and experiences of living with UI. A secondary aim was to describe the perception of UI among cultures other than the Swedish mainstream, exemplified in this case by Syrian women living in Sweden. Both quantitative and qualitative methods were used, including questionnaires and interviews. Studies I and II were quantitative studies based on a population-based study. Together with a postal survey on general health and living conditions “Life & Health”, a questionnaire on urinary incontinence was sent out to 15 360 randomly-selected residents aged 18-79 in Orebro County, Sweden. In Study I, UI was found to affect 19%. The majority of the respondents experienced minor problems, and only 18% of those reporting UI wanted treatment. However, there was also a group who reported severe problems, but despite this 42% of them did not want treatment. Study II investigated why people with UI refrain from seeking care and treatment. It was found that the desire for treatment was regulated by the frequency of UI, being restricted from participating in various activities, the degree of inconvenience, and the type of UI. Studies III and IV were both qualitative interview studies, describing older women’s experiences of living with UI (Study III) and Syrian women’s perceptions of UI (Study IV). There were similarities between the results of these two studies; the women described UI as a normal and expected problem, and they knew that the district nurse could prescribe incontinence protections and that treatments existed. In both studies, the women expressed difficulties in making contact with the health care service, while the women who did not speak Swedish (Study IV) also had difficulties due to different communication problems. In conclusion, it is important that health care resources are optimized to identify and meet the needs of those who experience major problems with UI, and that there is awareness of the communication difficulties that can be present in meeting with people who speak other languages. However it is also important not to medicalize those who experience minor problems and who have the desire to manage on their own.
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| 3. |
- Edlund, Ann-Catrine, 1959-
(författare)
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Sälen och Jägaren : De bottniska jägarnas begreppssystem för säl ur ett kognitivt perspektiv
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In the North Scandinavian area of investigation, which is in focus in this dissertation, seal-hunting has been an important means of livelihood from prehistoric times up to the present. The Swedish-speaking seal-hunters' conceptual system for seal during the 20th century is analysed here. The analysis is mainly based on oral recorded interviews with hunters from the coastal areas around the Gulf of Bothnia – from Norrbotten and Västerbotten in Sweden, and Österbotten in Finland. A cognitive perspective is applied in the analysis, in which focus is on the hunters' knowledge of the seal with the purpose of investigating the construction of the hunters' conceptual system for seal. The dissertation's theoretical starting-point is taken in cognitive linguistics and cognitive anthropology.The investigated vocabulary contains 150 different words for seal. The analysis also includes the cultural and ecological context of the hunt. The hunters' conceptual system for seal is characterised by breadth and variation. There is regional variation in the construction of the conceptual system in the investigated area. In addition to that there is also variation with regard to different hunting seasons, something which is apparent both in the vocabulary and in the structure of the conceptual system.The summer and autumn hunt was not particularly complicated and there was consequently no need for categorising the seal. During this season a limited conceptual system with more general terms was used, which included all seals that were hunted at that time. The late winter and early summer hunt, on the other hand, required an immense amount of knowledge, for example with regard to ecology. In that connection the hunters used an extended conceptual system for seal. The analysis of the conceptual system of the late winter and early summer hunt is based on three different scenarios in which the categories for seal direct the actions of the hunters – in locating the seals in the ice environment, in the hunters' actions during the hunt and in the utilisation of the seal as a resource.A number of categories for seal which were used during the late winter and early spring hunt are the same in the whole area of investigation and can be said to constitute a cognitive and communicative basic level.
