| 1. |
- Finnbogadóttir, Hafrún
(författare)
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Exposure to domestic violence during pregnancy : impact on outcome, midwives’ awareness, women´sexperience and prevalence in the south of Sweden
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objective: The overall aim of this thesis was to investigate pregnant women’shistory of violence and experiences of domestic violence during pregnancy andto explore the possible association between such violence and various outcomemeasures as well as background factors. A further aim was to elucidate midwives’awareness of domestic violence among pregnant women as well as women’sexperiences and management of domestic violence during pregnancy.Design/Setting/Population: Paper I utilised material derived from a populationbasedmulti-centre cohort study. A total of 2652 nulliparous women at nineobstetric departments in Denmark answered a self-administrated questionnaireat 37 weeks of gestation. Among the total sample, 37.1% (985) women met theprotocol criteria for labour dystocia. In Paper II an inductive qualitative methodwas used, based on focus group interviews with sixteen midwives working inantenatal care in southern Sweden who were divided into four focus groups. InPaper III a grounded theory approach was used to develop a theoretical modelof ten women’s experiences of intimate partner violence during pregnancy. PaperIV was a cross-sectional study including a cohort of 1939 pregnant women whoanswered a self-administered questionnaire at their first visit to seventeen ANCsin south-west Scania in Sweden.Results: In paper I, 35.4 % (n = 940) of the total cohort of women reportedhistory of violence, and among these, 2.5 % (n = 66) reported exposure toviolence during their first pregnancy. Further, 39.5% (n = 26) of those had neverbeen exposed to violence before. No associations were found between historyof violence or experienced violence during pregnancy and labour dystocia atterm. However, among those women consuming alcoholic beverages during latepregnancy, women exposed to violence had increased odds of labour dystocia(crude OR 1.49, CI: 1.07 – 2.07) compared to women who were unexposedto violence. In Paper II, an overarching category ‘Failing both mother and theunborn baby’ highlighted the vulnerability of the unborn baby and the needto provide protection for the unborn baby by means of adequate care to thepregnant woman. Also, the analysis yielded five categories: 1) ‘Knowledge about‘the different faces’ of violence’ 2) ‘Identified and visible vulnerable groups’, 3)‘Barriers towards asking the right questions’, 4) ‘Handling the delicate situation’and 5) ‘The crucial role of the midwife’. In Paper III, the analysis of the empiricaldata formed a theoretical model, and the core category, ‘Struggling to survivefor the sake of the unborn baby’, constituted the main concerns of women whowere exposed to IPV during pregnancy. The core category also demonstratedhow the survivors handled their situation. Three sub-core categories wereidentified that were properties of the core category; these were: ‘Trapped inthe situation’, ‘Exposed to mastery’ and ‘Degradation processes’. In Paper IV,‘history of violence’ was reported by 39.5% (n = 761) of the women. Prevalenceof experience of domestic violence during pregnancy, regardless of type or levelof abuse, was 1.0 % (n = 18), and prevalence of history of physical abuse byactual intimate partner was 2.2 % (n = 42). The strongest factor associated withdomestic violence during pregnancy was history of violence (p < 0.001). Thepresence of several symptoms of depression was associated with a 7-fold risk ofdomestic violence during pregnancy (OR 7.0; 95% CI: 1.9-26.3).Conclusions: Our findings indicated that nulliparous women who have ahistory of violence or experienced violence during pregnancy do not appearto have a higher risk of labour dystocia at term, according to the definitionof labour dystocia used in this study. Additional research on this topic wouldbe beneficial, including further evaluation of the criteria for labour dystocia(Paper I). Avoidance of questions concerning the experience of violence duringpregnancy may be regarded as failing not only the pregnant woman but also theunprotected and unborn baby. Still, certain hindrances must be overcome beforethe implementation of routine enquiry concerning pregnant women’s experiencesof violence (Paper II). The theoretical model “Struggling to survive for the sakeof the unborn baby” highlights survival as the pregnant women’s main concernand explains their strategies for dealing with experiences of violence duringpregnancy. The findings may provide a deeper understanding of this complexmatter for midwives and other health care professionals (Paper III). The reportedprevalence of domestic violence during pregnancy in southwest Scania in Swedenis low. Both history of violence and the presence of several depressive symptomsdetected in early pregnancy may indicate that the woman also is exposed todomestic violence during pregnancy (Paper IV).
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| 2. |
- Afzelius, Maria
(författare)
-
Families with parental mental illness : supporting children in psychiatric and social services
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Children living with a parent with a mental illness can face difficulties. Parentalmental illness may influence the parents’ ability to cope with family life, where theparents’ awareness of their illness plays an important role. Family interventionsprovided by psychiatric and children’s social care services can be a way to supportthese children, making them feel less burdened, and improving the relationshipswithin the family. The aim of this thesis was to illuminate how children infamilies with a parent with a mental illness are supported in psychiatric and socialservices, especially by means of family interventions, and how families experiencethe support. Study I explored how professionals in adult psychiatric outpatient servicesdeal with children and families when a parent has a mental illness. The findingsshowed that professionals balanced between establishing, and maintaining,a relationship with the patient and fulfilling the legal obligations towards thepatient’s children. Asking the patient about their children could be experiencedas intrusive, and involving the patient’s family in the treatment could be seen asa dilemma, in relation to the patient. Efforts were made to enhance the familyperspective, and when the patient’s family and children joined the treatment thisrequired flexibility from the professional. Study II examined how professionals in children’s social care services experienceworking with children and families when a parent has a mental illness. The socialworkers’ objective was to identify the needs of the children. No specific attentionwas paid to families with parental mental illness; they were supported in thesame way as other families. When the parental mental illness became difficult tohandle both for the parent and the social worker, the latter had to set the child’sneeds aside in order to support the parent. Interagency collaboration seemed likea successful way to support these families, but difficult to achieve. Study III investigated if patients in psychiatric services that are also parentsof underage children, are provided with child-focused interventions or involvedin interagency collaboration between psychiatric and social services and childand adolescent psychiatry. The findings showed that only 12.9% of the patientsregistered as parents in Psykiatri Skåne had registered children under the ageof 18 years. One fourth of these patients had been provided with child-focusedinterventions in psychiatric service, and 13% of them were involved in interagencycollaboration. If a patient received child-focused interventions from the psychiatricservices, the likelihood of being involved in interagency collaboration was fivetimes greater as compared to patients receiving no child-focused intervention.Study IV explored how parents and their underage children who were supportedwith family interventions experienced these interventions. The results showedthat parents experiencing mental illness were eager to find support in explainingto and talking with their children about their mental illness, although the supportfrom the psychiatric service varied. Both children and other family membersappreciated being invited to family interventions. After such an intervention, theyexperienced the atmosphere in the family as less strained and found it easier tocommunicate with each other about difficulties. Unfortunately, the participatingpartners felt that they were left without support specifically targeted at them. The thesis showed that there is a gap between how professionals deal withquestions concerning these families and their support, and the parents’ and thefamilies’ needs to receive support in handling the parental mental illness in thefamily. The psychiatric and social services need to expand their approach andwork with the whole family, in order to meet the needs of the child and otherfamily members involved.
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| 3. |
- Albèr, Cathrine
(författare)
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Humectants and skin : effects of hydration from molecule to man
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Humectants belong to a group of hydrophilic compounds frequently used in skin care products with the aim to diminish the clinical symptom of skin dryness. The biochemical and biophysical mechanisms by which humectants interact with the skin barrier are far from fully understood. Increased understanding of such mechanisms can enhance the possibilities to tailor skin care products for various skin abnormalities.The work presented in this thesis centres on one high (hyaluronan) and two low (urea and glycerol) molecular weight humectants and their interactions with water, as well as their effect on the barrier properties of the outermost layer of the skin, i.e. the stratum corneum (SC). We explore the effect of hydration on thermodynamic properties of humectants, in particular hyaluronan, by using isothermal sorption calorimetry, differential scanning calorimetry and small- and wide-angle X-ray scattering. By combining data from several methods, a binary phase diagram of the hyaluronan - water system was constructed.We also investigate the effect of hydration and presence of humectants on the SC permeability in vitro by using an experimental set-up that allows for control of the boundary conditions in terms of water activity. In contrast to low molecular weight humectants, like urea and glycerol, it was concluded that hyaluronan (17 kDa) does not penetrate the skin barrier due to size exclusion. Addition of urea, glycerol or hyaluronan to aqueous formulations inevitably lowers the water activity of the formulation, which in tum affects the SC permeability when being applied. Moreover, it was shown that skin permeability of a model drug metronidazole decreases upon addition of hyaluronan to the formulation, while high skin permeability was maintained with addition of urea or glycerol. In addition, skin membrane electrical resistance, which normally increases at dehydrating skin conditions, remained low in presence of urea and glycerol.Excised skin hydrated at different hydration levels were examined with confocal Raman microspectroscopy. Large water inclusions were observed in fully hydrated SC after 24h exposure to a buffer solution. Addition of urea was shown to promote the formation of these inclusions. Urea and glycerol were also shown to improve the hydration capacity of isolated comeocytes.Similar approach as used in vitro was employed in vivo to explore the effect of hydration and humectants on skin permeability. It was shown that the water activity of the applied formulations have a marked effect on the barrier properties and urea and glycerol was shown to improve skin hydration even at reduced water activity of the applied formulation.
