| 1. |
- Högberg, Karin
(författare)
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Web-based counselling to patients with haematological diseases
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Patients with haematological diseases are entitled to supportive care. Considering organisational and technological development, support in the form of caring communication provided through the web is today a possible alternative. The aim of this thesis was to examine the usefulness and importance of a web-based counselling service to patients with haematological diseases. The basis for the thesis was a development project funded by the Swedish Cancer Society, which provided an opportunity to offer patients communication with a nurse through a web-based counselling service.Four studies were performed from a patient perspective. Study I had a cross-sectional design, measuring occurrence of anxiety and depression, and these variables’ associations to mastery, social support, and insomnia among patients with haematological diseases. Study II was a qualitative content analysis focusing on conditions for provision and use of the web-based counselling service. Study III used a qualitative hermeneutical approach to focus on patients’ experiences of using the counselling service. Study IV was a qualitative deductive analysis examining how communication within the web-based counselling service can be caring in accordance to caring theory.The results revealed that females of 30-49 years of age are vulnerable to experiencing anxiety. Low sense of mastery and support are associated with anxiety and/or depression. Being able to self-identify the need for support as well as appreciate the written medium are necessary conditions for the web-based counselling service to be used. The counselling service must also be part of a comprehensive range of supportive activities and web-based services to be useful. The main importance of the communication is that the patient’s influence on the communication is strengthened, and that the constant access to individual medical and caring assessment can imply a sense of safety. When patients share their innermost concerns and search for support, nursing compassion and competence can substantiate in explicit written responses.A conclusion is that there is a caring potential in communication within a web-based counselling service. To make this form of communication possible, nurses should take possession of and ensure that this medium for communication is offered to patients. Nurses should also increase their knowledge of caring communication in writing and how this possibly can impact patients.
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| 2. |
- Ahonen, Hanna
(författare)
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The multifaceted concept of oral health : Studies on a Swedish general population and perspectives of persons with experience of long-term CPAP-treated obstructive sleep apnea
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Oral health is a multifaceted and changeable part of our overall health and well-being as it contributes to important everyday functions such as eating, talking, and conveying feelings. Our oral health can be affected by a range of determinants, one of which is obstructive sleep apnea [OSA] treated with continuous positive airway pressure [CPAP]. Even though xerostomia has been frequently reported upon, the possible relationship between oral health and CPAP-treated OSA is not clearly understood. The World Dental Federation [FDI] recently proposed a definition and theoretical framework of oral health, intended to be globally applicable and to move dentistry toward a more promotive approach. By using the FDI’s framework as a basis for exploration, studies in a general population can increase the understanding of different aspects of oral health and set the frame of reference for whether and how CPAP-treated OSA can be experienced to affect a person’s oral health.The overall aim of this thesis was to gain a deeper understanding of how the FDI’s theoretical framework of oral health can be applied in a general population and how oral health is experienced in a specific population of persons with increased risk for adverse oral health.The FDI’s framework was explored with empirical data from a general population (N=630) and a population of persons with experience of CPAP-treated OSA (N=18). In papers I and II, the FDI framework was tested and evaluated with quantitative methods (principal component analysis and structural equation modeling), using cross-sectional data from the Jönköping studies. In papers III and IV, qualitative methods (directed content analysis and critical incident technique) were used where personal views and experiences were explored using individual semi-structured interviews.The findings in paper I showed that factors such as dental caries, periodontal disease, experience of xerostomia, and aesthetic satisfaction can be included in the FDI’s component the core elements of oral health. In paper II, driving determinants and moderating factors were found to have direct effects on all core elements of oral health except aesthetic satisfaction. Three of the core elements of oral health (oral health-related quality of life, aesthetic satisfaction, and xerostomia) had direct effects on the latent variable overall health and well-being. Driving determinants and moderating factors had no direct effect on overall health and well-being, and no indirect effects were found. In paper III, the study participants’ views on oral health determinants were described and could be categorized into all the FDI framework dimensions. The component driving determinants could include a range of determinants affecting a person’s oral health such as CPAP treatment, age, the influence of family and social surroundings, interdental cleaning, willingness to change when needed, and relationship with oral healthcare professionals. In paper IV, the study participants described both negative and positive experiences occurring with or without their CPAP. The negative experiences included increased xerostomia, pain or discomfort, tooth wear, and negative feelings. The positive experiences included decreased xerostomia and improved oral health habits due to improved sleep. Many of the difficulties could be managed by easily accessible facilitators. The experiences the study participants described could be included in all the FDI framework components.In conclusion, the FDI’s framework can be applied in a general population to describe different components of oral health, and is also useful to describe a person’s views and experiences of oral health in a specific population. CPAP treatment could be considered an oral health determinant as it can affect a person’s oral health. Both positive and negative experiences can contribute to CPAP adherence as negative experiences often can be successfully managed.
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| 3. |
- Broström, Anders, 1978-
(författare)
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Strategists and Academics :
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This doctoral thesis consists of five self-contained essays on interaction in R&D between university researchers and private firms. Together, these essays explore the conditions under which private firms benefit from spillovers from publicly funded and organised research. From the first essay, which sets out to empirically validate the theoretical arguments about the benefits of university-industry interaction for private firms, the thesis follows a line of pursuit that goes back and forth between exploration of the different benefits that firms enjoy from university interaction and the relationships between these benefits and the conditions of interaction. In essay II, a typology of rationales for establishing cooperative relations is presented. A considerable breadth of interaction rationales is documented, but on closer examination, a “core” set of rationales related to innovation in terms of invented or improved products or processes are found to be the main drivers of interaction. Developing this view, three critical issues previously studied within innovation economics are re-considered from the point of view of firm rationales for interaction; public co-funding of university-firm interaction (essay II), the role of geographic proximity for interaction on R&D (essay III) and the organisation of public sector research (public research institutes and universities) in relation to firm level competences (essay IV). In a fifth essay, four ideal types of strategy for localised interaction between R&D subsidiaries and universities are proposed. Through the framework developed in this essay, the rationales for interaction are related to the overall R&D strategy of multinational firms. Concluding the thesis, it is discussed how the research presented herein opens up for improved theorizing around the roles of academic research for industrial innovation.
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| 4. |
- Eriksson, Kerstin
(författare)
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Postoperative pain assessment and impact of pain on early physical recovery, from the patients' perspective
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Pain is a common postoperative experience. Guidelines recommend performing regular pain assessments, which include self-rated pain and additional communication to capture patients' experiences. During hospitalisation, pain intensity is found to be a vital factor influencing other aspects of an early physical recovery, and is consequently an important item in questionnaires for recovery. These tools consist of extensive questionnaires which are difficult to use in everyday clinical work. A simplified method of monitoring postoperative recovery would benefit both patients and healthcare professionals.Aim: The overall aim of this thesis was twofold: (A) to determine the ability of extending the use of pain ratings to reflect and predict early physical postoperative recovery and (B) to describe patients’ perspectives on pain assessments.Methods: The studies were carried out at one (I), three (IV) and four hospitals (II, III) involving general surgical and orthopaedic inpatients. Two quantitative methods were used based on data from questionnaires and medical records. They consisted of one cross-sectional study (I) and one study with repeated measures (IV). An association was sought between pain intensity and postoperative recovery on days 1 and 2 (I, IV), and prehospital data (IV). Two qualitative methods were used involving a phenomenographic (III) approach and Critical Incident Technique (IV), where semi-structured interviews were performed postoperatively and analysed inductively in accordance with the approach.Results: An association was found between moderate/severe average pain intensity compiled from monitoring records and impact on early physical postoperative recovery on day 1 (I). Retrospective average pain intensity at rest and during activity reflected impact on recovery on postoperative day 1 (IV). Severe pain intensity at rest and during activity on postoperative day 1 predicted impact on physical recovery items on day 2 (IV). The use of the Numeric Rating Scale (NRS 0-10) was considered to facilitate communication about pain, but to involve difficulties of interpretation and place demand on healthcare professionals and care routines (II). Patients’ descriptions of their experiences when in need of describing pain indicated two main areas: patients’ resources when needing to describe pain and ward resources for performing pain assessments (III). Descriptions of their actions when they were in pain indicated two main areas: patients used active strategies when needing to describe pain or patients used passive strategies when needing to describe pain (III).Conclusions: This thesis contributes to knowledge about the possibility of using patients' self-rated average pain intensity to reflect early physical postoperative recovery on day 1 and to predict recovery on the following day. The pain scale gave patients and healthcare professionals a shared vocabulary, which facilitated communication. Furthermore, dialogue during pain assessments was described as critical in ascertaining whether pain intensity had an impact on different aspects of physical recovery. Environmental factors such as the attitude of healthcare professionals, workload and staffing influenced how pain assessments were performed.