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| 4. |
- Nilsson, Per A., 1957-
(författare)
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Studying abroad : exploring mobility, expectations and experiences among mobile students
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis deals with the experiences and outcomes of temporarily studying abroad, via follow-up studies, aiming to explore international student mobility with a focus on the individual’s perspective. The specific research questions, dealing with the individual students’ expectations and experiences, are addressed in three papers. The fourth paper is a framing of these studies, using results from a global study.The first research question connects to the attractiveness of international study experiences: Q1. What are the individual’s expectations for studying abroad, among inbound and outbound students, and what are the students’ reported experiences compared with these expectations? The second research question connects to the mobility culture of youth: Q2. Does students’ reported life satisfaction change in any way after studying abroad?A main finding for outbound students was an appreciation of courses offered at the destination higher education institution that were not available at Umeå University. The students also had a desire to change their environment and have new experiences. Conversely, the desire to work abroad in the future was lower after returning home. A major finding for inbound students was that they assigned higher value to personal development than academic development. The experience made the students positive in regard to working abroad. Inbound students reported significantly higher satisfaction at follow-up six months later for the domains somatic health and activities of daily living. For both in- and outbound students, experiencing a new culture was more important than pure academic experiences.When the experience was compared with the expectation, in most cases the outcomes were positively related for both in- and outbound students. The motives for international study were primarily related to personal achievements, indicating a fulfilment of one’s potential and curiosity about a sojourn abroad.Finally, the results from the Umeå studies were compared with a global survey. The Umeå studies shows that the respondents viewed studying abroad as an important experience and as a merit later in life. The global survey results indicate that the transition from education to the world of work is of increasing importance to students, and that it matters more for non-European students. The global study showed that employability, teaching ability, expert lectures, and course organization are important to international students.
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| 5. |
- Pettersson, Hans, 1980-
(författare)
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Risk of hearing loss from combined exposure to hand-arm vibrations and noise
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Hearing loss from noise exposure is one of the most common occupational injuries, and exposure to vibrations may increase the risk of noise-induced hearing loss. Earlier cross-sectional and longitudinal studies found an increased risk of noise-induced hearing loss among workers with vibration-induced white fingers (VWF) symptoms compared to workers without such symptoms. It has been suggested that vibrations to the hand stimulate the sympathetic nervous system and cause vasoconstriction in both the exposed hand and the ears and that this contributes to noise-induced hearing loss. The overall aim of this thesis was to examine how hand-arm vibrations (HAV) interact with noise in the development of noise-induced hearing loss.The experimental study in this thesis examined the effects of HAV and noise, both separately and combined, on the temporary threshold shift (TTS) in hearing in 22 healthy male and female subjects. The two longitudinal studies in this thesis were based on a cohort of 189 male workers at a heavy engineering workshop. The first cohort study examined the risk of noise-induced hearing loss from long-term exposure to HAV and noise. The second cohort study examined if workers with VWF had an increased risk of noise-induced hearing loss compared to workers without such symptoms. Finally, the questionnaire study in this thesis examined the occurrence of Raynaud’s phenomenon among 133 men and women with noise-induced hearing loss in relation to exposure to vibrations.In the experimental study, no differences in TTS in hearing were observed after combined exposure to HAV and noise compared to exposure to only noise. In the first cohort study, there was an increased risk of noise-induced hearing loss with increased exposure to HAV in a noisy environment. In the second cohort study, it was found that workers with VWF had an increased risk of noise-induced hearing loss compared to workers without VWF. In the questionnaire study, many men and women with noise-induced hearing loss had used hand-held vibrating machines suggesting that vibrations might contribute to noise-induced hearing loss. A high prevalence of Raynaud’s phenomenon was found among men.This thesis demonstrated that there was a long-term effect on noise-induced hearing loss from combined exposure to noise and HAV, but no short-term effect, and that having Raynaud’s phenomenon may also increase the risk of noise-induced hearing loss.