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| 4. |
- Aleksejeva, Olga
(författare)
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Blue copper proteins as bioelements for bioelectronic devices
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis is focused on bioelements for biological electric power sources,specifically, on blue copper proteins with and without an intrinsic biocatalyticactivity, i.e. ability to reduce oxygen directly to water. These proteins, viz. differentlaccases, ceruloplasmin, and rusticyanin, were characterised in detailand employed for the construction of both self-charging and conventional biosupercapacitors.First, similarities and particularities of oxygen electroreductionvs. bioelectroreduction were reviewed. Moreover, being a promising candidatefor the construction of autotolerant implantable biocathodes, the electrochemistryof human ceruloplasmin was revisited. For the first time, a clearbioelectrocatalytic reduction of oxygen on ceruloplasmin modified electrodeswas shown. Second, computational design combined with directed evolutionresulted in a high redox potential mutated laccase, GreeDo, with increased redoxpotential of the T1 site, increased activity towards high redox potentialmediators, as well as enhanced stability. Third, GreeDo was electrochemicallycharacterised in detail. The mutant exhibited higher open circuit potentialvalues and onset potentials for oxygen bioelectroreduction compared to the parental laccase, OB-1. Moreover, the operational stability of GreeDo modifiedgraphite electrodes was found to be more than 2 h in a decidedly acidicelectrolyte, in agreement with the extended operational and storage stabilitiesof the enzyme in acidic solutions. Fourth, multi-cell single-electrolyte glucose/oxygen biodevices with adjustable open-circuit and operating voltages,which are independent on the difference in equilibrium redox potentials of thetwo redox couples, gluconolactone/glucose and oxygen/water, viz. 1.18 V, butdependent on the number of half-cells in the biodevice construction, were designedand tested. The biodevices were made from tubular graphite electrodeswith electropolymerised poly(3,4-ethylenedioxythiophene) modified withTrametes hirsuta laccase and Neurospora crassa cellobiose dehydrogenase as the cathodic and anodic biocatalysts, respectively. Due to the interplay betweenfaradaic and non-faradaic electrochemical processes, as well as betweenionic and electronic conductivities, the open-circuit voltage of the self-chargedbiodevice is extraordinarily high, reaching 3 V, when seven biosupercapacitorsoperating in a common electrolyte were connected in series. Moreover,glucose/oxygen biodevices could be externally discharged at an operatingvoltage exceeding the maximal limiting open-circuit value of 1.24 V for thecomplete glucose oxidation. Last but not least, a conventional biosupercapacitor,i.e. a biodevice lacking self-charging ability, was composed of Acidithiobacillusferrooxidans rusticyanin modified gold electrodes. The complete biodevicesas well as separate electrodes were thoroughly characterised electrochemically.The symmetrical biosupercapacitor based on two identical goldelectrodes modified with rusticyanin is able to capacitively store electricityand deliver electric power, accumulated mostly in the form of biopseudocapacitance,when charged and discharged externally.
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| 5. |
- Ali, Abdullah, 1985-
(författare)
-
Topical formulations, design and drug delivery : "A dive into water"
- 2021
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Water is a vital component regulating the properties of topical formulations and their interaction with biological barriers, such as skin and mucosa. Changing the watercontent within the frame of the pharmaceutical triangle will have a huge impact on which type of formulation, such as a cream, ointment, gel, or lotion, is formed, as well as the physical properties of the formulation. The composition of a formulation, and the subsequent reformulation after application, will govern the features of the residual film. This will in turn affect the barrier properties of the underlying tissue and consequently the penetration of various substances across skin or mucosa.The primary aim of this thesis has been to provide further understanding on differences between traditional surfactant-based formulations and particle-stabilized, Pickering, formulations and how specific excipients, like alcohols, emollients, and thickeners can affect their physical and/or sensorial properties. The secondary aim has been to gain more knowledge on the role of water in topical formulations and how it affects the properties of the underlaying tissue on application.By combining a portfolio of physicochemical techniques combined with sensory science, we have been able to identify differences between Pickering and surfactantstabilized formulations. Starch-based Pickering emulsions were perceived as less greasy and sticky than traditional creams, even at high oil content. Moreover, we were able develop a novel type of alcohol-based Pickering emulsion with combined moisturizing and antiseptic properties. We have also been able to link sensory attributes, evaluated by human volunteers, with physicochemical characterizations. Furthermore, the in vitro ForceBoard™ method was developed further and we evaluated its potential to be used as an ex vivo method using excised skin. In addition, we have shown that that the water gradient over a biological barrier has a general relevance with respect to drug absorption and should be considered not only in dermaldrug delivery but also for buccal and nasal drug delivery.
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| 6. |
- Andersson, Frida
(författare)
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The female offender : patterning of antisocial and criminal behaviour over the life-course
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The studies included in the thesis illustrate the patterning of female offending over the life course. The overarching aim is to contribute to a better understanding of the female offender and of the heterogeneity in female criminal offending trajectories over the life course, and also of factors that differentiate between these trajectories. In order to extend the knowledge on individual predictors of female offending, the thesis analyses the correlations between offending and measures of crime propensity. Study I analyses sex differences in criminal career patterns using a group-based trajectory method. The overall conclusion is that the females in the study were much less predisposed to offend than the males, but when they did, they tended to follow a similar set of career trajectories. Four offending trajectories were identified for each sex, two sex-invariant and two sex-unique. Among both females and males, a group of Low Rate Desisters (LRD) and a group of High Level Chronics (HLC) were identified, which correspond with the groups commonly identified in earlier research focused on various cohorts. In addition, every sixth female offender was characterized as an Early Onset Desister (EOD). The offending pattern of this group was characterized by a very early onset of criminality, followed by almost no offending at all in the subsequent age categories. The second of the two female-unique patterns was denoted Adult Onset (AO). The offending pattern of this group was characterized by a late onset in crime followed by a high level of criminal activity over subsequent years. Studies II and III explore the within- and between-individual patterning of the different female offending trajectories identified in the Study I. Individual and social characteristics were investigated, along with the question of how such factors change and shape patterns of criminal involvement. Research has consistently shown that childhood risk factors appear to be important for distinguishing chronic from adolescent-limited offenders. Based on the data available to this thesis, the analyses confirm that this baseline assumption appears also to apply to females. The analyses show that it is possible on the basis of variables measuring different aspects of socio-demographic background and family functioning to separate offenders from non-offenders, and chronics from less severe offenders. Study III examines the AO group in more detail. Predictors in childhood and adolescence that are known to be related to chronic offending all produced significant effects in relation to memberships of the AO group. In addition, variables related to working class background, such as father’s occupation and coming from a family that had received social welfare payments during childhood, a low level of educational achievement and unemployment in adulthood, all seem to be related to the AO trajectory and indicate a need for further research. Studies I-III had provided indications of sex differences not only in criminal patterning but also in risk factors and life events and transitions. In Study IV, the aim was to try to identify and evaluate whether and how self-control and morality affect criminal activity for females and males respectively. Results from a split sample analysis showed that self-control was the strongest independent predictor for both sexes; further, self-control did not help explain the gender gap in offending. Overall, different aspects of morality also seemed to be powerful predictors of offending for both sexes. As regards the explanation of sex differences in offending, the impact of anticipated guilt appeared to be most important. No interaction effects were found between self-control and morality.
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| 7. |
- Andersson, Linda
(författare)
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Endocytosis by human dendritic cells
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Dendritic cells (DCs) are specialized antigen-presenting cells with the ability to internalize antigen, and present antigen-derived peptides to T cells. The functions of DCs depend on the subset, as well as their location and activation state. Immature DCs act as sentinels by continuously sampling the antigenic environment through various endocytosing mechanisms. The aim of this thesis was to investigate the use of dealuminated zeolites as a delivery tool to study the early events during endocytosis, including recognition and uptake, in human DCs. In the first study, we showed that dealuminated zeoilte particles can be used to follow endosomal acidification and proteolysis in human peripheral blood DCs. In the following studies we further investigated zeolite particles, and showed that they have a unique capacity to adsorb various biomolecules, proteins as well as differently charged lipids. This feature makes zeolites an ideal tool to study receptor-mediated endocytosis. Using zeolites coated with different ligands, we could show major differences in the endocytic capacity in human blood plasmacytoid DCs (pDCs) and myeloid DCs (mDCs). The pDCs showed an almost complete lack of endocytosis whereas the mDCs had an efficient selective receptor-mediated endocytosis of IgG-, LTA-, and LPS-coated zeolite particles. Furthermore, capture was strongly dependent upon the density of the ligands adsorbed onto the zeolite particles. In the last study, we used zeolites to compare endocytosing capacity in mDC and MoDC (monocyte-derived DC). We could show that these cell populations differ considerably in their ability to capture particles, immune complexes and soluble molecules. Therefore, in vitro generated MoDCs does not seem to be an applicable model for peripheral blood mDCs when studying the early events of endocytosis. In conclusion, zeolite particles provide a valuable tool to gain more understanding of the endocytosing mechanisms not only in DCs but also in other endocytosing cell populations.