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| 5. |
- Hjelm, Carina, 1964-
(författare)
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Cognitive function in elderly patients with chronic heart failure
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- IntroductionApproximately 1-2% of the adult population in developed countries suffer from heart failure (HF), with the prevalence rising to more than 10% among patients 80 years of age or older. The HF syndrome is associated with elevated mortality and morbidity, and decreased quality of life. Cognitive dysfunction has been reported in patients suffering from a variety of cardiovascular disorders. However, few studies have systematically assessed cognitive performance in HF patients, its prevalence and other factors influencing cognition in HF patients. Further, it is of great interest to understand the relationship between self-care in HF and cognition. It may be important to screen for cognitive dysfunction as it may influence HF patients’ ability to perform self-care, e.g. make lifestyle changes, adhere to medical treatment and monitor, evaluate and treat symptoms of deterioration.AimThe overall aim of this thesis was to explore cognitive function in elderly patients with chronic heart failure with focus on prevalence, risk factors, sleep and self-care.Design and methodThis thesis is based on four quantitative studies. The data from study I and II were collected in a prospective longitudinal design, including Swedish same-sex twin pairs born in 1913 or earlier in Sweden. The study was conducted 1991-2002 and a total of 702 individuals aged 80 and older were included.Study III and IV had a cross- sectional design and included stable HF patients, median 72 years of age, living in the community in the south of Sweden. Data were collected between 2009 and 2012. Study III included a total of 137 patients and Study IV included 142 patients.ResultsStudy I found that octogenarians with HF had significantly poorer spatial performance and episodic memory, and that the episodic memory declined more over time compared to a non-HF population of the same ages.Study II showed that octogenarians with HF had a significantly higher prevalence of vascular dementia, 16% vs. 6%, and all types of dementia, 40% vs. 30%, than those not diagnosed with HF. Factors related to dementia in individuals with HF were depression, hypertension and increased levels of homocysteine. Diabetes was associated with an increased risk for vascular dementia.In study III we found that HF patients with sleep disordered breathing (SDB) (apnoea-hypopnoea index >15) had significantly higher saturation time < 90%, more difficulties maintaining sleep and lower levels of daytime sleepiness compared to those in the non-SDB group. Cognitive function did not differ between the SDB and the non-SDB-group. Only insomnia was associated with a decreased global cognititive function measured with the Mini Mental State Examination instrument.Finally, in study IV, the relationship between self-care and different dimensions of cognitive function was explored. Psycho- and visuomotor function (speed and attention) was the only dimension of cognitive function associated with self-care.ConclusionOctogenarians suffering from HF have a decreased performance in spatial and episodic memory and they also have a higher risk for developing dementia. Cognitive dysfunction as well as higher prevalence of dementia can contribute to decreased adherence to prescribed therapy and self-care management, and lead to other socio-behavioural problems. Self-care was found to be associated with psychomotor speed. This may influence sustained attention negatively and the ability to carry out more than one task at the same time. This may lead to decreased attention for receiving and understanding information on self-care.
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| 6. |
- Saiedi, Ed, 1987-
(författare)
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Essays on Financial Technology and SME Finance : A Tale of Two Effects of the Global Financial Crisis: Financing SMEs and Innovative Financing
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The financial crisis of 2008-2009 took place exactly half a century after the publication of the seminal Modigliani and Miller (M&M) theorem, often called the capital structure irrelevance principle. This timing is curious since the crisis has highlighted the significance of deviations from assumptions of this theorem, i.e. the importance of corporate finance. A decade on, this thesis explores consequences of this unprecedented event by examining the determinants and effects of financiers’ and firms’ financing decisions, whose irrelevance is implied by the capital structure irrelevance principle.The financial crisis has not only expanded our knowledge frontier on corporate financing, it has altered financing itself. A host of financial innovations have arisen in its wake, enabled by digital technologies, which reshape or remove the role of traditional intermediaries. By tracing the adoption of these technologies to the crisis, this thesis frames the crisis not merely as a source of value destruction, but also as a source of creative destruction. Specifically, this thesis aims to empirically investigate two overarching research questions:(1) What are the determinants and real effects of financing decisions and outcomes for Small and Medium Enterprises (SMEs), in the face of crisis-era contractions in bank lending? (Papers IV and III)(2) What are the main drivers of the adoption of new financial technologies? (Papers I and II)Paper I empirically examines whether distrust in financial institutions, exacerbated by the financial crisis, has been a factor in the growth of peer-to-peer lending. The study argues that distrust in the intermediary (i.e. banks) will shift an individual’s asset allocation towards alternative assets (e.g. crowdfunding). By exploiting geographical variation in such distrust on lending on one of the largest P2P lending markets, Prospser.com, this research finds that higher distrust in banks is positively associated with the likelihood and level of participation in loans, and is negatively correlated with volumes of commercial banks’ deposits and reliance on deposit financing.Paper II empirically investigates drivers of the spread of infrastructure necessary to maintain and grow Bitcoin as a system (Bitcoin nodes) and infrastructure enabling the use of bitcoins for everyday economic transactions (Bitcoin merchants). Specifically, it investigates the role of legal, criminal, financial and social determinants. Findings offer some support for the view that the adoption of cryptocurrency infrastructure is driven by perceived failings of traditional financial systems, in that the spread of Bitcoin infrastructure is associated with low trust in banks and the financial system among inhabitants of a region, and with the occurrence of inflation crises. Active support for Bitcoins is higher in locations with well-developed banking services. Finally, it lends support to the view that bitcoin adoption is partly driven by cryptocurrencies’ usefulness in engaging in illicit trade.Paper III investigates effects of funding rejections on firm investments and performance, through matching successful and observably-similar unsuccessful capital-seeking SMEs. This approach to disentangling supply- from demand-side forces by exploiting application outcomes is novel and robust to substitution effects between sources of capital. The study finds evidence of firms’ investments being hampered due to inability to access capital in the crisis. Whereas liquidity helps absorb this supply shock, rejection makes firms less prone to use liquidity for investments in the post-crisis period. Reduced investment plans following rejection are a primary channel through which firm performance is lowered. Results imply that capital substitutions were not adequate to shield SMEs from crisis-era distress to creditor balance sheets.Paper IV exploits two novel datasets, unique in enabling observation of SME applications for, and use of, various debt and equity instruments, to study determinants of financing choices and outcomes of European SMEs. It tests applicability of extant research to business cycle contractions and bank-based financial systems, and finds similar results. During the crisis, SMEs largely behave in accordance with the pecking-order theory. Innovative firms seek debt more, but innovativeness is only associated with successful search if SMEs are old or market-oriented, and not tech-intensive. Young firms with high investment needs in the crisis had difficulties obtaining debt, but were more likely than average to succeed if applying for equity.
