| 1. |
- Claesson Lingehall, Helena, 1965-
(författare)
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Delirium in older people after cardiac surgery : risk factors, dementia, patients’ experiences and assessments
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background:Delirium is common in older people undergoing cardiac surgery. Delirium is an acute or subacute neuro-psychiatric syndrome, characterized by a change in cognition, disturbances in consciousness; it fluctuates, develops over a short period of time and always has an underlying cause. It is associated with a disturbance in psychomotor activity, and is classified according to different clinical profiles such as hypoactive, hyperactive and mixed delirium. Delirium after cardiac surgery is not harmless, it increases the risk of complications such as prolonged stay in hospital, falls, reduced quality of life, reduced cognitive function and increased mortality.Aim:The overall aim of this thesis was to investigate postoperative delirium in older people undergoing cardiac surgery with Cardiopulmonary Bypass (CPB), focusing on risk factors, dementia and patients’ experiences; and to evaluate an assessment for screening delirium.Methods:This thesis compromises four studies. All participants (n=142) were scheduled for cardiac surgery with use of CPB at the Cardiothoracic Surgery Department, Heart Centre, Umeå University Hospital, Sweden, between February and October 2009. Six structured interviews were conducted preoperatively, day one and day four postoperatively, and in home visits, one, three and five years after surgery (2010, 2012 and 2014). The assessment scales used in Studies I, II and IV were: the Mini-Mental State Examination (MMSE) for cognition, the Organic Brain Syndrome Scale (OBS) for delirium, Geriatric Depression Scale 15 (GDS-15) for depression, Katz staircase with Activities of Daily Living (ADL) for participants’ functional status and the Numerical Rating Scale (NRS) for pain. During the hospital stay, nursing staff used the Swedish version of the Nursing Delirium Screening Scale (Nu-DESC) to assess delirium. Semi-structured interviews were also carried out (III) in the one-year follow up. Delirium, dementia and depression were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV TR).Results: Out of 142 participants 54.9% (78/142) developed delirium after cardiac surgery (I). Independent risk factors, predisposing and precipitating, associated with delirium were: age, diabetes, gastritis/peptic ulcer, volume load during operation, longer time on ventilator in intensive care, increased temperature and plasma sodium concentration in the intensive care unit. Out of 114 participants thirty (26.3%) developed dementia within the five years of follow-up. It was shown that a lower preoperative MMSE score and postoperative delirium were factors independently associated with development of dementia (II). One year after cardiac surgery, participants diagnosed with postoperative delirium described in detail feelings of extreme vulnerability and frailty. Despite this, the participants were grateful for the care they had received (III). Hypoactive was the most common symptom profile for delirium. The Swedish version of Nu-DESC showed high sensitivity in detecting hyperactive delirium, but low sensitivity in detecting hypoactive delirium (IV).Conclusion:Delirium was common among older patients undergoing cardiac surgery. Both predisposing and precipitating factors contributed to postoperative delirium. Preventive strategies should be considered in future randomized studies. It might also be suggested that cognitive function should be screened for preoperatively and patients who develop delirium should be followed up to enable early detection of symptoms of dementia. Whether prevention of postoperative delirium can reduce the risk of future dementia remains to be studied. To minimise unnecessary suffering, patients and next of kin should be informed about and prepared for the risk of delirium developing during hospitalization. The Swedish version of Nu-DESC should be combined with cognitive testing to improve detection of hypoactive delirium, but further research is needed. Healthcare professionals need knowledge concerning postoperative delirium in order to prevent, detect and treat delirium so as to avoid and relieve the suffering it might cause.
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| 2. |
- Olofsson, Jenny, 1978-
(författare)
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Go West : East European migrants in Sweden
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Many people have migrated between East and West Europe in recent decades. The daily life of these migrants is crucial not only for the migrants themselves but also for the development of future migration. The aim of this thesis is to explore the interaction between migration motives, integration, social networks and migration, and how this affects international migration processes in general. This is done using migration between Sweden on the one hand and Russia, Poland and the Baltic States on the other as a case study.The thesis consists of three empirical studies which derive from different sources of data: the first (Paper I) draws on individual Swedish register data while the second and third are based upon a questionnaire survey. Paper I explores aspects of transnational social spaces in the context of migration from the non-Baltic former Soviet republics to Sweden before and after the fall of the Iron Curtain in 1989. The results of this paper show rather limited migration and a lack of a more developed transnational social space. This is partly due to weak integration on the labour market, a high degree of intermarriage, no existing migrant community and limited return migration. The following two papers (II, III) focus on migrants from Russia, Poland and the Baltic States to Sweden after 1990. Paper II analyses migration motives and the outcome of the migration decision, and reveals significant gender differences in the motives for migrating and in how men and women adapt in their new country of living. While men mainly came for economic reasons, the majority of women came for intermarriage in Sweden; however, the migration motives have changed over time towards more economic ones. The final paper (III) shows significant gender differences in the migrants’ perceived sense of belonging in Sweden. Women report a stronger sense of belonging than their male counterparts, and while men’s sense of belonging is mainly affected by duration of stay in Sweden, language proficiency and citizenship, women’s sense of belonging is shown to be mostly affected by local social networks. In sum, the results in this thesis show that migration systems and transnational social spaces between Sweden and the respective countries have not yet emerged. This is partly due to the specific migrant composition and integration that characterize this migration process. The immigrants mainly function as weak bridgeheads, and do not facilitate the development of any further migration. However, with a changing migration flow, including migrants with different motives and migration agendas, future migrants can be stronger bridgeheads and facilitate further development of migration systems and transnational social spaces.