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| 8. |
- Andersson, Lisa
(författare)
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Problematisk opioidanvändning : om opioidrelaterade dödsfall och LARO i södra Sverige
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Problematic opioid use constitutes an extensive global problem. Correspondingly, opioid-related mortality is high and has increased in several Western countries, including Sweden, during the 2000s. In Sweden, the most effective treatment method, opioid substitution treatment (OST), was for a long time limited with respect to the number of patients. The treatment was also characterized by strict rules and conducted in a high-threshold manner, which has meant that it has not been fully appealing to people with problematic opioid use. Therefore, in Skåne County in southern Sweden, patient choice of treatment provider was introduced for OST in 2014 with the intention to increase the number of treatment places and strengthen patient empowerment. The overall aims of this thesis are (1) to investigate opioid-related deaths in Skåne with a focus on contact with care-providing authorities and in relation to increased access to OST, and (2) to examine patients’ and clinic managers’ attitudes towards the introduction of the patient choice reform for OST and their views of the reform's objectives of increased accessibility to OST and strengthening patients' empowerment and influence over their treatment.The four papers in this thesis are based on two research projects with various empiric material. Paper I and II are based on data on opioid overdose deaths from a period of two years before and two years following the introduction of the patient choice reform. Forensic data regarding the presence of various substances and which opioid caused the death, as well as demographic data and information on contact with care-providing authorities (health care, social services, and the Prison and Probation Service), were collected. Paper I examines clinical background and contact with care-providing authorities of opioid-related fatalities, as well as differences with regard to which opioid caused the death. Paper II examines the possible impact of the intervention on the development of opioid-related deaths in the region. National mortality data were also used in this study to investigate the development in Skåne compared to the rest of Sweden. The second research project focused on stakeholders’ views on the implementation of the patient choice reform. Paper III includes interviews with 33 OST patients, and paper IV consists of interviews with the managers of all OST clinics in Skåne. The results from paper I show that of the 180 deceased in opioid overdose included in the study, almost 90 per cent had been in contact with one of the examined care-providing authorities during the year prior to death. Few differences appeared with regard to which opioid contributed to the death. Paper II indicates that there has been no significant change in opioid-related deaths in Skåne after the patient choice reform and increased access to OST. An analysis on national mortality data however showed a significant yearly decrease in drug-related deaths in Skåne compared to other Swedish counties in the years following the reform (2015–2017). No change was noted in deaths related to methadone or buprenorphine in Skåne. The proportion of deaths among patients in OST increased after the introduction of the reform. The third paper indicates that patients in OST in Skåne have gained increased empowerment and influence over their treatment since the patient choice reform was introduced. Patients especially appreciated the knowledge that they could make an exit and change clinics if they so wished, even if they so far had chosen not to. In paper IV, the clinic managers were largely positive to the trend towards increased influence for patients over their treatment situation. They were more critical of the fact that there was no major differentiation between treatment providers, and that the competition that arose after the patient choice reform mainly was related to prescribing benzodiazepines.Conclusions drawn from the papers in this thesis include that patient choice of treatment provider can be viewed as a means of empowerment for patients in OST, which was regarded as positive by both patients and treatment providers. The limitations of such a system for providing OST that emerged were lack of diversity between clinics and that the competition between treatment providers largely comprised of differing views on the prescription of benzodiazepines. Further, improved access to low-threshold OST in Skåne was not associated with an increased overdose death-rate. The result that people who died from opioid overdose to a very large extent are known to society’s care-providing authorities suggests that there are considerable opportunities to reach people with problematic opioid use for therapeutic and harm reducing measures such as low-threshold OST and take-home naloxone.
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| 9. |
- Andersson, Mika
(författare)
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Hate crime victimization : consequences and interpretations
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The field of hate crime studies is a young one and as such it is characterized by a high proportion of explorative and inductive studies. This methodological approach is well founded when a field is unfolding as they often generate theoretical conclusions or assumptions. Since I began working with the present dissertation in 2013, I have observed an increased tendency towards deductive studies testing the conclusions and assumptions made by field pioneers. The present dissertation is part of this branch and has two primary aims; 1) to test field assumptions and 2) develop present theoretical frameworks on causes and consequences of hate crime.In Article 1, me and my co-author examine the assumption that hate crime victimization result in higher levels of fear in comparison to non-bias crime. The assumption is tested by comparing fear of crime, behavioral adaptations and place-based worry among students with an immigrant and/or national minority background. The results show that hate crime victims reported significantly higher levels of fear of crime in comparison to non-victims and non-bias victims. However, there were few significant differences in behavioral adaptations and place-based worry. From interviews with hate crime victims we learned that place-based worry is not primarily associated with the physical characteristics of a certain area, but geographical concentrations of racist attitudes. Moreover, the behavioral adaptations that the interview participants used to avoid future victimization were often based upon de-identification. From these results we can conclude that traditional measures of place-based worry and behavioral adaptations does not adequately capture consequences of hate crime.In Article 2, me and my co-authors examine the assumption that police reporting is lower among victims of hate crime that target more than one of their identity categories. Contrarily to the assumption, we find that victims of hate crime with multiple motives report their experiences to the police to a higher extent in comparison to victims of hate crime with single motives. We also found that participants with several intersecting group identities endowed with stigma were more likely to be targets of hate crime with multiple motives, but not more likely to experience repeat victimization. These results support the branch of intersectional theory holding that group belongings primarily influence the expressions of violence rather than the risk of being subjected to violence.In Article 3, me and my co-authors examine the assumption that hate targets the identity of the victim and thereby attack the core of the victim’s self. We found that hate crime targets a negative stereotype associated with the perceived identity of the victim. Consequently, interview participants did not regard hate crime as a direct attack on their selves as they did not identify with the negative stereotype. However, hate crime remain a violation of the self as it denies the victims self-representation. The results also showed that the meaning-making regarding hate crime victimization is reflexive as the participants used earlier experiences when assigning meaning to incidents. This process was also recursive as new incidents lead to re-interpretations of previous experiences. In sum, the participants developed and negotiated their experiences of hate crime over time.In Article 4, me and my co-authors examine the assumption that vicarious victims respond in similar ways as direct victims since hate crime signal the presence of threat beyond the initial victim, sometimes referred to as the in terrorem effect. We examine the in terrorem effect by comparing fear of crime between non-victims, vicarious victims of hate crime, and direct victims of hate crime in three communities; women, Muslims and sexual minorities. The results showed that direct victims were generally more afraid of crime in comparison to non-victims in all communities. Though not all differences were significant, the reaction pattern among non-victims, vicarious victims and direct victims in the studies commu-nities showed the pattern of a stair, with the lowest rates among non-victims and the highest rates among direct victims. These results thereby contradict the proposed pattern of the in terrorem effect in which vicarious victims and direct victims are held to react in similar ways.In sum, the results of the present dissertation call for a more complex understanding of both individual and community effects of hate crime. The theoretical development and integration in Chapter 3 along with the results of Articles 1-4 results in hypotheses for future research on causes and consequences of hate crime in Chapter 6.
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| 10. |
- Annersten Gershater, Magdalena
(författare)
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Prevention of foot ulcers in patients with diabetes mellitus
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Amputation in patients with diabetes mellitus preceded by a foot ulcer is a serious complication. Patients with the highest risk of developing a foot ulcer are often found in home nursing settings. The overall aim was to focus on how registered nurses are working with prevention of foot ulcers in patients with diabetes mellitus in outpatient settings: - to identify factors related to short term outcome of foot ul-cers in patients treated in a multi-disciplinary system until healing was achieved. - to assess what was documented by registered nurses regarding diabetes care in a Swed-ish municipality’s home nursing service; to what extent nursing actions were planned for, performed and evaluated according to the goals of metabolic control, treatment and prevention of complications.- to explore registered nurses’ professional work with foot ulcer prevention in home nursing settings. - to explore whether participant driven group information has an impact on ulceration in a patient group with previ-ous diabetes foot ulcer. Study I used logistic regression analysis to identify factors related to outcome in a cohort of 2480 consecutive patients with diabetic foot ulcer at a multidisciplinary foot clinic. Results: Healed primarily: 65% (n=1617), 9% (n=250) after minor am-putation, 8% (n=193) after major amputation and 17% (n=420) died unhealed. Primary healing was related to co- morbidity, duration of diabetes, extent of periph-eral vascular disease and type of ulcer. In neuropathic ulcers, deep foot infection, site of ulcer and co-morbidity was related to amputation. In neuro-ischemic/ischemic ul-cers amputation was related to co morbidity, peripheral arterial disease and type of ulcer. Study II was a cross sectional assessment of all nursing records of patients with dia-betes (N=172) in a municipality’s home nursing setting and analyzed with manifest content analysis. Results: The overall standard of nursing records was insufficient. Evaluation of blood glucose was documented in 61% (n=105) of the records, weight was documented in 6% (n=10), blood pressure in 10% (n=17) and ongoing foot ul-cers were documented in 21% (n=36). Study III was a qualitative interview study of 15 registered nurses from four munici-palities, analyzed with manifest content analysis. Results: Registered nurses in home nursing settings worked mainly through health care assistants. The nurses used lead-ership and education as the main tools to enable the nursing process. They mainly relied on experience based competence. Study IV was a randomized controlled trial comparing participant driven education in group with standard information, in patients with diabetes and previous foot ul-cers. An interim analysis was made 6 months after intervention of 131 included pa-tients. Results: After 6 months follow up, 58% (n=57) of the 98 evaluated patients had not developed a new foot ulcer. There was no statistical difference between the two interventions. The most common reasons for ulceration were plantar stress ulcer and minor external trauma. Five patients had deceased and 10 had withdrawn con-sent to participate. Conclusion: Patients with diabetes and high risk of developing foot ulcer constitute a fragile group that needs special foot protective attention. This requires a well edu-cated staff in the home nursing organization. In the future patient education should target low risk patients.