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| 7. |
- Stadin, Magdalena, 1987-
(författare)
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The digitalised work environment : Health, experiences and actions
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The aim of this thesis was to examine the association between technostress, operationalised as information and communication technology (ICT) demands, and indicators of work-related stress, as well as its association with self-rated health. Additional aims were to identify occupational groups at risk with regard to ICT demands, and to describe experiences of technostress and how it was handled by healthcare managers.Methods: The thesis includes four individual papers. Papers I–III have a quantitative (cross-sectional or prospective) study design and are based on data derived from the Swedish Longitudinal Occupational Survey of Health (SLOSH) and collected between 2006 and 2016. Data was analysed by statistical methods, such as linear and logistic regression analysis. Paper IV has a qualitative study design and is based on data from 20 semi-structured interviews with healthcare managers. The data was analysed using the critical incident technique.Results: ICT demands were correlated with job strain and effort-reward imbalance, especially the demands and effort dimensions of these measures. High ICT demands were associated with suboptimal self-rated health in cross-sectional analyses and in prospective analyses including repeated measurement. Managers, and particularly ‘managers in healthcare and other community services’, followed by ‘managers in education’, had the highest odds ratio of ICT demands, in comparison with both ‘non-managers’ and ‘all other managers’. Healthcare managers’ experiences of technostress could be categorised into the main areas ‘negative aspects of digital communication’, ‘poor user experience of ICTs’ and ‘needs to improve organisational resources’. The actions they took to cope with technostress were categorised into the main areas ‘culture, norms and social support’, ‘individual resources’ and ‘organisational resources’.Conclusions: Technostress operationalised as ICT demands is associated with suboptimal self-rated health. Occupational groups differ in their exposure to ICT demands by industry and position. Organisational efforts to ensure a sustainable and healthy digital work environment are warranted. ICT demands should be assessed against ICT resources for a comprehensive understanding of their association with health.
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| 8. |
- Wikström, Lotta
(författare)
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The clinical utility of patients’ self-rated postoperative pain after major surgery – the perspective of healthcare professionals'
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The Numeric Rating Scale (NRS) is suitable in postoperative settings, yet, the implementation has shown varying results. This has raised issues about the pain scales contribution to the identifying and understanding of pain. The aim of this thesis was to describe the clinical utility of patients’ self-rated postoperative pain after major surgery from a healthcare professional perspective.The aim of study I and II was to describe healthcare professionals’ perceptions of the use of pain scales, and to through considering critical incidents describe care experiences and actions taken by healthcare professionals’ when assessing pain. Participants in study I (N=25) and II (N=24) were enrolled- registered nurses and physicians with clinical experiences of pain scales. The aims of study III and IV were to determine the clinical applicability of NRS mode- and maximum- measures, and the NRS mode- and median measures at rest and during activity based on patients self-rated pain. The aim in study IV was additionally to determine the number of NRS ratings needed for the calculation of these measures. The number of surgical and orthopedic patients who completed study III were: n=157 and study IV: n=479.Study I and II confirmed earlier findings of patients’ self-reported pain scores as a facilitator in the understanding of their postoperative pain. Organizational routines, documentation devices, clinical competence, continuity in care, collaborative actions, time, and individual routines were healthcare related factors affecting the use of pain scales (I, II). Patient-related facilitating factors were patients’ ability and willingness to communicate pain, while disability and unwillingness to communicate or inconsistency in verbal communication with observed behaviors were barriers (II). Time and multidimensional communication approaches could bridge these barriers (I, II).Study III and IV showed acceptable reliability for the mode, median and maximum measures. Rank correlations for individual median scores, based on four ratings, versus patients’ retrospective self-rated average pain, were moderate and strengthened with increased numbers of ratings. The Svensson method showed an individual variation within the expected outcome and a significant systematic group change towards a higher level of reported retrospective pain. The calculated pain measures, particularly concerning pain at rest, generally were lower than patients’ recall of pain.The findings described beneficial effects of patient self-reported pain, however present healthcare did not fully support the utilization of pain scales. Because of the simple measurement characteristics, the use of daily NRS average pain measures, patients’ pain can be followed until resolved. The measures could additionally become important patient reported outcome measures and thus constitute new motivators to increase the utilization of pain scales.
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| 9. |
- Wu, Eline
(författare)
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Enhanced external counterpulsation treatment in patients with refractory angina pectoris with emphasis on physical capacity, health-related quality of life and safety : An explorative and interventional study
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Patients with refractory angina pectoris (RAP) suffer from debilitating symptoms with considerable limitation of functional capacity and impaired health-related quality of life (HRQoL) despite optimised medical therapy. In addition, frequent angina symptoms are strongly associated with psychological distress. The challenging management of RAP and the severe limitations and symptomatology experienced by these patients underscore the need for further research in more novel treatment approaches. Enhanced external counterpulsation (EECP) is a potential non-invasive treatment that can decrease limiting symptoms in patients with RAP and is generally given as 35 one-hour sessions (i.e., one course) over seven weeks.Aim: The overall aim was to obtain a deeper understanding of patients’ experiences undergoing EECP treatment and to evaluate the effects of the treatment with focus on physical capacity, HRQoL and safety.Methods: An explorative and interventional study comprising both qualitative (paper I) and quantitative (papers II, III, and IV) study designs were performed. In paper I, semi-structured interviews took place with 15 strategically selected patients who had finished an EECP course at the two existing EECP clinics in Sweden. Data were analysed using inductive qualitative content analysis. In paper II, a quasi-experimental study with one-group pre-test/post-test design with a six-month follow-up was performed with 50 patients who had undergone one EECP course. The following pre- and post-treatment data were collected: medication use, six-minute walk test (6MWT), functional class according to the Canadian Cardiovascular Society (CCS), self-reported (i.e., questionnaire data) cardiac anxiety, and HRQoL. The questionnaires were also completed at a six-month follow-up. In paper III and IV, sociodemographic, medical, and clinical data related to EECP were collected by reviewing medical records of 119 patients with RAP who had undergone one EECP course and a 6MWT pre- and post-treatment. An increased walking distance by 10% post treatment, measured with 6MWT, was considered an adequate treatment response.Results: In paper I, the findings were divided into four content areas, each comprising three categories: (1) experiences before EECP was initiated comprised of uncharted territory, be given a new opportunity and gain insight; (2) experiences during EECP sessions comprised physical discomfort, need of distraction, and sense of security; (3) experiences between EECP sessions comprised physical changes, socializing, and coordinating everyday life; and (4) experiences after one course of EECP treatment comprised improved physical well-being, improved mental well-being and maintaining angina in check. In paper II, patients used significantly less short-acting nitrates (p <. 001), walking distance increased on average by 46 m (p < .001), and CCS class improved after one EECP course (p < .001). In addition, all but one subscale of cardiac anxiety and all HRQoL components improved significantly, and the positive effects were maintained at the six-month follow-up (p < .05). In paper III, 49 (41.2%) of the 119 patients, were responders to EECP. CCS class ≥ 3, left ventricle ejection fraction < 50%, and previous revascularisation (i.e., ≤ one type of intervention) were predictors of response (p < .05). In paper IV, the treatment completion rate was high, and the occurrence of adverse events (AE) was low. Most device-related AE required nursing actions, while medical actions were needed more in the non-device-related AE. The AE distribution did not differ between responders and non-responders. Skin lesion/blister occurred mostly in responders and paraesthesia occurred mostly in non-responders.Conclusions: The EECP treatment was perceived as an unknown option among these patients but also as be given a new opportunity to get better. The presence and care provided by the cardiac nurse contributed to a sense of security during treatment. The treatment resulted in reduced symptom burden, improved physical capacity and HRQoL, and less cardiac anxiety, leading to increased physical activity and enhanced life satisfaction for patients with RAP. Moreover, the EECP should be considered preferentially for patients who have a greater functional impairment, evidence of systolic left ventricular dysfunction, and exposure to fewer types of revascularisation. The EECP treatment appears to be a safe and well-tolerated treatment option in patients with RAP.