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| 6. |
- Fornander, Elin, 1981-
(författare)
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Consuming and communicating identities : Dietary diversity and interaction in Middle Neolithic Sweden
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Isotope analyses on human and faunal skeletal remains from different Swedish Neolithic archaeological contexts are here applied as a means to reconstruct dietary strategies and mobility patterns. The chronological emphasis is on the Middle Neolithic period, and radiocarbon dating constitutes another central focus. The results reveal a food cultural diversity throughout the period in question, where dietary differences in part correspond to, but also transcend, the traditionally defined archaeological cultures in the Swedish Early to Middle Neolithic. Further, these differences, and the apparent continued utilisation of marine resources in several regions and cultural contexts, can only in part be explained by chronology or availability of resources depending on geographic location. Thus, the sometimes suggested sharp economic shift towards an agricultural way of life at the onset of the Neolithic is refuted. Taking the potential of isotope analyses a step further, aspects of Neolithic social relations and identities are discussed, partly from a food cultural perspective embarking from the obtained results. Relations between people and places, as well as to the past, are discussed. The apparent tenacity in the dietary strategies observed is understood in terms of their rootedness in the practices and social memory of the Neolithic societies in question. Food cultural practices are further argued to have given rise to different notions of identity, some of which can be related to the different archaeological cultures, although these cultures are not to be perceived as bounded entities or the sole basis of self-conceptualisation. Some of these identities have been focused around the dietary strategies of everyday life, whereas others emanate from practices, e.g. of ritualised character, whose dietary importance has been more marginal. Isotope analyses, when combined with other archaeological indices, have the potential to elucidate both these food cultural aspects.
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| 7. |
- Gustafsson Gillbrand, Patrik
(författare)
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Stenbruk : Stenartefakter, råmaterial och mobilitet i östra Mellansverige under tidig- och mellanmesolitikum
- 2018
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis examines artefacts, raw materials and lithic technology between c. 9200–6200 cal BC in Eastern Central Sweden. The overall purpose of this study is to investigate when people first came to Eastern Central Sweden and where they came from. More precisely, it provides a typological, geographical and chronological survey of artefacts and the use of different raw materials. The study deals with assemblages with artefacts from more than thirty archaeologically excavated sites and loose finds in Eastern Central Sweden. The objects consist of chubby pecked axes, core axes, flake axes, shaft hole picks, microliths and micro burins, points, burins, rulers, unifacial blade core, conical cores, micro blade cores, blades, drills, retouched blades and micro blades. The artefacts have been compared with established typologies and chronologies for the rest of the Nordic countries and to some extent Russia and the Baltic States. An analysis of different raw materials present at Early and Middle Mesolithic sites in Eastern Central Sweden was also carried out. The materials are put into a chronological and geographical context. The raw materials included in the study are the non-local rocks flint and Cambrian flint, as well as local raw materials such as quartz, greenstone, local vulcanite, mylonite and red porphyry. From 9200 cal BC there is evidence of the first groups of people in the area, just shortly after that the Weichselian ice cap had withdrawn. Throughout the period studied the artefacts as well as the non-local raw materials exhibit great similarities to those found in the western part of Sweden. The study also shows, regarding the use of different raw materials and presence of certain artefacts, that some major events took place, suggesting a new chronological time frame for the Early- and Middle Mesolithic periods. In addition, a discussion regarding mobility and migration in Eastern Central Sweden during Early Post Glacial time is carried out.
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| 8. |
- Henriksson, Mikael
(författare)
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Arkeologiska förväntningar i mötet med ett landskap : Stenålderns Blekinge ur ett kunskapsperspektiv
- 2019
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This study is about archaeological knowledge production. It is also about what kind of impact such knowledge may have on an antiquarian/archaeological practice as well as on society as a whole. The work focuses broadly on Stone Age archaeology and specifically on the middle-Mesolithic Age in the county of Blekinge in the South East of Sweden.Until the late 1990’s, large-scale archaeological excavations in this region were rare. In particular, there were significant gaps in early- and middle-Mesolithic archaeology of other regions. In particular, the study brings up the relationship with the defined Kongemose culture's settlements in Southern Scandinavia. From a knowledge perspective the study discusses how different kinds of methodological practices are important for both archaeology and society, to be able to see and understand a more complete historical picture. Based on this, the focus shifts the role of museums within regional archaeology. The study here argues for a more strategically executed dissemination and presentation of archaeological knowledge towards different stakeholders.