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| 3. |
- Selberg, Rebecca, 1982-
(författare)
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Femininity at Work : Gender, Labour, and Changing Relations of Power in a Swedish Hospital
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Gender scholarship has identified how paid care work reproduces male dominance and reinforces women’s subordination, but also how labour and workplaces provide a critical space for women through the development of new forms of identity and struggle. In this ethnographic study of Swedish nurses’ work, the concept of normative femininity is used in order to explore gender, labour, and changing relations of power in the context of the neoliberal transformation of the Swedish welfare state.The study shows how nursing has undergone dramatic changes in terms of work intensification and new forms of subordination and class boundaries. At the same time, the nursing profession has embraced nurses’ new role as adjunct managers in running clinics and taking on new responsibilities offered by New Public Management.Gendered subjectivities are at the level of the work place produced and reproduced through notions of femininities that shape and are shaped by the labour process. The study is located within the emerging field of ethnographies of neoliberalism and offers an empirical analysis of change and continuity in the relationship between femininity and care work among nurses employed in a Swedish hospital.
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| 4. |
- Bunar, Nihad
(författare)
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Skolan mitt i förorten : - fyra studier om skola, segregation, integration och multikulturalism
- 2001
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this dissertation is first to bring into focus and analyze how relations between schools and the local community are affected when negative economic developments in combination with stigmatizing public representations or portrayals segregate the area. The second aim is to lift up and analyze what role schools are expected to, and actually do, play when an area with a large proportion of immigrants and socially marginalized residents is to be integrated via a set of political-ideological proclamations and concrete efforts. The empirical material that I analyze in the dissertation has been collected in the following districts of Stockholm: Jordbro, Rinkeby, Tensta, and Husby. The heart of the dissertation comprises of four independent studies (chapters 5-8), as well as an introductory section (chapters 1-4), in which the dissertation's background factors, theoretical and methodological framework, and central concepts (segregation and integration) are delineated. Chapter 9 comprises of a concluding discussion of the central findings of the dissertation. My primary theoretical source of inspiration is the French sociologist Pierre Bourdieu's way of looking at the relations between individuals and structures. Against the background of his work I contend that it is first when positions, lived experiences, and representations are placed in relation to each other in a specific context - a field - that we can see the complexity that makes an explanation possible of why and how segregation of areas with high proportions of immigrants and their schools can be carried out and maintained. This is the framework that I operationalize in my dissertation. The role in integration that schools are officially expected to play in the local community, and that is accepted as legitimate and worth pursuing by the leadership in schools has, for the most part been unsuccessful. In some respects it never really started. The reason for this is the way that the negative socio-economic conditions and representations have impacted the relations between various actors in the schools and local communities. I have also been able to show that when these relations work relatively well, there can be positive benefits for both the school and its socio-economically deprived, predominantly immigrant catchment area. The positive effects for the schools are marked, with regard to reputation, status, an improved economic situation, pedagogic development, and higher grades among the students. The positive benefits for the local community come primarily in the form of higher status and reputation.
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| 5. |
- Dannefjord, Per, 1964-
(författare)
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Organisationspraktiker och målförändring : Exemplet svensk socialdemokrati
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The thesis emanates from a comparison between three points of time in the history of the Swedish social democratic party (SAP); 1889, 1905 and 1933. The comparison is partly about the political and organizational situation of the party, and partly about the goals the party expressed. The problem that I study, based on this comparison, is the identified changes of the party’s hierarchy of goals.I argue that goal change should be viewed as a process, not as a decision. There is no simple rationality in goal formulations or in the relation between goals and practices where the practices are shaped by the goals.My case shows the importance of the opposite causal direction where the practices reshape the goals. The organization formulates goals and intermediate goals. These are connected to practices directed towards the intermediate goals. The more resources the organization attach to these practices, the more difficult it is to change them and the higher status in the organizational activity they will get. The primary goals can still be important as justification, but their role will be reduced to a ritual rhetoric without practical significance. They will have to be reinterpreted and reformulated in correspondence to the practices in order to regain a practical significance in the activity of the organization. Thereby we have a practical goal change, which shouldn’t be confused with at rhetoric goal change. The rhetoric of the organization can remain unchanged even though no practices are directed towards the rhetorically important goals.One implication of this is that goals cannot be understood by their formulations only. The importance and meaning of the formulations will change over time and should therefore be related to the context and the organization’s position in the organizational field. When we study an organization over time it will be hard to understand it adequately if we don’t relate the organizational changes to the context.
