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- Engström, Jon, 1980-, et al.
(författare)
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Service design in healthcare : a segmentation-based approach
- 2022
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Ingår i: Journal of Service Management. - : Emerald Group Publishing Ltd. - 1757-5818 .- 1757-5826. ; 33:6, s. 50-78
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Tidskriftsartikel (refereegranskat)abstract
- Purpose - The study aims to explore how segmentation as a methodology can be adapted to the healthcare context to provide a more nuanced understanding of the served population and to facilitate the design of patient-centric services.Design/methodology/approach - The study was based on a collaborative project with a national healthcare organization following the principles of action design research. The study describes the quantitative segmentation performed during the project, followed by a qualitative interview study of how segments correspond with patient behaviors in an actual healthcare setting, and service design workshops facilitated by segments. A number of design principles are outlined based on the learnings of the project.Findings - The segmentation approach increased understanding of patient variability within the service provider organization and was considered an effective foundation for modular service design. Patient characteristics and life circumstances were related to specific patterns of health behaviors, such as avoidance or passivity, or a persistent proactivity. These patterns influenced the patients' preferred value co-creation role and what type of support patients sought from the care provider.Practical implications - The proposed segmentation approach is immediately generalizable to further healthcare contexts and similar services: improved understanding of patients, vulnerable patients in particular, improves the fit and inclusivity of services.Originality/value - The segmentation approach to service design was demonstrated to be effective in a large-scale context. The approach allows service providers to design service options that improve the fit with individual patients' needs for support and autonomy. The results illuminate how patient characteristics influence health and value co-creation behaviors.
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| 2. |
- Gasparini, Alessandro, et al.
(författare)
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Prevalence and recognition of chronic kidney disease in Stockholm healthcare
- 2016
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Ingår i: Nephrology, Dialysis and Transplantation. - : Oxford University Press (OUP). - 0931-0509 .- 1460-2385. ; 31:12, s. 2086-2094
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Tidskriftsartikel (refereegranskat)abstract
- Background. Chronic kidney disease (CKD) is common, but the frequency of albuminuria testing and referral to nephrology care has been difficult to measure. We here characterize CKD prevalence and recognition in a complete healthcare utilization cohort of the Stockholm region, in Sweden. Methods. We included all adult individuals (n = 1 128 058) with at least one outpatient measurement of IDMS-calibrated serum creatinine during 2006-11. Estimated glomerular filtration rate (eGFR) was calculated via the CKD-EPI equation and CKD was solely defined as eGFR <60 mL/min/1.73 m(2). We also assessed the performance of diagnostic testing (albuminuria), nephrology consultations, and utilization of ICD-10 diagnoses. Results. A total of 68 894 individuals had CKD, with a crude CKD prevalence of 6.11% [95% confidence interval (CI): 6.07-6.16%] and a prevalence standardized to the European population of 5.38% (5.33-5.42%). CKD was more prevalent among the elderly (28% prevalence >75 years old), women (6.85 versus 5.24% in men), and individuals with diabetes (17%), hypertension (17%) or cardiovascular disease (31%). The frequency of albuminuria monitoring was low, with 38% of diabetics and 27% of CKD individuals undergoing albuminuria testing over 2 years. Twenty-three per cent of the 16 383 individuals satisfying selected KDIGO criteria for nephrology referral visited a nephrologist. Twelve per cent of CKD patients carried an ICD-10 diagnostic code of CKD. Conclusions. An estimated 6% of the adult Stockholm population accessing healthcare has CKD, but the frequency of albuminuria testing, nephrology consultations and registration of CKD diagnoses was suboptimal despite universal care. Improving provider awareness and treatment of CKD could have a significant public health impact.
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| 3. |
- Mossmark, Fredrik, 1975, et al.
(författare)
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Aggressive groundwater chemistry caused by underground constructions
- 2008
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Ingår i: Proceedings of the 33rd International Geological Congress, Oslo, Norway, August 2008.
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Konferensbidrag (refereegranskat)abstract
- When considering the degradation process and lifetime of the support system and equipment in underground facilities, the selection of materials is (normally) based on established criteria for the chemical composition of the groundwater. This is important for decisions regarding the steel quality and protection of reinforcement bolts, as well as the material used for the waterproofing system and lining. The criteria are imposed through groundwater sampling and analysis of groundwater prior to the construction of an underground facility. However, studies of the impact on groundwater chemistry from the construction of underground structures and experiments with groundwater extraction indicate that the groundwater chemistry is likely to change over time. Underground facilities are known to cause hydrological changes, especially during the construction phase. However, extensive monitoring programmes of groundwater chemistry are unusual. To further investigate possible changes of water chemistry due to hydrological changes, an experiment with groundwater extraction has been carried out. The experiment was conducted through the constant extraction of groundwater for a period of five years (between the years 2000 and 2005) from within a small watershed (28000 m2) at Lake Gårdsjön, located 50 km north of Gothenburg in Sweden. The area was also monitored during a few years before the extraction started and during the recovery phase. The area of the experiment is characterized by Precambrian crystalline bedrock covered by a thin overburden of glacial till and organic soils. The extraction caused the runoff from the watershed to decrease by nearly 50 % and the groundwater level to fluctuate more than at a nearby reference area. The hydrological impact of the experiment, with increased groundwater recharge, lead to changes and increased seasonal variations in the chemical composition of the groundwater in the bedrock. The hydrochemical variations were caused by seasonal variations in both the amount of water available for groundwater recharge and the chemical composition of the recharging water. Compared to the reference area, the seasonal variations were observed to increase for all the parameters included in the criteria used by the Swedish authorities for selection of construction materials (pH, hardness (Ca), alkalinity, salinity (EC)). An established method to assess the impact of the water composition on the corrosion of steel materials is the use of Langeliers index. The experiment with groundwater extraction caused a larger fluctuation of Langeliers index in the test area compared to the reference area. The results from the experiment confirm the observations from previous tunnelling projects, and show that the methods commonly used to assess the expected future aggressivity of the groundwater in the planning for underground facilities should be reviewed.