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| 10. |
- Fagrell, Per, 1969-
(författare)
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Change and inertia in the development of Swedish engineering education : The industrial stakeholder perspective
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis investigates higher education development in Sweden from an external stakeholder perspective, with a particular focus on engineering education. Industry has long been a major external stakeholder in the development of profession-oriented higher education, not least in the context of engineering education. Representatives of industry and other employers have continuously called for developments in the curriculum to prepare students for an evolving profession. Scholars of higher education have gone so far as to depict employers as the definitive stakeholder in higher education today. However, it has also been claimed that engineering education and its institutions are, and always have been, rather unresponsive to external calls for changes. These partly contrasting views call for a study of the role of industry vis-à-vis the different strategies that higher education institutions can draw upon to respond to external calls for change. Thus, the following overarching research question is posed: What kind of role does an external stakeholder such as industry have in the development of engineering education?The conceptual framework for the thesis is based on literature on organisational continuity and change, response strategies to external calls for change, university–business collaboration, and curriculum development and quality. The main theoretical concept presented in the thesis, however, is stakeholder theory and stakeholder analysis. A model for stakeholder analysis is chosen and presented in which the assessment of the attributes power, legitimacy and urgency form the basis for the analysis of the stakeholders’ salience.Empirically, the thesis is based on three studies, which have yielded four appended papers. The studies represent different situations in which external stakeholders have had the possibility of impacting higher education. All three studies have an interpretative and qualitative methodological approach, with semi-structured interviews as the main source for data collection, combined in the second study with historical document studies. In order to frame these studies in their historical context, an overview of the development of engineering education in Sweden is presented as a background. In this overview, the development of relationships between industry and engineering education institutions are depicted with reference to a series of milestone events.The results show that, from a historical perspective, industry has indeed been an influential stakeholder to engineering education. It is argued that while industry still is an important stakeholder, higher education institutions today have to attend to the interests of a broader range of stakeholders, including students, government and others. Claims in the international literature that employers are the definitive stakeholder in higher education does not seem to fit well with the Swedish context, as analysed in this thesis. This may be partly understood as a consequence of a shift away from national-level decision-making regarding higher education development, leaving previous structures for active stakeholder influence less potent.Important decisions about engineering education have in Sweden moved from a national and centralised level to an international level, exemplified by the Bologna Process and the global quality assurance and enhancement scheme called the CDIO[1] Initiative, and at the same time to a local level due to an ambitious autonomy scheme for higher education institutions in Sweden. This can be seen as a divergent trend compared to an international setting, specifically in Anglophone countries where the Washington Accord acts as the basis for curriculum development. This accreditation agreement is heavily influenced by the accreditation scheme for engineering education in the United States, the ABET criteria, in whose formulation employer representatives have a major impact. It may be questioned whether industry representatives have fully recognised this shift in the decision-making process in the engineering curriculum in Sweden. With regard to earlier claims that engineering education and its institutions are unresponsive to external calls for change, the thesis concludes that higher education institutions respond and act, but not always in the way external stakeholders expect or want. External stakeholders have to persist in their eternal quest for progress and development in engineering education, but they may have to adjust and divert their attention to both an international and local context at the same time.[1] CDIO: Conceive-Design-Implement-Operate
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| 11. |
- Johansson, Peter, 1962-
(författare)
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Health‐related quality of life, depression, sleep and breathing disorders in the elderly : With focus on those with impaired systolic function/heart failure
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to describe the prevalence of depressive symptoms, sleep disordered breathing (SDB) and sleep complaints, as well as to investigate the prognostic value of health-related quality of life (Hr-QoL) and depressive symptoms on mortality in an elderly community living population with a focus on those with impaired systolic function/heart failure (HF). Descriptive, prognostic and explorative study designs were used to examine if a single question about global perceived health (GPH) is associated with the domains of Hr-QoL as assessed by the SF-36 (I), as well as to evaluate whether GPH provided prognostic information concerning cardiovascular mortality (II). The aim was also to evaluate if depressive symptoms are associated with mortality (III), and to describe the prevalence of SDB and its relationship to impaired systolic function, different insomnia symptoms, as well as excessive daytime sleepiness (IV).In primary care elderly patients with HF, GPH correlated to the physical and mental aspects of Hr-QoL. Patients who rated poor GPH also scored worse physical and mental Hr-QoL compared to patients with good GPH, but the mental aspect of Hr-QoL was however not significant (p<0.07) (I). Moreover, GPH also had an independent association with cardiovascular mortality during a ten-year follow-up. Compared to patients with good GPH, those who scored poor GPH had a four times increased risk for cardiovascular mortality (II). A total of 24% of the patients with HF suffered from depressive symptoms, not significantly different compared to 19% among those without HF. Depressive symptoms were a poor prognostic sign during the six-year follow-up and HF patients with depressive symptoms had the highest risk for cardiovascular mortality compared to HF patients without depressive symptoms (III). SDB is common among elderly people living in the community, almost one quarter (23%) had moderate or severe SDB. However, people with moderate impaired systolic function had a median apnea hypopnea index that was more than twice as high compared to those with normal systolic function (10.9 vs. 5.0, p<0.001). No obvious associations between SDB and excessive daytime sleepiness or the insomnia symptoms; difficulties maintaining sleep; non-restorative sleep; or early morning awakenings were detected. Difficulties initiating sleep were however more common in those with moderate or severe SDB (IV).GPH can be used as a simple tool in clinical routine practice as an aid in identifying patients in need of additional management. SDB is a common phenomenon among elderly people and associated with impaired systolic function, but with a limited impact on subjective sleep complaints. Depressive symptoms were shown to be a poor prognostic sign and may amplify the patient’s experience of suffering. Screening for depressive symptoms could therefore be an important action in the management of patients with HF.
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| 12. |
- Koldestam, Maria, 1968-
(författare)
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MILO - A Conceptual Learning Model Grounded in a Hermeneutical and a Caritative Caring Perspective : Development and Evaluation
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim was to develop and evaluate a conceptual learning model grounded in a caritative caring perspective aimed to facilitate undergraduate nursing students’ learning during clinical practice.Methods: This thesis comprises four studies with a descriptive explorative design overall. In the inductively applied research, different designs using both qualitative and quantitative methods, were used. Studies I–III used qualitative methods; data for study I were collected using the Delphi method and analysed using qualitative data analysis. In study II, data were collected using focus group interviews and analysed using latent content analysis. In study III, data were collected using individual interviews and analysed using a phenomenographic approach. Study IV used quantitative methods and data were collected using a questionnaire and analysed using statistical methods.Results: Study I resulted in a conceptual learning model grounded in hermeneutics and a caritative caring perspective. The Model for Improvement in Learning Outcomes (MILO) encompasses eight concepts: four intrapersonal, i.e. the students’ own characteristics, reflecting understanding, and four contextual concepts, i.e. environmental concepts, reflecting structure. Study II showed that students’ learning is facilitated as a result of natural actions and elements that occur in daily life, integrating natural caring with professional caring. Studies III and IV showed that students’ learning was a gain in knowledge and understanding of supportive elements for learning and the perspective of the patients, and a gain in engagement and dedication. Study IV also showed that the intrapersonal concepts were valued more than the contextual concepts in the three different semesters studied. The use of the applications was valued more at the start of the students’ education. Some of the concepts and their applications had not been used in accordance with MILO’s implementation in the region involved.Conclusions: The fundamentals needed to become a professional caring nurse include having compassion and competence. Undergraduate nursing students’ learning during clinical practice needs to be facilitated by a theoretical foundation establishing an ethical bearing, by knowledge and understanding of one self and of the patient as a whole, and by challenged learning using a diversity of tools to achieve the intended outcome of better health and well-being for the patient.