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| 6. |
- Eriksson, Magnus, 1966-
(författare)
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Studenter och utbildningar vid ett nytt universitet : Växjöstudenternas bakgrund, utbildningsval och arbetsmarknad
- 2009
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Uppsatsens syfte är att utifrån olika ansatser ge en bred bild av ett relativt nyetablerat universitet. Genom att fokusera på studenters utbildningsval och motiv utifrån deras bakgrunder och erfarenheter i relation till Växjö universitets olika typer av utbildningar, vill jag studera förutsättningar för formningen av lärosätets utbildningsmiljö samt konsekvenser för studenternas vidare öden. Växjö universitets studenter och utbildningar studeras i relation till andra lärosätens studenter och utbildningar i ett historiskt och nutida perspektiv. De Växjöstudenter som jag koncentrerar mig på är den stora grupp högskolenybörjare som studerar på helfart som finns vid universitetet. Dessutom beskrivs och analyseras olika utbildningsprograms studenter och deras utbildningsmotiv i den lokala utbildningsmiljön. Ett antal övergripande frågeställningar vägleder arbetet: Vilka är Växjö universitets utbildningar och dess studenter jämfört med andra lärosäten?Vilka studenter rekryterar universitetets olika utbildningar?Vilka är studenternas motiv till valet av utbildningar?Hur ser relationen ut mellan bakgrund, motiv och utbildning? [1] För mer ingående diskussion om studentgruppen, se kapitel 2, och appendix, kapitel 2.
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| 7. |
- Hansen, Jessica, 1962-
(författare)
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"Så fixade vi Allhallen" : Resursmobilisering och organisationsförtätning i ett lokalsamhälle
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Hur går det till att mobilisera människor och resurser i ett svenskt lokalsamhälle? Avhandlingen analyserar hur en idé genom olika slags kontakter, nätverk och människors tillhörigheter i olika organisatioenr frigjorde och skapade tillräckligt med resurser för att bygga en allaktivtetshall. Den visar hur ett organisatoriskt nätverk som går på tvärs mot etablerade intressegrupperingar växer fram och bildar mobiliseringens bas.
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| 8. |
- Lövfors, William, 1991-, et al.
(författare)
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A comprehensive mechanistic model of adipocyte signaling with layers of confidence
- 2022
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Adipocyte cellular signaling, normally and in type 2 diabetes, is far from fully studied. We have earlier developed detailed dynamic mathematical models for some well-studied, and partially overlapping, signaling pathways in adipocytes. Still, these models only cover a fraction of the total cellular response. For a broader coverage of the response, large-scale phosphoproteomic data is key. There exists such data for the insulin response of adipocytes, as well as prior knowledge on possible protein-protein interactions associated with a confidence level. However, methods to combine detailed dynamic models with large-scale data, using information about the confidence of included interactions, are lacking. In our new method, we first establish a core model by connecting our partially overlapping models of adipocyte cellular signaling with focus on: 1) lipolysis and fatty acid release, 2) glucose uptake, and 3) the release of adiponectin. We use the phosphoproteome data and prior knowledge to identify phosphosites adjacent to the core model, and then try to add the adjacent phosphosites to the model. The additions of the adjacent phosphosites is tested in a parallel, pairwise approach with low computation time. We then iteratively collect the accepted additions into a layer, and use the newly added layer to find new adjacent phosphosites. We find that the first 15 layers (60 added phosphosites) with the highest confidence can correctly predict independent inhibitor-data (70-90 % correct), and that this ability decrease when we add layers of decreasing confidence. In total, 60 layers (3926 phosphosites) can be added to the model and still keep predictive ability. Finally, we use the comprehensive adipocyte model to simulate systems-wide alterations in adipocytes in type 2 diabetes. This new method provide a tool to create large models that keeps track of varying confidence.Competing Interest StatementThe authors have declared no competing interest.