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| 9. |
- Hoogendoorn, Billy W., et al.
(författare)
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Formation of Different Zinc Oxide Crystal Morphologies Using Cellulose as Nucleation Agent in the Waste Valorization and Recycling of Zn-Ion Batteries
- 2023
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Ingår i: Rare Metal Technology 2023. - Cham : Springer.
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Konferensbidrag (refereegranskat)abstract
- The formation of zinc oxide particles of different hierarchical morphologies was investigated. By performing elemental analysis on samples extracted from the supernatant solution during precipitations yielding two distinctly different morphologies, the consumption of zinc ions was used to follow the liquid-to-solid phase formation. While a rapid Zn-ion consumption was synonymous with the formation of predominantly oxygen terminated flower-shaped ZnO-particles, with half of the zinc ions being precipitated during the first minute, less than 10% of the zinc ions were converted to sea urchin-shaped ZnO-particles (with mixed terminations) after 1 min of the reaction. The unique ZnO-particle morphologies may therefore be related to the precipitation rates, which can be further explored as a tool for understanding how ZnO-particles with differently facetted surfaces form. Interestingly, the different formation rates remained with identical patterns when 0.5 g/L cellulose (0.005 wt%) was added to the reactions as nucleating agent for improved yields. The controlled formation of specific functional ZnO-particle surfaces is an important method for recycling inexpensive zinc waste from batteries to high value materials useful in a variety of catalytic applications.
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| 10. |
- Håkansson, Carita, et al.
(författare)
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Organizational and social work environment factors, occupational balance and no or negligible stress symptoms among Swedish principals : a cross-sectional study
- 2021
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Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Few studies have assessed the mental health of principals, or studied associations with both organizational and social work environment factors and occupational balance. The purpose of the present study was therefore to investigate associations between supporting and demanding organizational and social work environment factors, occupational balance and stress symptoms in principals. Methods: A total of 4309 surveys (2316 from the first round, 1992 from the second round), representing 2781 Swedish principals who had responded to at least one of two surveys, were included in the present study. The surveys include questions about socio-demographic factors, occupational balance, overtime work, and supporting and demanding organizational and social work environment factors, as well as questions about personal stress and exhaustion. Generalized Estimating Equations (GEE) models were used to specify a repeated measures model with a dichotomous outcome (binary logistic regression) and multiple independent factors. Data from two surveys were combined, taking into account dependent observations due to the fact that many study subjects had participated in both surveys. Results: Associations were found between occupational balance (Q1: OR 2.52, 95% CI 2.03–3.15; Q2: OR 4.95, 95% CI 3.86–6.35; Q3: OR 9.29, 95% CI 6.99–12.34), overtime work (Once a week: OR 1.51, 95% CI 1.10–2.08; Sometimes a week: OR 1.31, 95% CI 1.03–1.66), supportive private life (OR 1.50, 95% CI 1.36–1.66), supportive colleagues at the leadership level (OR 1.24, 95% CI 1.14–1.36), supportive management (OR 1.17, 95% CI 1.07–1.28) and no or negligible stress symptoms. In addition, role demands (OR 0.72, 95% CI 0.63–0.83), having a container function (OR 0.72, 95% CI 0.64–0.82), collaboration with employees (OR 0.77, 95% CI 0.66–0.89), role conflicts (OR 0.75, 95% CI 0.66–0.89) and having a buffer function (OR 0.86, 95% CI 0.77–0.97) were associated with lower likelihood to rate no or negligible stress symptoms. Conclusions: The occupational balance of principals is strongly associated with no or negligible stress symptoms, and thus is a promising venue for promoting well-being. Improvements should be made to several factors in the organizational and social work environments to improve principals’ chances of having occupational balance, and therefore better mental health.
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