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| 13. |
- Mårtensson, Sophie
(författare)
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Bridging the gap between caring theory and nursing practice : Learning experiences of undergraduate nursing students in a caring behavior course
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Healthcare providers are obligated to practice with scientific knowledge in order to deliver high quality and safe care based on patients’ needs. Despite this obligation, complaints from care recipients and their significant others regarding healthcare providers’ lack of compassion and competent care in their professional encounters have increased. In the discipline of nursing, theoretical structures of caring, conceptualized as behaviors, have been established as the heart and core value of guidance in all nursing practice. In nursing education, however, caring has tended to be taught as an intangible aspect of nursing practice, described as hidden curricula, thus, focus more on developing knowledge and psychomotor skills instead of learning caring behaviors. Studies that examine how undergraduate nursing students can learn caring behaviors explicitly are rare. Thus, a stronger emphasis on the learning of caring in the context of a caring behavior course that uses a variety of learning didactics is needed. Without adequate theoretical structures for caring-based observational behavioral instruments assessing verbal and non-verbal caring and non-caring behaviors, there is little evidence to help develop the learning of caring behaviors.Aim: The overall aim of this thesis was to study how a caring behavior course in undergraduate nursing education influenced students’ learning of caring behaviors.Method: This thesis was conducted among undergraduate nursing students at a university in Sweden. The participants attended a 7.5-credit (five-week) Caring Behavior Course (the CBC) in semester four during spring and fall 2018 and spring 2019. The CBC was facilitated through a student-centered learning approach intertwined into reflective practice with the learning didactics of narrative pedagogy and simulation; it comprised six voluntary lectures, five mandatory seminars, and two mandatory caring behavior simulation days and examinations. All data were collected from the students participating in the CBC. Two of the four scientific papers constituting this thesis had a qualitative design based on focus group interviews (paper I) and individual written reflections (paper II). Analyses was conducted using qualitative content analysis. One paper had an instrument development design to develop and test an observational behavioral instrument based on Swanson’s Theory of Caring (paper III). Lastly, one paper had a quantitative observational design using the CBCS on video-recorded observational behavioral data collected in the CBC (paper IV). Analyses was conducted using descriptive statistics and Wilcoxon signed rank test (paper IV).Results: The undergraduate nursing students’ participation in the CBC influenced their learning of caring behaviors. It deepened their understanding and knowledge of caring. The students became aware that learning caring is a task that requires effort because the meaning of caring encompasses nurses’ active engagement in practicing caring behaviors. These findings are also supported through the observational behavioral instrument, through the developed Caring Behavior Coding Scheme based on Swanson’s Theory of Caring; it was found that participation in the CBC influenced the undergraduate nursing students verbal and non-verbal caring and non-caring behaviors.Conclusions: This thesis demonstrated that bridging the gap between caring theory and nursing practice in the CBC using a variety of learning didactics influenced undergraduate nursing students’ learning of caring behaviors. The results contributed to strengthening the knowledge that caring and learning are parallel processes in the undergraduate nursing students’ development into becoming compassionate and competent caring nurses, with the intended outcome of patient healing and well-being.
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| 14. |
- Riandita, Andra, 1988-
(författare)
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Inter-firm relationships for sustainability : Incumbent firms and sustainability ventures
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The magnitude of global environmental and social challenges puts business firms under constant scrutiny. To address such challenges, incumbent firms initiate and manage partnerships with external organizations. Among various types of partnerships, incumbent firms have increasingly engaged with sustainability ventures – newly-created ventures dedicated to tackling sustainability issues. This thesis studies this type of partnership. Specifically, the thesis aims to unpack the antecedents of and determinants behind the formation, and development, of inter-firm relationships between incumbent firms and sustainability ventures – issues which have hitherto received scant scholarly attention in the management and entrepreneurship fields.With a particular emphasis on drivers and outcomes of such collaborative relations, the thesis builds on three empirical studies. These studies are set in the food and manual service sectors in Europe and combine qualitative and quantitative research approaches. The three studies are reported in four independent papers. Paper I provides a descriptive analysis of how incumbent firms leverage inter-organizational partnerships in their sustainability efforts. The paper identifies a shift where firms increasingly ally with sustainability ventures to bring about sustainability-oriented innovation while reducing their engagement in philanthropic partnerships. Paper II adopts the perspective of such ventures and investigates how they achieve sufficient legitimacy in the eyes of incumbent firms to enable the initiation of a partnership. In Paper III, the incumbent firms’ interest in such partnerships is investigated. Paper IV, finally, sheds light on the question as to if and when being profiled as actively prosocial helps suppliers win contracts with incumbents.The thesis offers two broad lines of contribution to our understanding of firms’ contemporary efforts to tackle sustainability challenges. First, the thesis contributes to the field of inter-organizational relationships for sustainability by delineating the role of sustainability ventures as a novel type of partner and a key partner for incumbent firms. In doing so, this thesis demonstrates that the combined elements that the incumbents can gain from their relationships with sustainability ventures may enable the transformation of the firm into more sustainable businesses. Second, the thesis complements extant literature on sustainable entrepreneurship that previously considered the role of such ventures in advancing sustainable development as that of competition for incumbent firms. By clarifying the two collaborator roles of sustainable ventures, i.e., as strategic partners and as prosocial suppliers, the thesis demonstrates how forming and developing ties with incumbents may lead to long-term success for sustainability.
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| 15. |
- Ryttberg, Malin, 1970-
(författare)
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Professional Support Staff at Higher Education Institutions : Navigating Ambiguities in Hybrid Roles
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis focuses on how professional support staff within the support services at higher education institutions (HEIs) perceive their roles. A combination of the broader expectations on HEIs from the surrounding society, changed ideals for governance and research indicating changed profiles for the roles of these support staff has motivated this research. Staff at HEIs have commonly been described by dividing them into those with academic positions and those with positions designated non-academic in much of the literature. This thesis focuses on a category of support staff who do not describe themselves as administrators, but who do not have academic positions either. Embedded in the roles of this category of staff are tensions in relation to academics. What do these professional support staff do, how are they organised and what does the division of labour in the HEIs look like? The overarching aim of this thesis is to explore how the professional support staff understand their roles with a particular emphasis on their working relationship with academics. The opening chapter provides an overview of the discussion of the roles of professional support staff in previous research. This includes an outline of structural and national features, as well as discursive aspects related to their roles. In addition, the implications of the changing roles of the professional support in relation to academics are discussed. Related to these changes is an inherent increase in their level of expertise in which a high level of discretion is a central feature. This is discussed under the umbrella of theories about professionalism. A complementary theoretical approach is the concept of a third space, which is developed as a tool to explore and understand the roles of both professional support staff and academics, as well as their working relationship. The thesis includes four papers based on interviews with three different professional support staff categories at Swedish HEIs. Their perceptions of their roles have been mapped and analysed from different perspectives. These three categories represent professional support staff with roles related to strategic work at their HEIs. A fifth paper is based on interviews conducted in Norway and the Netherlands, with a focus on professional support staff with management roles and their perceptions of how well-functioning support should be organised. One finding that runs through all five papers is that these professional support staff perceive themselves as back office support staff. They are clear 2 about having support roles and not being decision makers. Another finding is that they describe themselves as having great discretion both in the design of their roles and in the way they organise their work. On the one hand, this discretion is described as a central precondition for the attractiveness of the role. On the other hand, it may also imply some vulnerability concerning their competences. The combination of their closeness to the university leadership team, the tasks related to the HEIs’ strategic work and the fact that they themselves have designed their roles implies that these roles could be described as examples of hybrid forms of professionalism. This is an expression of the coming together of different and potentially contradictory sets of principles, values and logics in the structuring of work in one role. These professional support staff have to navigate between the logics of the governance ideals of the university leadership team and their own claims to expertise. This navigation is played out in a field dominated by the norms and values of academics.