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| 9. |
- Olofsson, Madelen, 1981-
(författare)
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On the investigation of chemical parameters reflecting microbial activity linked to nutrient availability in forest soil
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- As agrarian society developed, the most fertile soils able to sustain the nutritional requirements needed for high crop yield were assigned to farming, while the more penurious soils were left to uphold the forest ecosystems. Some temperate forests are developed on acidic soils considered to be nutrient poor, as much of the inorganic nutrients are entrapped in poorly weatherable soil minerals and not easily accessed by plant roots. In an undisturbed ecosystem, the largest contribution of available nutrients comes from the recycling of organically bound nutrients via the decomposition of dead plant material. If biomass is removed, for instance with a more intensified exploitation of the forest ecosystems including whole tree harvesting, this source of nutrients is consequently decreased. The importance of soil mineral weathering as a source of nutrients, and especially that promoted by soil biota, is thereby emphasized.This thesis addresses biotic parameters associated with mineral weathering. Different aspects of soil solution sampling strategies and analysis of different organic ligands as well as biomarkers for the estimation of fungal biomass were investigated. These chemical parameters were also evaluated as indicators of microbial activity in relation to mineral nutrient availability in soil.With the assumption that the current nutrient status of a soil will affect the microbial interest of certain minerals as sources of inorganic nutrients, a mineral amendment trial was performed in a Swedish boreal forest soil. Overall, the amended soil presented good nutrient status, but with a possible shortage of iron. Due to this, it was hypothesized that the amended mineral with the highest iron content i.e. biotite would cause an elevation of microbial activity in its vicinity when compared to the bulk soil.The level of microbial activity in the vicinity of the amended minerals was evaluated via quantification of organic acids and siderophores, as well as estimation of fungal biomass and enzymatic activity.The highest microbial activity was measured for the O horizon of the investigated podzol, although nothing indicated an elevated association with the amended minerals. In the E horizon, however, elevation in microbial activity was observed in the vicinity of the biotite mineral when compared with bulk soil, although only a few of the investigated parameters differed significantly when evaluated separately. To enable this study, a highly sensitive analytical method employing liquid chromatography and mass spectrometry was developed to quantify a number of hydroxamate siderophores. On-line pre-concentration enabled detection of these organic ligands in the pico-molar range – a necessity when analyzing natural samples.Furthermore, an analytical method was developed for the estimation of fungal biomass via quantification of chitin-derived glucosamine, which also employed liquid chromatography and tandem mass spectrometry. Unlike currently available methods, the one presented in this thesis did not involve analyte derivatization, which resulted in high sample throughput while simultaneously avoiding complications involved with the additional derivatization procedure.The distribution of a group of organic ligands known as aromatic low molecular mass organic acids was also studied in a boreal forest podzol soil. Different sampling and samples preparation techniques, namely tension-lysimeters, soil centrifugation and liquid-soil extraction, were compared when analyzing soil solution components. Significant differences in analyte amount and species type were found between these sampling techniques. Some of the differences could be accounted for by variation in soil composition at different depths of the investigated podzol, but others could be attributed to structural differences within the studied analyte group. This clearly illustrated the intricacy of sampling and analysis when working with a sample matrix as complex and diverse as soil.As previously, liquid chromatography and mass spectrometry was used to quantify the analytes of interest. A highly sensitive analytical method was developed that was able to detect eleven aromatic low molecular mass organic acids in the nano-molar range. High selectivity was ensured by applying multiple reaction monitoring enabled by collision induced fragmentation of the analytes.
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| 10. |
- Sarstrand, Anna-Maria, 1976-
(författare)
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De första invandrarbyråerna : Om invandrares inkorporering på kommunal nivå åren 1965-1984
- 2007
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Immigration to Sweden increased during and after the Second World War. Initially the in-crease consisted of refugees, but after the war labour migration became the dominant form of migration to Sweden. The immigrants were expected to manage the adaptation to the Swedish society on their own, possibly with the help of voluntary organizations or the company they worked for. This situation began to change in the 1960s. The immigrants’ situation received public attention and different actions were taken to reduce the risk of marginalizing the immi-grants. Many of these actions started on a local level, in the municipalities, prior to the devel-opment of the first national immigrant policy in 1975. The first local public administrations for handling immigrant incorporation developed approximately ten years before. These or-ganizations, soon to be called Immigrant bureaus, were among the first public initiatives, on both state and local level, to actively take measures to incorporate the immigrants. The licen-tiate thesis is a comparative case study of five Swedish municipalities which started Immi-grant bureaus in the middle of the 1960s. The objective of the thesis is to study the creation and development of these organizations up until 1984. Thereby, the study gives an image of the creation and development of a specific local public administration for immigrant incorpo-ration. It describes and analyzes the common features of the bureaus as well as the unique character of each individual bureau. Accordingly, a theoretical perspective which stresses the early development in an organization’s history and accentuates the importance of specific contexts for understanding different organizational developments has been used. The result shows that the immigrant bureaus were initiated by different local actors, such as the public administration, labour unions and educational associations which meant that the purposes were somewhat divergent. Yet another consequence was not only variation in development between different bureaus, but also within each of them over time.
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