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| 4. |
- Mårtensson, Olof, et al.
(författare)
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Effects of fermented, ropy, non-dairy, oat-based products on serum lipids and the faecal excretion of cholesterol and short chain fatty acids in germfree and conventional rats
- 2002
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Ingår i: Nutrition Research. - 0271-5317. ; 22:12, s. 1461-1473
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Tidskriftsartikel (refereegranskat)abstract
- Three fermented, ropy, non-dairy, oat-based products were evaluated for their effect on serum lipids, faecal cholesterol and faecal short chain fatty. acids in germfree and conventional rats. Three different exopolysaccharide (EPS) producing lactic acid bacteria strains were used to ferment the non-dairy oat-base (Adavena(R) G40) (Ceba Foods AB, Lund; Sweden). Two commercial non-dairy products based on oats (Mill Milk(TM)) (Ceba Foods AB, Lund, Sweden) and rice (Rice Dream(R)) (Imagine Foods, London, UK) were used as non-ropy and unfermented controls. All the standardized feeds were sterilized before being fed to the animals. Adult, germfree-and conventional AGUS rats, were fed the above sterile diets ad libitum for 21 days. Blood samples and faecal samples were collected and the animals' weight gain was monitored throughout the study. No significant change in serum lipids or faecal excretion of cholesterol was observed between the groups on the different diets. A difference in faecal SCFA pattern was observed in conventional rats fed on the oat-based diets in comparison. to the group fed on the rice-based diet. More evidence is needed to support the effect of fermented, ropy, oat-based products and their potential effect on serum lipids, faecal cholesterol/coprostanol levels and amounts of short chain fatty acids.
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| 5. |
- Mårtensson, Olof, et al.
(författare)
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Fermented, ropy, oat-based products reduce cholesterol levels and stimulate the bifidobacteria flora in humans
- 2005
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Ingår i: Nutrition Research. - : Elsevier BV. - 0271-5317. ; 25:5, s. 429-442
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Tidskriftsartikel (refereegranskat)abstract
- This investigation determined the effects of fermented oat-based products containing both native and microbial beta-glucans on plasma lipids and on fecal total bacterial count and Bifidobacterium ssp. The study was randomized, double blind with 3 parallel groups. Sixty-two free-living volunteers with moderately increased plasma cholesterol levels were recruited. In the final analysis, 56 subjects remained, as 6 subjects had left the study either due to lack of time (n = 2), unwillingness to continue the regimen (n = 2), or for other reasons (n = 2). During the first 3 weeks, all subjects received a fermented dairy-based product (control product, run-in period). On the following 5 weeks, I group continued with the control product, whereas the other 2 groups were given fermented oat-based products (intervention period, 3-3.5 g native beta-glucans per day). One of the oat products (ropy) was cofermented with an exopolysaccharide-producing strain, Pediococcus damnosus 2.6. A significant (P = .022) reduction in total cholesterol by 6% was observed in volunteers who had eaten the fermented, ropy, oat-based product compared with the control group. No other significant changes in plasma lipids were found. A significant increase in total bacterial count (P = .001) and Bifidobacterium ssp (P = .012) was observed in fecal samples from volunteers in the group who had eaten the fermented, ropy, oat-based product. This study shows that a fermented, ropy, oat-based product, containing both native and microbial glucans, can reduce the blood cholesterol level and also stimulate the bifidobacteria flora in the gastrointestinal tract. (c) 2005 Elsevier Inc. All rights reserved.
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| 6. |
- Westin, Jonas, et al.
(författare)
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Godsflödesanalyser för Trafikverket region Nord och Mitt
- 2016
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Denna rapport är framtagen och finansierad på uppdrag av Trafikverket Region Nord och Region Mitt. Syftet med rapporten har varit är att sammanställa och redovisa godsflöden längs vägar, järnvägar och sjörutter i Trafikverkets region Nord och Mitt så som de beskrivs i Trafikverkets Samgodsmodell. Trafikverkets Samgodsmodell är central för Trafikverkets inriktnings- och åtgärdsplanering, vid skapandet av en lägesbild över godsflöden och godstransportefterfrågan i regionen är det därför viktigt att bygga arbetet utifrån denna modell.
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