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| 16. |
- Sunnergren, Ola
(författare)
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Obstructive sleep apnea : General characteristics in hypertensive patients, positional sensitivity, and upper airway sensory neuropathy
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Obstructive sleep apnea (OSA) is a highly prevalent disorder, especially in populations with cardiovascular disease. Unfortunately most cases with OSA remain undiagnosed. The ability to identify OSA is important for both the individual and the society, as it is a treatable risk factor for cardiovascular disease and also associated with impaired quality of life. This could be particularly important in populations with cardiovascular disease where the most beneficiary treatment effects could be expected. However, the diagnostic process in OSA may be affected by positional dependency (a majority of OSA patients have more breathing interruptions in supine sleep compared to other sleeping positions). Based on the assumption that individuals have different proportions of supine and non-supine sleep on different nights, positional dependency may be a potential confounder in both diagnosis, classification of OSA severity and evaluation of treatment efficacy. Another aspect of OSA is that the pathogenesis is not fully understood. Data indicate that OSA might be a progressive disease, and many patients report years of snoring before witnessed apneas and symptoms occur. One hypothesis on the pathogenesis of OSA is that long-standing, snoring-induced vibrations cause neurogenic lesions in upper airway tissues, progressively damaging the reflex circuits responsible for keeping the upper airway open during sleep.Aims: To describe the occurrence of undiagnosed OSA and to identify determinants of moderate/severe OSA in patients with hypertension (study I). To describe the prevalence of position dependent OSA (POSA) and its relation to OSA severity classification (study II). To compare two methods for quantitative testing of cold sensory function (as a sign of neuropathy) in the upper airway with special focus on test-retest repeatability (study III). To evaluate signs of upper airway sensory neuropathy, by cold sensory testing, in non-snorers, snorers, and snoring OSA subjects with special reference to AHI and duration of snoring history (study IV).Methods: In study I 411 consecutive patients with hypertension from four primary care health centers in Sweden were evaluated for OSA as measured by the apnea hypopnea index (AHI) through polygraphic (PG) recordings. Different predictors for moderate/severe OSA were evaluated. In study II the PG recordings of 265 subjects were specially assessed for POSA and the relation between severity classification based on POSA and traditional OSA severity classification. In study III 40 non-snoring subjects were tested for cold detection thresholds at the soft palate and the lip at two separate occasions with two different methods (MLE/MLI). Bland-Altman analysis was used to compare test-retest repeatability. In study IV cold sensory testing of the soft palate and lip was used to evaluate signs of upper airway sensory neuropathy in both non-snorers; snorers, and subjects with OSA (groups were formed based on AHI and snoring history, n=90).Results and Conclusions: Undiagnosed OSA is common in Swedish primary care patients with hypertension, and male gender, BMI>30 kg/m2, and a clinical history of snoring and witnessed apneas are predictors of moderate/severe OSA. POSA is common both in subjects that by traditional classification had OSA as well as those without OSA. The severity of OSA, if based on total AHI, could be dependent on supine time in a substantial amount of subjects. Cold sensory testing is easily performed in the oropharynx, with acceptable test–retest repeatability. MLI is considerably faster to perform and have a slightly better repeatability than MLE. Therefore MLI should be the used method for cold thermal testing at the soft palate. Both self-reported snoring years and OSA severity are correlated to the degree of cold sensory impairment in the upper airway. Our results strengthen the hypothesis that snoring vibrations may cause a neuropathy in the upper airway, which may contribute to the progression and development of OSA.
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| 17. |
- Ulander, Martin, 1980-
(författare)
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Psychometric aspects of obstructive sleep apnea syndrome
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Obstructive sleep apnea (OSA) is a common chronic disorder consisting of episodes with impaired breathing due to obstruction of the upper airways. Treatment with Continuous Positive Airway Pressure (CPAP) is a potentially effective treatment, but adherence is low. Several potential factors affecting adherence, e.g., subjective sleepiness and personality, are only quantifiable through questionnaires. Better knowledge about psychometric properties of such questionnaires might improve future research on CPAP adherence and thus lead to better treatment options.Aim: Study I: To describe the devlopment and initial testing of the Side Effects of CPAP treatment Inventory (SECI) questionnaire. Study II: To describe the prevalence of Type D personality in OSAS patients with CPAP treatment longer than 6 months and the association with self-reported side effects and adherence. Study III: To study whether any of the items in the Epworth Sleepiness Scale (ESS) exhibit differential item functioning and, if so, to which degree. Study IV: To examine the evolution of CPAP side effects over time; and prospectively assess correlations between early CPAP side effects and treatment adherence.Patients and Methods: In study I, SECI items were based on a literature review, an expert panel and interviews with patients. It was then mailed to 329 CPAP-treated OSAS patients. Based on this, a principal component analysis was performed, and SECI results were compared between adherent and non-adherent patients. In study II, the population consisted of 247 OSAS patients with ongoing CPAP treatment. The DS14 was used to assess the prevalence of type D personality, and SECI and adherence data from medical records were used to correlate Type D personality to side effects and adherence. In study III, the population consisted of pooled data from 1,167 subjects who had completed the ESS in five other studies. Ordinal regression and Rasch analysis were used to assess the existence of differential item functioning for age and gender. The cutoff for age was 65 years in the Rasch analysis. In study IV, SECI was sent to 186 subjects with newly diagnosed OSAS three times during the first year on CPAP. SECI results were followed over time within subjects, and were correlated to treatment dropout during the first year and machine usage time after 6 months.Results: SECI provides a valid and reliable instrument to measure side effects, and non-adherent patients have higher scores (i.e., were more bothered by side effects) than adherent patients (study I). Type D personality was prevalent in approximately 30 % of CPAP treated OSAS patients, and was associated to poorer objective and subjective adherence as well as more side effects (study II). Differential item functioning was present in items 3, 4 and 8 for age in both DIF analyses, and to gender in item 8 the Rasch analysis (study III). Dry mouth and increased number of awakenings were consistently associated to poorer adherence in CPAP treated patients. Side effects both emerged and resolved over time (study IV).Conclusions: Differences in previous research regarding side effects and CPAP adherence might be explained by differences in how side effects and adherence are defined. While some side effects are related to adherence, others are not. Side effects are furthermore not stable over time, and might be related to personality. ESS scores are also related to CPAP adherence according to previous research, but might be affected by other factors than sleepiness, such as age and possibly gender.