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| 11. |
- Axnäs, Nina, 1973-
(författare)
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Utredningsbara misshandelsbrott? : En studie av polisens förutsättningar och förmåga att utreda och klara upp misshandelsbrott
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The police are involved in almost all phases of a criminal investigation, starting with the crime itself and ending in court. The clearance rate is a core issue. If this rate is low or decreases, perpetrators will not be prosecuted and sentenced, and the police will be criticized. If this is to be rectified it is necessary to understand why it happens (causes).The aim of this study has been to investigate the prerequisites for the investigation of assault crimes and the police's ability to solve these crimes. The objective has been to produce knowledge for a follow-up model that can provide a more multifaceted picture of the police investigation results, beyond just reported preliminary investigation protocols (FUP).The data consist of 384 police reports regarding assaults that were assessed to be non-serious. In line with the aim of the study, the study employs a Swedish equivalent of the Evidence-Based Investigative Tool (EBIT) (McFadzien et al., 2020; Sherman, 2018).Rational decision theory (March, 1994) has been applied, along with theories focused on the way street bureaucracies manage and prioritize among an incessant influx of cases (Lipsky, 2010) and on various mechanisms that influence the approaches employed (Brodkin, 2011a; Jönsson, 2021). As a measure of the prerequisites for police investigations, a number of basic variables have been employed to reflect whether there is an identified victim, who then cooperates with the investigation, and an identifiable perpetrator. Other basic variables reflect whether there are witnesses, or surveillance cameras that may have captured the incident. As a measure of the police's investigative ability, the study employs variables focused on whether victims and witnesses have been interrogated and whether the police have checked/obtained footage from surveillance cameras.The results show that the conditions for investigating assault are not optimal. Only one third of cases meet all the specified requirements. In about 75 percent of these cases, the police had carried out the investigative measures that were possible. In the remaining investigations, the victims had not been interviewed, the police had not questioned witnesses, or they had not checked and retrieve surveillance footage. To some extent this might be explained by the fact that the reported crime was minor, that the case included information about a counter allegation, the crime would be difficult to prove, or a claim of self-defense difficult to disprove.The study’s results are in several respects neither unexpected nor remarkable. According to the Swedish Police’s national investigative strategy, high priority must be given to cases of domestic violence and only crimes that are expected to lead to prosecution should be investigated. However, there were also some surprising findings: The police succeeded in confirming or disproving assault in 29 percent of all reported non-serious assault crimes. Solving reported crimes is not always equivalent to prosecuting.Finally, the results indicate that a tool for predicting clearance could be utilized to reduce the workload of Principal Investigators. However, this would require more extensive investigative measures to be undertaken at the time the crime report is initially registered. The results show that the documentation on which decisions are based is in many cases insufficient for an assessment of whether or not a prosecution is likely, since it lacks information on the presence or absence of witnesses or surveillance cameras, and whether these substantiate the crime.
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| 12. |
- Baghir-Zada, Ramin
(författare)
-
Illegal Aliens and Health (Care) Wants. The Cases of Sweden and the Netherlands
- 2009
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis deals with illegal aliens in Sweden and the Netherlands with the main focus on health aspects. The three-fold aim is to investigate emergence of healthcare wants among illegal aliens, how they satisfy these wants (if they do so at all), and to explore the relation between their healthcare wants and health wants. Extensive fieldwork was conducted in both countries, including 42 interviews with illegal aliens in Sweden – and 38 in the Netherlands. In Sweden, except for a trivial exception, there are no state provisions on subsidized healthcare services to illegal aliens - while in the Netherlands, there is a state fund enabling a reimbursement for certain healthcare providers offering "medically necessary care" to this group. Subsidized care services are not restricted to a state. Activities of six private voluntary health-care initiatives (PVHIs) providing care to illegal aliens were also documented. Access to (subsidized) care actively promoted by the human rights framework (as operationalized by the UN Special Rapporteur on the Highest Attainable Standard of Health) and by the medical establishment, showed to be not necessarily sufficient in either addressing or satisfying health (care) wants of illegal aliens. More consistency is desired from different stakeholders working in this subject.
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| 13. |
- Bahtsevani, Christel
(författare)
-
In search of evidence-based practices. Exploring factors influencing evidence-based practice and implementation of clinical practice guidelines
- 2008
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Within the evidence-based movement means are developed to support the practitioner in becoming a research consumer with knowledge and skills to create an evidence-based practice (EBP). But little is actually known about whether, and how, this evidence-based accumulation of knowledge is used by practitioners and in what way any actual use leads to improved outcomes. Clinical practice guidelines (CPGs) are described to provide means to keep up with scientific development and may serve as an interface between science and practice. Implementation of evidence and guidelines in daily care are very complex and knowledge about the best way to implement evidence to facilitate best practices is still limited. The overall aim of this thesis was to explore factors that influence an evidence-based clinical practice, and more specifically, to investigate outcomes of an evidence-based practice, the dissemination and awareness of evidence-based literature, and to describe factors of importance when implementing CPGs. A systematic review was conducted to identify outcomes, and different experimental designs have been used for the purpose of describing awareness and dissemination of evidence-based literature as well as experience of the implementation of CPGs. Furthermore, a test-retest was conducted to test the reliability of items constructed from factors drawn from The Promoting Action on Research Implementation in Health Services (PARIHS) framework.The findings of the systematic review showed that it is difficult to prove effects of an EBP and the studies that managed this had implemented evidence-based CPGs. Although improvements in outcomes were reported for patients, personnel and the organisation, the synthesis showed a weak scientific foundation for the overall result since the studies included were heterogeneous in their designs. In a questionnaire study, in the area of psychiatric nursing with a pre-post design in relation to published evidence-based nursing reports, some differences were detected over time. But still 39.5 % of the sample reported no access to evidence-based literature one year after the publication of the two evidence-based nursing reports, and few of the respondents who had access to evidence-based literature reported any use of it. In the test-retest items of factors such as clinical experience, patients experience, leadership, context, culture, evaluation and facilitation was included. The findings of the test-retest showed that the reliability varied from good to fair agreement regarding the Kappa values, with a predominance of moderate agreement. The interview study, with an interpretive qualitative design, revealed several factors that appeared to be of importance for the implementation CPGs. The factors seemed to form a base consisting of circumstances, conditions and requirements. These have a relation to components that constitute a process, thus illustrating that implementing CPGs are continuous processes of creating reliable and tenable routines which involve all staffs member and are expected to lead to better and safer care of patients and increase knowledge and confidence among the staff.In conclusion, it is complicated, but not impossible, to demonstrate the outcomes of an EBP. To implement evidence-based CPGs is one way to make an evidence-based care visible. But more research is needed to strengthen the scientific foundation and to establish whether the tendency towards improved outcomes reported can be further supported. To implement CPGs is described as processes of bringing about a certain level of best practice that benefits patients as well as the staff. There are several factors influencing the process in relation to both positive and negative aspects and depending on which aspects will rise in the foreground the processes are visible or concealed, move forward or stagnate, promote or impede a successful implementation.
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| 14. |
- Berlin Hallrup, Leena, 1967-
(författare)
-
Experiences of everyday life and participation for people with intellectual disabilities : from four perspectives
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- People with intellectual disabilities are dependent in many ways on the support ofothers if they are to have access to social life, services and support in society. Inorder to participate in various activities, they need intellectual and social support.This means that participation for them, depends in several ways on other people´swillingness to facilitate and promote participation. This imposes high demands onthose professionals providing formal support for them. Hence, the overall aim ofthis thesis was to explore and describe from four perspectives the experiences ofeveryday life and participation for people with intellectual disabilities. The thesiscontains four qualitatively oriented studies, which have evolved over time. StudiesI-II, including participant observations and interviews, and were conducted ingroup homes with staff and adults with intellectual disabilities. Furthermore, itemerged that adults with intellectual disabilities experienced different limitationsin their everyday life, which indicates a lack of opportunity for participation (StudyII). From the findings of these two studies, it became clear that participation is acentral focus and that leadership is of particular significance for how participationis implemented; therefore, interviews were conducted with service managers (Study III). Lastly, within the framework of this thesis, the aim was directed atfocus groups with significant others as the fourth perspective to provide a broadframing of what participation can mean for people with intellectual disabilities.Despite the fact that the disability policy has contributed to improvements forthis target group, there are currently extensive shortcomings. This study hasrevealed deficiencies such as the lack of working methods to help staff facilitateparticipation (Study I); the lack of care worker´ continuity and the existence ofmany routines and rules in the group homes (Study II); more overarchingly, thefinancial situation was not adequate to promote participation (Studies III and IV).Consequently, there were also strengths and opportunities for a good everyday life and for participation. All four perspectives are important as, together, theycontribute with a deeper understanding of what participation is and is not, inrelation to people with ID. From the findings presented in this thesis, it can be saidthat participation is double-edged as the four studies highlight both the absenceand presence of participation.
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| 15. |
- Bogdanova, Ekaterina
(författare)
-
Effect of water on the glass transition and properties of solid-state pharmaceutical formulations
- 2022
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to increase our knowledge of the glassy state and the glass transition phenomenon and to evaluate the effect of water on the glassy state. To accomplish this, investigations were focused on the amorphous sucrose-water (paper I, II, III), trehalose-water (paper I), maltodextrin-water (paper I), and lysozyme-sucrose-water (paper IV) systems.We studied temperature-induced and isothermal glass transition (I, II, III, IV), as well as the impact of water on the activation energy of the relaxation process (II). It has been shown that water undergoes glass transition with disaccharides, but in polysaccharides water dynamics is uncoupled from the polymer matrix. This results in differences in the water diffusion coefficient: water moves several orders of magnitude faster in the polymers than in disaccharides (I). Water reduces the activation energy of the relaxation process in the sucrose-water system (II). Attenuated water diffusion at sub-zero temperatures leads to a delay in water crystallization/melting in the sucrose-water system, which does not happen in a polysaccharide - water system (III). The Tg of the lysozyme-sucrose system increases with increasing lysozyme concentration, i.e., the DCp of the mixtures does not follow the prediction based on the properties of the pure components. Consequently, lysozyme does not modulate the glass transition of the sucrose matrix and the increase of the Tg of the mixtures is a result of the confinement of amorphous sucrose in the space between lysozyme molecules. The amorphous structure and unfolding of lysozyme in the presence of sucrose was investigated by DSC and SAXS. These data revealed an increase of the protein-protein distance upon addition of sucrose and upon heating, as a result of lysozyme unfolding (IV).