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| 18. |
- Viklund Ros, Ingrid, 1988-
(författare)
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Exploring the links between knowledge spillovers, trade, productivity, and innovation
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis consists of four papers which consider internal and external determinants of innovation, productivity, or export at the firm level sing matched panel data from various national and international databases.In the first paper, we examine a universal set of Swedish employer-employee panel data for the period 2000-2014. There is evidence for spillover from exporters to almost 1,300 non-exporting small and medium-sized enterprises (SMEs) through outside board directors. The identification strategy to account for endogenous selection of external board members relies on external instruments and applications of different instrumental variable approaches, which capture also unobserved heterogeneity. Our findings are robust to controlling for export background among managers and employees, as well as firm size, human capital, total factor productivity, productivity spillovers, firm location, and industry classification.The second paper investigates whether board directors interlocked with or employed by innovative firms affect start-up firms’ propensity to be innovators themselves. Drawing upon a sample of more than 50,000 Swedish start-up firms, we find that board connections to incumbent innovators have a causal impact on the new firms’ probability to apply for patents. The results are robust when controlling for industry, geography, and firm age as well as spillovers through worker and managerial mobility, external knowledge sourcing through patent disclosure, access to venture capital, and board attributes.The third paper examines the impact of offshoring on patenting and total factor productivity using a panel of 7,000 mainly small Swedish manufacturing firms over the period 2001-2014. We apply the United Nations Broad Economic Categories (BEC) system to identify offshoring-related intermediate imports. The results show that the link between offshoring and innovation as well as productivity is largely explained by self-selection and reverse causality. We find a positive but statistically weak impact of offshoring on innovation, and no effect on productivity.The fourth paper examines solar innovation drivers in a panel of firms seeking energy patents across 12 European countries. Using 26-year micro and macro observations plus a 10-year pre-sample, it finds a strong link between electricity prices and solar photovoltaic patents. For a sample of 108 unique firms from the 12 European countries, Poisson estimates are insignificant for public policies like feed-in tariffs, investments, subsidies, and support. Positive spillover from solar and wind patent stocks and negative impact from fossil energy patents are found. Studying 226 firms located outside of the 12 European countries, the results suggest that European feed-in tariffs and public solar investments increase the propensity for patent protection within the 12 European countries.
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| 19. |
- Wang, Ruoli
(författare)
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Biomechanical consequences of gait impairment at the ankle and foot : Injury, malalignment, and co-contraction
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The human foot contributes significantly to the function of the whole lower extremity during standing and locomotion. Nevertheless, the foot and ankle often suffer injuries and are affected by many musculoskeletal and neurological pathologies. The overall aim of this thesis was to evaluate gait parameters and muscle function change due to foot and ankle injury, malalignment and co-contraction. Using 3D gait analysis, analytical analyses and computational simulations, biomechanical consequences of gait impairment at the ankle and foot were explored in ablebodied persons and in patient groups with disorders affecting walking. We have characterized gait patterns of subjects with ankle fractures with a modified multi-segment foot model. The inter-segmental foot kinematics were determined during gait in 18 subjects one year after surgically-treated ankle fractures. Gait data were compared to an age- and gender-matched control group and the correlations between functional ankle score and gait parameters were determined. It was observed that even with fairly good clinical results, restricted range of motion and malalignment at and around the injured area were found in the injured limb. Moment-angle relationship (dynamic joint stiffness) - the relationship between changes in joint moment and changes in joint angle - is useful for demonstrating interaction of kinematics and kinetics during gait. Ankle dynamic joint stiffness during the stance phase of gait was analyzed and decomposed into three components in thirty able-bodied children, eight children with juvenile idiopathic arthritis and eight children with idiopathic toe-walking. Compared to controls, the component associated with changes of ground reaction moment was the source of highest deviation in both pathological groups. Specifically, ankle dynamic joint stiffness differences can be further identified via two subcomponents of this component which are based on magnitudes and rates of change of the ground reaction force and of its moment arm. And differences between the two patient groups and controls were most evident and interpretable here. Computational simulations using 3D musculoskeltal models can be powerful in investigating movement mechanisms, which are not otherwise possible or ethical to measure experimentally. We have quantified the effect of subtalar malalignment on the potential dynamic function of the main ankle dorsiflexors and plantarflexors: the gastrocnemius, soleus and tibialis anterior. Induced acceleration analysis was used to compute muscle-induced joint angular and body center of mass accelerations. A three-dimensional subject-specific linkage model was configured by gait data and driven by 1 Newton of individual muscle force. The excessive subtalar inversion or eversion was modified by offsetting up to ±20˚ from the normal subtalar angle while other configurations remain unaltered. We confirmed that in normal gait, muscles generally acted as their anatomical definitions, and that muscles can create motion in many joints, even those not spanned by the muscles. Excessive subtalar eversion was found to enlarge the plantarflexors’ and tibialis anterior’s function. In order to ascertain the reliability of muscle function computed from simulations, we have also performed a parametric study on eight healthy adults to evaluate how sensitive the muscle-induced joints’ accelerations are to the parameters of rigid foot-ground contact model. We quantified accelerations induced by the gastrocnemius, soleus and tibialis anterior on the lower limb joints. Two types of models, a ‘fixed joint’ model with three fixed joints under the foot and a ‘moving joint’ model with one joint located along the moving center of pressure were evaluated. The influences of different foot-ground contact joint constraints and locations of center of pressure were also investigated. Our findings indicate that both joint locations and prescribed degrees-of-freedom of models affect the predicted potential muscle function, wherein the joint locations are most influential. The pronounced influences can be observed in the non-sagittal plane. Excessive muscle co-contraction is a cause of inefficient or abnormal movement in some neuromuscular pathologies. We have identified the necessary compensation strategies to overcome excessive antagonistic muscle cocontraction at the ankle joint and retain a normal walking pattern. Muscle-actuated simulation of normal walking and induced acceleration analysis were performed to quantify compensatory mechanisms of the primary ankle and knee muscles in the presence of normal, medium and high levels of co-contraction of two antagonistic pairs (gastrocnemiustibialis anterior and soleus-tibialis anterior). The study showed that if the co-contraction level increases, the nearby synergistic muscles can contribute most to compensation in the gastrocnemius-tibialis anterior pair. In contrast, with the soleus-tibialis anterior co-contraction, the sartorius and hamstrings can provide important compensatory roles in knee accelerations. This dissertation documented a broad range of gait mechanisms and muscle functions in the foot and ankle area employing both experiments and computational simulations. The strategies and mechanisms in which altered gait and muscles activation are used to compensate for impairment can be regarded as references for evaluation of future patients and for dynamic muscle functions during gait.
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| 20. |
- Öberg, Sandra, 1974-
(författare)
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The Hit-IT project : The development and evaluation of an internet-based complex intervention for primary healthcare patients with cardiovascular disease and insomnia
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- There is a need to explore insomnia among patients with cardiovascular disease (CVD), since they have increased risk for disease deterioration, poor quality of life and a shorter lifetime expectancy. Cognitive behavioral therapy (CBT) is the main recommended insomnia treatment, although it is a rare treatment choice in the healthcare due to lack of certified CBT therapists.The aim of the thesis was therefore to investigate a nurse-led internet-based CBT for insomnia (I-CBTI) tailored for patients with CVD, that includes qualitative and quantitative measures to explore the patients’ characteristics and treatment motive, insomnia experience, treatment effect, adherence and the usability of a complex intervention called the Hit-IT program.The first paper had a mixed study design to investigate the participants (n=126) sleep, physical and psychological characteristics in relation to insomnia via baseline questionnaires, as well as interviews (n=19) covering their motivation and expectations when participating in the Hit-IT treatment study. The second paper was a qualitative study using a Critical incident technique, to capture the experience of the participants (n=20) with CVD and insomnia sleep situation, and determine how they managed their insomnia. The third paper included 48 participants who were randomised to test the nine-week nurse-led I-CBTI treatment, tailored for patients with CVD or a three-week of self-studies (control group) without support. Paper four was a qualitative study to explore the experience and management of the Hit-IT program.The thesis findings showed that the participants were primarily male participants of older age, and that insomnia symptoms were significantly associated with worse somatic symptom severity, reduced physical quality of life, increased levels of depressive symptoms and cardiac anxiety. The participants were motivated to engage in the Hit-IT study, but were concerned the comorbid condition would be a hindering factor for the required behavioral change if randomized to the nine-week Hit-IT program. The participants also experience physical and cognitive insomnia triggers caused by cardiac symptoms at night. However, the participants in the Hit-IT program group significantly improved their insomnia symptoms compared to the three-week self-study control group. Also, the participants adherent to the Hit-IT program significantly increased their physical quality of life compared to those not adherent to treatment. Moreover, the results showed that the participants had trust in the Hit-IT program and experienced the intervention as very interesting yet challenging. The major treatment adherence facilitator was to experience improved sleep during the course of treatment.The thesis findings conclude that nurses have the skills to deliver a nurse-led I-CBTI treatment, tailored for patients’ with CVD with a sleep improvement outcome. The findings also confirm that primary healthcare patients of older age living with CVD and insomnia, are interested in and able to use internet-based complex interventions to improve their sleep.
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| 21. |
- Alimoradi, Zainab, et al.
(författare)
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Effects of cognitive behavioral therapy for insomnia (CBT-I) on quality of life : A systematic review and meta-analysis
- 2022
-
Ingår i: Sleep Medicine Reviews. - : Elsevier. - 1087-0792 .- 1532-2955. ; 64
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Forskningsöversikt (refereegranskat)abstract
- The effects of cognitive behavioral therapy for insomnia (CBT-I) have consistently been shown to improve insomnia symptoms and other health-related outcomes, but the effects on QoL have been inconsistent. Many factors including the type CBT-I delivery and type of instrument used to assess QoL make the topic complex. The present systematic review and meta-analysis synthesized the evidence of CBT-I efficacy on QoL outcomes across different populations, delivery modes, and methodological aspects. Following the guidelines on preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a literature search was conducted through PubMed, Web of Science, Scopus, and PsycINFO using keywords from relevant MeSH terms based on PICOS (Participants, Intervention, Comparison, Outcome and Study) criteria. Clinical trials investigating the effect of CBT-I as an intervention on QoL with any kind of control group were eligible if they reported mean scores and variation of QoL. Meta-analysis using a random-effect model was conducted to calculate the standardized mean differences (SMDs) in a set including all identified studies, as well as in three sub-sets: face-to-face CBT-I using randomized controlled trials (RCTs), online CBT-I using RCTs, and one-group pre- and post-treatment design. A total of 24 studies comprising 1977 participants (808 in an intervention group) from 12 countries were eligible for meta-analysis. The overall pooled estimate of SMD of QoL when all 24 studies were included was 0.47 (95% CI: 0.22; 0.72; I-2 = 84.5%; tau(2) = 0.31; p < 0.001). The overall pooled estimate of SMD of QoL was 0.46 (95% CI: 0.01-0.90; I-2 = 87.5%; tau(2) = 0.48, p < 0.001) for intervention groups with face-to-face CBT-I compared to controls; 0.47 (95% CI: 0.02-0.92; I-2 = 88.3%; tau(2) = 0.36; p = 0.04) for intervention groups with digital CBT-I compared to controls, and 0.46 (95% CI: 0.12-0.80; I-2 = 52.9%; tau(2) = 0.07; p = 0.08) for one-group pre- and post-comparison using CBT-I intervention compared to baseline. Moreover, effects of CBT-I on QoL were different across populations (pooled SMD = 0.59 for patients with insomnia; 0.29 for patients with insomnia comorbid with another major disorder; and 0.48 for other conditions) and types of QoL instruments (pooled SMD = 0.36 for disease-specific QoL instrument not on insomnia, 0.43 for generic QoL instrument, and 0.67 for a single-QoL-item instrument). The probability of publication bias was ruled out in overall and design specific sub-group analysis based on funnel plot and Egger's test. In conclusion, this meta-analysis confirmed a moderate, overall effect of CBT-I in improving QoL. However, due to small power and heterogeneity, future studies are needed to better explore the impact of moderating factors such as mode of delivery and type of QoL measure for assessment used. (C) 2022 The Author(s). Published by Elsevier Ltd.
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| 22. |
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| 23. |
- Andersson, Bodil T.
(författare)
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Radiographers’ Professional Competence : Development of a context-specific instrument
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims: The overall aim of this thesis was to explore and describe radiographers‟ professional competence based on patients‟ and radiographers‟ experiences and to develop a context-specific instrument to assess the level and frequency of use of radiographers‟ professional competence.Methods: The design was inductive and deductive. Both qualitative and quantitative methods were used. The data collection methods comprised interviews (Studies I-II) and questionnaires (Studies III-IV). The subjects were patients in study I and radiographers in studies II-IV. In study I, 17 patients were interviewed about their experiences of the encounter during radiographic examinations and treatment. The interviews were analysed using qualitative content analysis. In study II, 14 radiographers were interviewed to identify radiographers‟ areas of competence. The critical incident technique was chosen to analyse the interviews. Studies III and IV were based on a national cross-sectional survey of 406 randomly selected radiographers. Study III consisted of two phases; designing the Radiographer Competence Scale (RCS) and evaluation of its psychometric properties. A 42-item questionnaire was developed and validated by a pilot test (n=16) resulting in the addition of 12 items. Thus the final RCS comprised a 54-item questionnaire, which after psychometric tests was reduced to 28 items. In study IV, the 28-item questionnaire served as data. The level of competencies was rated on a 10-point scale, while their use was rated on a six-point scale.Results: In study I, the female patients‟ comprehensive understanding was expressed as feelings of vulnerability. The encounters were described as empowering, empathetic, mechanical and neglectful, depending on the radiographers‟ skills and attitudes. Study II revealed two main areas of professional competence, direct patient-related and indirect patient-related. The first focused on competencies in the care provided in close proximity to the patient and the second on competencies used in the activities of the surrounding environment. Each of the two main areas was divided into four categories and 31 sub-categories that either facilitated or hindered good nursing care. In study III the analysis condensed the 54-item questionnaire in two steps, firstly by removing 12 items and secondly a further 14 items, resulting in the final 28-item RCS questionnaire. Several factor analyses were performed and a two factor-solution emerged, labelled; “Nurse initiated care” and “Technical and radiographic processes”. The psychometric tests had good construct validity and homogeneity. The result of study IV demonstrated that most competencies in the RCS received high ratings both in terms of level and frequency of use. Competencies e.g. „Adequately informing the patient‟, „Adapting the examination to the patient‟s prerequisites and needs‟ and „Producing accurate and correct images‟ were rated the highest while „Identifying and encountering the patient in a state of shock‟ and „Participating in quality improvement regarding patient safety and care‟ received the lowest ratings. The total score of each of the two dimensions had a low but significant correlation with age and years in present position. The competence level correlated with age and years in present position in both dimensions but not with the use of competencies in the “Nurse initiated care” dimension.Conclusion: This thesis has shown that professional competence is important in the encounter between patient and radiographer. It has also demonstrated that radiographers‟ self-rated professional competence is based on nursing, technological and radiographic knowledge. From a radiographer‟s perspective, „Nurse initiated care‟ and „Technical and Radiographic processes‟ are two core dimensions of Radiographer Competence Scale. The 28-item questionnaire regarding level and frequency of use of competence is feasible to use to measure radiographers‟ professional competence.
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- Broström, Anders, Docent, 1978-, et al.
(författare)
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Negotiating meritocracy and gender equality across organisational spaces : the case of a tenure track system
- 2024
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Ingår i: Higher Education. - : Springer Nature. - 0018-1560 .- 1573-174X.
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Tidskriftsartikel (refereegranskat)abstract
- In this article, we study how meritocratic systems and gender equality concerns are negotiated across different organisational spaces in Higher Education Institutions (HEIs). Based on a case study of the organising of a tenure track system in a Swedish university, we suggest that the intersection of meritocratic processes and gender equality work can be analysed as a set of negotiated orders in these spaces. This fragmentation may imply problems for advancing gender equality agendas in relation to established notions of meritocracy but may also imply opportunities for change as existing organisational spaces can be reconstructed or new ones created. Our notions of fragmentation and negotiated orders thereby suggest that the current situation is both stable and legitimate and that re-negotiations need to involve reconstructions of the various spaces and not only interventions into them.
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