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| 16. |
- Boonsatean, Wimonrut
(författare)
-
Living with type 2 diabetes in a Thai population : excperiences and socioeconomic characteristics
- 2016
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Type 2 diabetes is a matter of global concern, and has been shown to have an impact on an individual’s way of living, family, and social life. In addition, there is limited knowledge concerning the life experiences of Thai people with diabetes. The aim of this thesis was to explore the experiences of people with type 2 diabetes who live in partly low socioeconomic suburban areas of Thailand. Both qualitative analyses with 19 women of low socioeconomic status with diabetes and quantitative analyses, including 220 people with diabetes, were conducted in the suburban communities near Bangkok between 2012 and 2015. The thesis consists of the results of four studies described in four papers. In paper I the aim was to explore how Thai women of low socioeconomic status handled their lives with diabetes. The findings showed that the women went through many stages of changes in the process of adaptation in handling their vulnerable situation influenced by diabetes and socioeconomic status. A threatened loss of status was sometimes seen as a barrier to handling their disease, whereas empowerment by one’s family helped them to feel powerful and gave them a sense of hope in living with this disease. Paper II illuminated the life experience of Thai women of low socioeconomic status living with diabetes. The findings revealed that women confronted susceptible feelings such as worrying about an unpredictable future and fears of being a burden to their family. However, they were able to maintain a balance through empowerment via the inner and outer sources of their beliefs. In paper III the aims were to investigate and compare the illness perception and self-management among women and men with diabetes, examine the association between illness perception and self-management, and to investigate the psychometric properties of the translated instruments. Both Thai versions of the measurement tools (the revised illness perception, diabetic version questionnaire and the new revision of the diabetes self-management questionnaire) demonstrated acceptable content validity and reliability, includinginternal consistency, inter-rater, and test-retest reliability. The findings showedthat the illness perception and self-management strategies among the womenand men had similar patterns, except for three aspects of illness perception.Whereas the women more often perceived the consequences of diabetes andfluctuating symptoms, the men felt more confident about efficiency of thetreatment prescribed by the healthcare professionals. Furthermore, the illnessperception, especially the confidence in controlling diabetes by themselves andthe confidence about treatment effectiveness, in both women and men showeda weak possitive association with many aspects of self-management strategies.Paper IV examined the illness perception and self-management of Thai peoplewith diabetes according to their socioeconomic status, as defined by income andeducational level. The participants of the low-income and low-education groupsperceived more negative consequences of diabetes, and the participants in the highincomeand high-education group felt more confident in controlling the diabetesby themselves and were more confident about the treatment effectiveness. Theparticipants in the low-education group perceived more fluctuating symptomsof the disease, and the high-education group showed greater understanding oftheir disease conditions. Furthermore, the participants in the low-education group demonstrated less effective self-care in terms of overall self-management strategiesand physical activity.The Thai people with type 2 diabetes demonstrated an ability to be able toadjust to their life situation and to keep a balance in their minds to continuetheir usual life with the disease. Their experiences of living with diabetes werepartially affected by sex differences and socioeconomic characteristics. It may behelpful to take educational level into consideration when designing specific andproper interventions for people with diabetes in low socioeconomic areas. TheThai sociocultural context, especially in terms of family closeness and Buddhistbeliefs, might also have an effect on the life of people with diabetes.
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| 17. |
- Boyd, Hannah, 1994-
(författare)
-
On the structure and mechanical properties of in vitro salivary pellicles
- 2021
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Salivary pellicles display exceptional hydration and lubrication performance. At present, there are still gaps in the understanding of how this is achieved. The aim of this thesis was therefore to increase our knowledge on the mechanisms underlying these properties and deepen the understanding of how they are related to the composition and structure of pellicles, with a focus on those formed under in vitro conditions. This has applications ranging from the development of artificial saliva and lubricating coatings for biomedical applications to methodological approaches for initial testing of oral healthcare products. For this, we also focused on developing suitable methodological approaches for these studies, centering on atomic force microscopy, quartz crystal microbalance with dissipation monitoring, ellipsometry and neutron reflectometry techniques, to investigate in vitro and model salivary pellicles.First, we confirmed a two-layer structure for in vitro salivary pellicles and showed that the outer layer is mainly composed by the oral mucin MUC5B, but that it also contains other salivary components that enhance swelling and hydration. In the presence of bulk saliva, the outer layer also contains a reversibly and loosely bound fraction. This fraction increases the adhesiveness of the pellicle but unexpectedly has no significant effect on its lubrication performance. We also investigated the effect of mechanical confinement on model salivary pellicles by means of Neutron Reflectometry, revealing that at a pressure of 1 bar they are already completely compressed and dehydrated. Finally, with the aim to advance towards better oral healthcare products, we investigated the effect of nonionic and amphoteric surfactants on salivary pellicles, showing that they have a gentler effect on pellicle structure than the commonly employed anionic surfactants.
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| 18. |
- Brännvall, Mari
(författare)
-
Frigörelse med förhinder : om polisanmälan när kvinnor tar sig ur mäns våld i nära relationer
- 2016
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Avhandlingen uppmärksammar polisanmälan vid mäns våld mot kvinnor i nära relationer. Studiens syfte är att undersöka kvinnors syn på polisanmälan och deras interaktioner med det straffrättsliga systemet när de tar sig ur mäns våld i nära relationer. Avhandlingens teoretiska ramverk omfattar främst teorier om mäns våld mot kvinnor, kvinnors uppbrott ur våld och organisationer. En kvinna anses ha tagit sig ur våld när hon separerat, frigjort sig emotionellt från mannen, definierar våldet som mäns våld mot kvinnor i nära relationer samt när mannen upphört med våldet. Kvalitativa intervjuer genomfördes under 2010 och 2011 med tjugo kvinnor som lämnat en våldsutövande partner. En tematisk analys har genomförts av empirin, som består av 33 intervjuer. Avhandlingen belyser en komplex beslutandeprocess om polisanmälan. Under denna process framstår polisanmälan som alltmer tänkbar i takt med att kvinnan frigör sig från våld – såväl emotionellt, som kognitivt samt genom separation – samtidigt som mannens våld fortsätter. Vid beslutet om polisanmälan tar kvinnan hänsyn till dess förväntade konsekvenser, såväl för hennes möjligheter att ta sig ur våld, som för hennes livssituation i övrigt. Avhandlingen belyser även polisanmälans betydelse för frigörelsen från våld. Resultaten visar att det straffrättsliga systemets gensvar på våldet, i synnerhet rättsprocessens utfall, är central för den betydelse polisanmälan får. Gensvar i form av giltiggörande bemötanden, adekvata skyddsåtgärder, frihetsberövanden och fällande domslut kan underlätta en separation, underlätta förståelsen av våldet samt försvåra för mannen att fortsätta utsätta kvinnan för våld. Och omvänt, gensvar i form av ogiltiggörande bemötanden, otillräckligt skydd och nedläggningsbeslut kan försvåra möjligheten att definiera våldet och göra kvinnan fortsatt åtkomlig för mannens våld. Resultaten tyder på att både våldsutövare och våldsutsatta kan uppfatta rättsprocessens utfall som en signal om vad som är tillåtet respektive otillåtet i samhället, vilket i sin tur kan få konsekvenser för förekomsten av fortsatt våld. Avhandlingen synliggör även olika hinder för att våldsutsatta kvinnor ska få tillgång till rättssystemets skydd, stöd och hjälp. Det omfattar såväl hinder för att kvinnor ska vända sig till rättssystemet, som hinder för att kvinnor som vänt sig dit ska erhålla dess stöd. Avslutningsvis belyser avhandlingen rättssystemets praktiska hantering av våldet, i relation till det jämställdhetspolitiska målet om att mäns våld mot kvinnor ska upphöra. Ett mål rättssystemet fått i uppdrag att medverka till. Resultaten tyder på att samtidigt som rättssystemet genomför satsningar för att motverka mäns våld mot kvinnor i nära relationer, så kan den praktiska hanteringen av våldet ha motsatt verkan, och i förlängningen reproducera könsojämlikhet.
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| 19. |
- Carlson, Elisabeth
(författare)
-
Sjuksköterskan som handledare. Innehåll i och förutsättningar för sjuksköterskors handledande funktion i verksamhetsförlagd utbildning - en etnografisk studie
- 2010
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Under de tre senaste decennierna har det skett stora förändringar i sjuksköterskeutbildningarna internationellt såväl som nationellt. De snabba samhälleliga förändringarna och dess effekter på hälso- och sjukvården kommer att kräva andra kompetenser i en förändrad sjuksköterskeroll. Detta innebär att studenter behöver förberedas för det livslånga lärandet där en grundutbildning inte skall vara detaljstyrd utan inriktad på att stödja studenternas utveckling av kritiskt tänkande, förmåga till självständigt arbete och problemlösningsförmåga. Verksamhetsförlagd utbildning (vfu) där kliniskt verksamma sjuksköterskor handleder studenterna är en viktig del i denna lärprocess. Handledande sjuksköterskor förväntas därmed skapa en lärandemiljö där studenterna ges möjlighet att integrera teoretisk och praktisk kunskap för att utveckla sin yrkeskompetens. Sjuksköterskor handleder även i interprofessionella utbildningsmiljöer där studenter från olika utbildningsprogram möts för att arbeta och lära tillsammans. Sjuksköterskans handledande funktion och förutsättningarna för hur handledarskapet kan genomföras blir därför central för att säkerställa en hög akademisk nivå genom hela sjuksköterskeutbildningen. Studiens övergripande syfte var att beskriva innehåll i och förutsättningar för sjuksköterskors handledande funktion i verksamhetsförlagd utbildning. Avhandlingen presenterar resultaten från en etnografisk studie där datainsamling har skett genom observation av handledande sjuksköterskor på två vårdavdelningar samt vid en klinisk utbildningsavdelning. För att få en fördjupad förståelse av sjuksköterskornas handledande funktion har även intervjuer genomförts individuellt såväl som i grupp. Resultaten visade att handledning är relation mellan handledare och student som bygger på trygghet och tillit. I handledningssituationer använder sjuksköterskor sig av flera olika pedagogiska tekniker av såväl kognitiv som perceptuell karaktär. Det innehåll som förmedlas är till stor del av medicinsk och teknisk karaktär. Men sjuksköterskorna poängterar även omvårdnadsaspekten där patienten är i centrum och beskriver hur de stöttar studenten att se professionens möjligheter och begränsningar. Sjuksköterskorna bidrar på så sätt till att studenterna kan utveckla sin kommande yrkesidentitet. Vid den kliniska utbildningsavdelningen fokuseras handledningen på samarbete över yrkesgränser. Handledarnas uppgift blir här att stötta studenternas möjlighet till självständigt arbete genom att fokusera på hur studenterna samarbetar i team. Organisatoriska rutiner, kollegialt stöd och ett väl fungerande samarbete mellan vårdverksamhet och lärosäte beskrevs som centrala för att handledningen ska kunna utföras på ett sätt som stöttar studenternas lärande. Den faktor som framförallt upplevdes som ett hinder för de handledande sjuksköterskorna var att tid för handledarskapet inte var specifikt avsatt. Handledning av studenter fick därför pågå parallellt med ordinarie arbetsuppgifter. Vid den kliniska utbildningsavdelningen där handledarskapet utgjorde den primära arbetsuppgiften upplevdes tiden följaktligen inte som samma hinder. Avhandlingen har visat på komplexiteten i sjuksköterskans handledande funktion. Den handledande sjuksköterskan skall kunna handleda yrkesspecifikt såväl som teamorienterat. Handledning av studenter i en akademisk utbildning kräver dels pedagogiskt kompetenta handledare dels att handledningen organiseras på sådant sätt att tid avsätts till sjuksköterskornas handledande funktion. Detta kräver fortsatt samverkan mellan verksamheter och lärosäten för att säkerställa en sjuksköterskeutbildning som uppfyller kraven för en god akademisk utbildning i alla led.
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| 20. |
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| 21. |
- Carlström, Charlotta
(författare)
-
BDSM : paradoxernas praktiker
- 2016
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BDSM är en akronym för bondage/disciplin, dominans/submission (underkastelse) och sadomasochism som används för att beskriva flera, ofta sexuella, former av beteenden och uttryck, där ett utforskande av makt är centralt. Avhandlingens syfte är att söka förståelse för BDSM som en dynamisk, komplex och kollektiv företeelse. Den fokuserar på hur utövare, genom sina berättelser, ger mening till sina upplevelser och erfarenheter. Avhandlingens teoretiska ramverk innefattar både poststrukturalism och symbolisk interaktionism. Etnografiskt fältarbete genomfördes under 2012 och 2013 i flera BDSM-gemenskaper i Sverige. Fältarbetet omfattar intervjuer, observationer och deltagande på möten, workshops, pub- och klubbkvällar. Totalt intervjuades 29 personer som definierar sig som BDSM-utövare. Avhandlingen visar hur olika synsätt, tolkningar och politisk-ideologiska praktiker har format och strukturerat den sociala verklighet som utgör BDSM av idag. Denna process har ägt rum på olika diskursiva arenor; från medicin och forskning till politisk aktivism, litteratur, film och media. Dominerande diskurser, där makt och våld är centrala, utmanas av motdiskurser, där motstånd till heteronormativa normer och sexualitet är betydande. Utövandet ses som en väg att uppnå känslor av trygghet och tillhörighet. BDSM möjliggör ett utrymme där starka affekter, kroppsliga sensationer, förändrade medvetandetillstånd och spirituella upplevelser kan utforskas och erfaras. Beteenden som i andra situationer betraktas som felaktiga och omoraliska, kan göras moraliskt försvarbara i en BDSM-kontext. Avhandlingen belyser ambivalenser och paradoxer i utövandet, där diskurserna såväl möjliggör som begränsar utövarna.
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| 22. |
- Chrysoulakis, Alberto P., 1987-
(författare)
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Situational sources of rule-breaking acts : an analytic criminology approach
- 2022
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Criminology has long been divided by mainly focusing on people’s propensities to commit crimes, on the one hand, and environmental characteristics conducive to crime, on the other. Such a division must be bridged to advance knowledge about why some people, but not others, commit rule-breaking acts in some environments but not in others. Furthermore, explanations require causal mechanisms explaining how the outcome, a rule-breaking act, is produced. Analytic Criminology offers a general framework for how to theoretically and empirically structure the study of crime. It does so by connecting macro- and micro-levels – structuring the convergence of certain people in certain places – through a mechanistic account. Within this framework, the situational action theory (SAT) proposes a causal mechanism explaining how said convergence triggers the perception-choice process: a rule-breaking act must first be perceived to be subsequently chosen. The main drivers during this process are the person’s crime propensity and the criminogeneity of the behaviour setting. Identifying the central components also enables the theorising of changes in crime involvement, which is the subject of the developmental ecological action (DEA) model of SAT. Drawing on data from the longitudinal project Malmö Individual and Neighbourhood Development Study, this thesis aimed to test SAT and its DEA model, thus bridging said division. It did so through four studies with specific reference to adolescents’ crime propensity, exposure to criminogenic settings, their convergence, and finally, change over time. Study I and study II investigated adolescents’ time use and connections to rule-breaking. The former examined how adolescents spend time in unsupervised and unstructured socialising with peers, during which hours of the day, in which neighbourhoods, and what level of collective efficacy the neighbourhoods have. Study II focused on adolescents’ routine activities and how they differentially place adolescents in unstructured socialising. Furthermore, it tested whether adolescents with higher crime propensity run a higher probability of reporting a rule-breaking act during unstructured socialising irrespective of their routine activities. Study III extended the situational analysis by investigating how adolescents form rule-breaking intentions in randomised scenarios depending on their morality, self-control, and the setting characteristics (varying in level of motivation and deterrence). Study IV applied a developmental perspective to key theoretical constructs derived from the DEA model, focusing on how morality, peer delinquency, and unstructured socialising change, and how the change in each is related to change in the others. Together, the studies found that adolescents with different levels of crime propensity are differently exposed to criminogenic settings but that such exposure simultaneously increases the probability of rule-breaking more for adolescents with higher crime propensity. In sum, the studies have bridged the person–place division in different ways by being rooted in a mechanistic account of rule-breaking, which is proposed as a way forward for criminology as a discipline.
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| 23. |
- Cinthio, Hanna
(författare)
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Rörelser i gränslandet : om komplexa hedersnormer och samhälleliga markeringar
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Avhandlingen bygger på två separata delstudier förenade av den övergripande tematiken hedersnormer. Ur ett fenomenologiskt livsvärldsperspektiv undersöks tankar och erfarenheter i två olika grupper. Den första delstudien bygger på djupintervjuer med 15 ungdomar som lever i kontexter där familjegemenskap, socialt anseende och kvinnlig kyskhet ges stor betydelse, och där föreställningar kopplade till detta präglar deras vardag och handlingsutrymme. Ungdomarna har olika etnisk och religiös bakgrund men har vuxit upp i samma bostadsområde. Med sex av dem har uppföljande intervjuer gjorts efter några år. Delstudie nummer två har genomförts i samverkan med Kriminalvården. Den omfattar en analys av 64 domar varur olika grad av hedersrelaterade omständigheter kunnat utläsas, samt djupintervjuer med 13 personer dömda för brott som av myndighetens personal bedömts ha koppling till hedersnormer. Även här varierar etnisk och religiös bakgrund såväl som brottstyper och strafftider. Två av de dömda klienterna har intervjuats vid mer än ett tillfälle. I intervjuerna berörs upplevelser av normer och normkonflikter kring olika fenomen som familjelojalitet, värdering och reglering av relationer och sexualitet, kön och könsroller, våld, (icke-)svenskhet etc. Berättelserna beskriver ett invecklat spänningsfält mellan å ena sidan individuell frihet och autonomi och å andra sidan betydelsen av grupptillhörighet och kollektiv identitet. Gemensamt för båda grupper är att de lever i sammansatta världar där hederns betydelse förvisso är påtaglig men samtidigt svår att urskilja från andra påverkansfaktorer. I de uppföljande intervjuerna kan förändringar i normerna både på individ- och familjenivå skönjas över tid. Hedersrelaterat våld och förtryck har varit en uttalad angelägenhet för den svenska staten under flera decennier. Frågan har laddats med betydelse på olika plan och lett till konflikter och positioneringar i den akademiska världen såväl som i politik och praktik. Under åren har kontexten kring forskningsfrågorna förändrats genom sociala skeenden och politiska åtgärder i syfte att bekämpa problematiken. Detta syns bland annat i reformerna av lagstiftningen, där nya brottsrubriceringar med särskild inriktning på heder tillkommit, samt i nya formuleringar om ansvar för att motverka hedersrelaterat våld och förtryck i grund- och gymnasieskolans läroplaner. Därmed blir det intressant att resonera kring hur samhällets försök att komma tillrätta med hedersproblematiken kan förstås utifrån det empiriska underlaget, det vill säga rösterna från personer som själva på olika sätt lever eller har levt i kontexter präglade av hedersnormer. Avhandlingen utmynnar således i en diskussion kring hur systemnivån i form av samhälleliga intentioner och interventioner förhåller sig till nyanserna i de berördas livsvärldar. Några av de drag som framstår är att problematiken inte är enkel att förstå och tolka, och att hedern som fenomen är svår att särskilja och ringa in på det sätt som lagar och styrdokument kräver. Genom avhandlingen belyses att hedersrelaterat våld och förtryck förvisso är en allvarlig problematik som behöver mötas av insatser på många olika nivåer, men att det är fråga om ett komplext fenomen som innebär en utmaning för många olika verksamheter vad gäller både förståelse och hantering, och som kräver ett relationellt och dialogbaserat förhållningssätt med de målgrupper som berörs.
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| 24. |
- Correa M., Yubexi Y.
(författare)
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Role of lipoprotein structure and dynamics in disease development : from atherosclerosis to Covid-19
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Lipoproteins play a crucial role in lipid metabolism, serving as carriers for lipids such as cholesterol and triglycerides in the bloodstream. Atherosclerosis is a complex cardiovascular disease characterized by the accumulation of cholesterol-rich plaques in arterial walls, leading to narrowed and hardened arteries. Recently, the spike protein from the SARS-CoV-2 virus, responsible for COVID-19, has been the subject of research concerning its potential impact on lipid metabolism and its association with cardiovascular disease. Understanding the interaction between lipoproteins and the spike protein influence on lipid metabolism could have implications for our knowledge of cardiovascular health.In this research, we investigated the ultrastructure of HDL from individuals with different lipid profiles as well as the interaction of mature HDL and model of nascent HDL with model membranes. Understanding these differences will help create novel rHDL particles with superior lipid-removing and CVD-treating properties. Finally, the interaction between the spike protein and HDL in model cell membranes to study potential imbalances in lipid metabolism. To achieve the different objectives, lipid deposition, exchange and removal were followed by techniques such as Neutron reflection and attenuated total reflection Fourier transformation infrared spectroscopy while, the ultrastructure was unravelled by small-angle X-ray scattering.
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| 25. |
- Djampour, Pouran
(författare)
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Borders crossing bodies : The stories of eight youth with experience of migrating
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In public discourse on migration, people who migrate are often portrayed as deviating from the rest of the population. This is especially true for the group categorised as ‘unaccompanied’ children who are portrayed as homogeneous and not seldom with a common history. Such simplifications create a ‘single story’ that reduces people who migrate and their complex lives to stereotypes. This dissertation derives from a willingness to contest this single story through multiple stories by multiplestorytellers. This is done by seeking tocomprehend what borders do in the lives of eight youth with experience of migrating. The aim is thus to study what borders do and how the participants navigate, experience and challenge those borders at different stages of their lives.This study is based on ethnography among eight youth, who at some point have been categorised as ‘unaccompanied’ children in Sweden and other countries. The fieldwork was carried out during a period between 2013 and 2017 involving interviews and conversations with the participants. Borders are analysed from a multiperspectival standpoint, which means that borders are seen as practices of both material and symbolic divisions performed by different actors constituting control. Borders not only hinder or stop some while granting passage to others; they also construct people differently. Those who are repeatedly crossed by borders eventually become inhabitants of the borderlands. Influenced by feminist and postcolonial scholarship, this study calls for epistemic plurality by acknowledging different sources of knowledge which are placed in dialogue with the stories of the youth. Aspects of their lives before moving from their homes are considered equally important for their experience of borders as their lives in Europe.
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| 26. |
- El-Schich, Zahra
(författare)
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Novel imaging technology and tools for biomarker detection in cancer
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Cancer is a leading cause of death worldwide. Normally the balance betweencell growth and cell death is strongly controlled. Chronic lymphocytic leukemiais an indolent disease that has a highly variable clinical course and is the mostcommon hematological malignancy amongst adults in the Western countries.The protein tyrosine phosphatase SHP-1 is a key regulator that controls theintracellular phosphotyrosine level in lymphocytes by inhibiting the B cell receptorsignals. We have compared the expression and activity of SHP-1 inchronic lymphocytic leukemia cells from lymph nodes with matched peripheralblood samples. The expression levels of SHP-1 were higher in peripheral blood,but the phosphatase activity in lymph nodes and peripheral blood did not differsignificantly. All cells in the body normally present glycans on the cell surface,which are involved in cellular communication and in processes like cell differentiation,proliferation and infection, including protecting the cells from invadersand in cell-cell contacts. Sialic acid occurs on the terminal end of glycans,and the frequency of sialic acid expression is increased on metastatic cancer cellsand overexpression controls tumor cell growth and cell differentiation. Theavailability of specific antibodies against sialic acid is limited. We have beenscreening sialic acid on cancer cells by using a molecular imprinting polymertechnique. Our results show that sialic acid is expressed on chronic lymphocyticleukemia cell lines at different levels at the plasma membrane. Higher expressionof sialic acid in the more aggressive chronic lymphocytic leukemia cell lineswas observed. To analyze morphological changes of death cells, digital holographicmicroscopy was used. Digital holographic microscopy is an approachfor label-free non-invasive 3D imaging of cultured cells. We have analyzed celldeath of adherent cancer cells using digital holographic microscopy and developedit to analyze suspension cells by combining this technique with antibodybased microassays. Digital holographic microscopy can be used for cell-deathinduced cell analysis of both adherent cells and suspension cells. This thesistakes us one step further in cancer research as regards developing techniques forscreening circulating cancer cells in blood as well as for individualized treatmentof cancer patients.
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| 27. |
- Engström, Alexander
(författare)
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Everyday life, crime, and fear of crime among adolescents and young adults
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Drawing on lifestyle-routine activity theory, this dissertation explores associations between everyday life, crime, and fear of crime among adolescents and young adults. It also examines the operationalisation of the concepts of lifestyle and routine activities, and explores the use of experience methods, via a smartphone application named STUNDA, to collect data about everyday life. Of the four studies conducted, Study I shows that different specific lifestyle measures are of varying relevance for victims, offenders, and victim-offenders, which indicates that no single universal lifestyle feature is of relevance for all outcomes studied. The findings from Study II reveal that spending time with friends in the city-centre is associated with lower levels of fear of crime across months, days, and moments. However, other associations between everyday life variables and fear of crime are inconsistent across these reference periods. Study III, a systematic review of the literature, shows that measures of lifestyle and routine activities differ in the frequency with which they are used in studies on interpersonal victimisation and offending. Illegal activities are often used as lifestyle/routine activity measures in studies on victimisation while unstructured and peer-oriented activities dominate in studies on offending. However, the measures used in the included studies are diverse, which indicates that researchers use a wide range of activities that are intended to measure lifestyle/routine activities. The final paper, Study IV, explores fear of crime in relation to moments of everyday life and finds that specific features of settings, such as being in semi-public and public spaces and on public transport, increase the odds for experiencing fear of crime.The overall conclusions of the studies point to methodological and theoretical directions for future research. First, research in the field of lifestyle-routine activity theory needs to consider specific and potentially different activities when examining victimisation, offending, and the overlap between these two outcomes. Further, fear of crime research must consider different reference periods, such as months, days and moments, since fear may not only be defined as a more stable trait-like phenomenon but also as a momentary and transitory experience in everyday life. The types of measures used to represent everyday life also require consideration, particularly in terms of the inclusion of lifestyle/routine activity measures that are actually related to criminogenic exposure. For theory more specifically, the implications of the findings point to an overall confirmation of the view that exposure to various environmental circumstances is associated with crime and fear of crime. However, across all of the studies conducted, the findings point to potential weaknesses of the theory. In particular, the lack of an elaborated perspective on individual traits and characteristics limits the explanatory scope of lifestyle-routine activity theory. For instance, people with similar lifestyles still vary in terms of their victimisation, offending, and fear of crime, which necessitates the inclusion of additional individual-level factors that could explain these variations. Future research must thus either modify lifestyle-routine activity theory or open up for other theoretical perspectives that provide a more holistic approach to understanding the role of both environ-mental and individual factors when studying everyday life, crime, and fear of crime.
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| 28. |
- Fagerström, Anton
(författare)
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Effects of surfactant adjuvants on plant leaf cuticle barrier properties
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- I avhandlingen undersöks växelverkan mellan det yttersta lagret på växters blad (cutikeln), aktiva substanser, och ämnen som tillsätts för att öka bekämpningsmedlens effekt, i detta fall vissa former av tensider. Barriären som hindrar upptag av främmande ämnen i växten sitter i cutikeln. Det är väl känt att tensider förstärker effekten av aktiva substanser. Kunskapen är dock liten om de mekanismer som underlättar upptaget i växtblad. Det övergripande målet i avhandlingen är att öka kunskapen om hur dessa mekanismer verkar. Att klargöra vilka effekter tensider har på cutikeln och hur dessa möjliggör ett ökat upptag av aktiva substanser. Ytterligare ett mål är att bidra till en mer ekologiskt hållbar användning och förnuftig applicering av bekämpningsmedel inom jordbrukssektorn. Det senare av dessa två mål kan uppnås genom att använda den mest effektiva tensiden för respektive bekämpningsmedel, samt det mest effektiva bekämpningsmedlet för respektive växtsort för att på så vis minimera mängden bekämpningsmedel. Men optimering kräver givetvis förståelse. Det övergripande målet har uppnåtts genom kartläggning av vad som sker i växelverkan mellan tensid, vatten och växtblad. Beståndsdelarna som upprätthåller bladets barriäregenskaper beskrivs, samt hur deras smältbeteende och strukturella egenskaper förändras då vatten tillförs och då tensider är närvarande. En ny modell av vaxbarriären i cutikeln etableras och kartläggs. Modellen används till att undersöka de mjukgörande effekterna tensider och vatten har på cutikeln. Hur tensider ordnar sig i en vattenlösning och hur ordningen förändras när vatten avdunstar beskrivs i avhandlingen. Vidare kartläggs hur tensider absorberas i cutikeln och vilka strukturer som påverkas där. Drivkraften för upptag av bekämpningsmedel i växtblad förklaras, hur tensider påverkar drivkraften och vilka egenskaper hos en blandning som påverkar upptaget utrönas. Hur tensider påverkar parametrar i barriären beskrivs också. Dessa parametrar behandlas på ett sätt som gör det möjligt att förklara de effekter som tensider faktiskt har på distributionen av bekämpningsmedel inuti cutikeln. Slutligen så utvärderas formuleringar på intakta växtblad. Detta möjliggör kartläggning över vilka roller mättnadsgraden av bekämpningsmedel i formuleringar samt effekten av tensider på växtblads barriäregenskaper spelar i bladets upptag av bekämpningsmedel. Dessa resultat sammanfattas i en ny algoritm som gör det möjligt att förutse distributionen av bekämpningsmedel i växtblad vid en given blandning. Växter utgör basen för en klart dominerande del av världens sammantagna produktion av livsmedel och djurfoder. De är också en råvara i ett flertal industriella produkter. Då befolkningen ökar och levnadsstandarden förbättras, ökar också efterfrågan på bättre mat och förbrukningsartiklar från växtbas. För att tillgodose efterfrågan strävar producenter och odlare ständigt efter ökad avkastning. Detta uppnås genom ökade odlingsarealer, effektivare användning av befintlig odlingsmark samt skydd mot skadeangrepp på växter. Det sistnämnda kan göras med hjälp av olika bekämpningsmedel som innehåller aktiva substanser. Faktum är att en livsmedelsproduktion på dagens nivå inte hade varit möjlig utan användning av bekämpningsmedel. Dessa ämnen innebär dock risker, användningen är inte fullt optimerad och förståelsen för skeenden och processer i samband med dess användning är i vissa avseenden fortfarande bristfällig.
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| 29. |
- Falk, Magnus
(författare)
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Direct electron transfer based biofuel cells : operating in vitro and in vivo
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- I vår moderna värd är vi väldigt beroende av elektrisk energi som vi använder för det mesta i får vardag: för att lysa upp våra hus, generera värme, driva våra datorer och mobiltelefoner och mycket mer. Produktion av elektrisk energi har dock ofta en negativ på-verkan på vår miljö. Ett alternativt sätt att producera elektrik energi är att använda sig av bränsleceller, vilka kan liknas vid öppna batterier som ständigt kan förses med nytt bränsle och således inte behöver bytas ut efter ett tag. Bränslet som används kan väljas så att dess förbrukning inte innebär någon negativ påverkan på miljön. Den här avhandlingen fokuserar sig på en viss typ av bränsleceller, där man använder sig av specifika proteiner, enzymer, för att omvandla energi från bränslet till elektrisk energi. Som bränsle kan vanligt förekommande kolhydrater, dvs. socker, samt syre användas. Socker och syre används även av vår kropp för att skapa energi, och genom att använda sig av rätt sorts enzymer kan även bränsleceller använda sig av dessa ämnen för att producera elektrisk energi. Således är det möjligt för dessa bränsleceller att producera elektrisk energi placerade inuti oss. Dessa biobränsleceller kan sedan användas för att driva t.ex. olika sensorer direkt i vår kropp som kontinuerligt skulle kunna ge information till sjukvården, utan att använda sig av batterier som behöver bytas ut. Avhandlingen är baserad på att undersöka hur olika bränsleceller som använder sig av enzym fungerar samt att testa dem i olika mänskliga kroppsvätskor samt även inuti levande organismer. Genom att öka förståelsen för detta är förhoppningen att bränsleceller baserade på enzym inom en inte allt för avlägsen framtid kan finna tillämpningar som elektriska försörjare för t.ex. självförsörjande biomedicinska sensorer.
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| 30. |
- Gegner, Harald, 1973-
(författare)
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Statlig kunskapsstyrning : regionala utvecklingsledare i styrning av socialtjänstens barnavård
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Consisting of four scientific papers and a comprehensive overview, this thesis concerns governance in and of social work. More specifically, it studies governing of knowledge in social service with children and youth. Through the growing focus on evidence-based social work since 2000, state governing of knowledge has become an increasingly established concept. In general terms, it refers to the national level’s efforts to govern based on knowledge in order to solve social services’ ”knowledge problems”. However, there are more aspects to state governing of knowledge. Thus, this thesis focuses on the doing of such governance – a praxis that involves actors at national, regional and municipal levels. Here, regional development leaders in social service with children and youth are one of the central actors; consequently, they constitute the empirical focus of the thesis when analysing the doing of governing of knowledge. The aim of this study is to describe and analyse how state governing of knowledge is conducted by examining how development leaders perceive and concretise the task of governing of knowledge in social service’s childcare. The overall questions are as follows: 1. How do regional development leaders in social service with children and youth perceive and interpret the EBP knowledge model in relation to their task? 2. How do regional development leaders act when they govern with knowledge within social service? 3. What characterizes the professional practice of regional development leaders, and how can we understand it in the context of governance?Data have been collected through individual interviews and focus group interviews with 28 regional development leaders. In addition, the empirical material includes a field study with participant observations during network meetings and a questionnaire survey with 29 development leaders. The data have been analysed from three theoretical perspectives: governance as floating signifier, governance as joint doing, and governance as a relational exercise of power. The first perspective, governance as floating signifier, implies that governance changes over time, both in terms of how it can be understood and how it is applied. The second perspective, governance as joint doing, refers to governance as it takes place in and through interaction between actors involved in governance. Here, we can note a mutual influence between those who govern and those who are being governed. The third perspective focuses on power as a central element of governance and how it is constructed in a relational interaction between actors who are part of a common context of governance.The analysis shows that the ambiguity that surrounds state governing of knowledge creates a discretion for interpretation and action. This gives development leaders the opportunity to saturate their work with their own content, depending on the purpose and context, which is very much about developing and organising social work in social services. Working with development, change and innovation is thus of importance in the governing of knowledge of social service with children and youth. In carrying out their tasks, development leaders combine hierarchical top-down management with horizontal, relational management. This becomes evident in the development leaders’ choice of governance practices, which involves networking with managers in senior positions who have a mandate to make decisions. The interaction between development leaders and managers is characterised by mutual influence, which results in development leaders sacrificing certain areas of their mission in favour of activities that managers consider important to implement. Such governance praxis is likely to have implications for the outcomes of governing of knowledge. The establishment of the development leader as an actor in the governing of social work can be understood as a reaction to changing institutional conditions for the management and organisation of the public sector. The work of development leaders is characterised by a hybridised professional practice: they integrate seemingly incompatible logics and thus have to manage different tensions in a professional role, which is probably a prerequisite for navigating complex governing tasks.
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| 31. |
- Gerell, Manne
(författare)
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Neighborhoods without community : collective efficacy and crime in Malmö, Sweden
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Brottslighet i utsatta bostadsområden har de senaste åren fått stort utrymme i samhällsdebatten. Polisen har börjat sammanställa nationella listor över de bostadsområden i Sverige som anses präglas av kriminella nätverk, samtidigt har media rapporterat att vissa brott, främst skjutningar och bilbränder, är betydligt vanligare i dessa områden än i andra delar av samhället. Denna avhandling undersöker utsatta bostadsområden och brottslighet i Malmö och bidrar på så vis till att öka kunskapen om brottslighet i denna typ av områden. Mina studier visar att det finns en stark koppling mellan ett bostadsområdes kollektiva förmåga, kombinationen av tillit och samarbete för att lösa problem, och mängden gatuvåld, men inte någon sådan koppling till anlagda bränder på bostadsområdesnivå. Studierna visar även att såväl anlagda bränder som kollektiv förmåga förstås bäst på mycket mindre geografiska analysenheter än bostadsområden. Avhandlingen berör två grundläggande frågeställningar, som båda är av relevans för hur vi kan förstå utsatta bostadsområden. Den första frågan handlar om hur bostadsområden ska definieras, och hur stora områden det är meningsfullt att prata om som sammanhängande enheter. I polisens sammanställning av utsatta områden räknas till exempel Rinkeby-Tensta i Stockholm med 34 903 invånare som ett sådant, men också Seved i Malmö som är en del av bostadsområdet Södra Sofielund med 5 570 invånare. Den andra frågan handlar om huruvida kopplingen mellan brottslighet och fattigdom, segregation kan förklaras av skillnader i de boendes kollektiva förmåga att hantera problem. Kollektiv förmåga definieras som kombinationen av tillit och gemensamma förväntningar om att agera för det allmännas bästa i ett bostadsområde, och kan ses som en form av socialt kapital som är särskilt viktig i relation till brott, oordning och otrygghet. I avhandlingen studeras huruvida kollektiv förmåga kan förklara varför det är mer gatuvåld och anlagda bränder i vissa bostadsområden i Malmö. Avseende gatuvåld identifieras mycket riktigt en sådan koppling. Utsatta områden som bland annat präglas av ekonomisk och social utsatthet samt etnisk heterogenitet och stor omflyttning har mer gatuvåld än andra platser, men om hänsyn tas till att dessa områden också har också en lägre kollektiv förmåga spelar inte längre nivån av utsatthet, etnisk heterogenitet eller omflyttning någon roll. Förståelsen för gatuvåld förbättras dessutom när hänsyn tas till variabler baserade på rutinaktivitetsteorin, som bland annat säger att var brott begås till stor del kan förstås utifrån var motiverade gärningspersoner och potentiella offer möts. Centrala platser i staden kommer att ha mer brott just på grund av mängden folk, alldeles oavsett nivå av utsatthet eller mängden invånare i bostadsområdet. För att mäta det inkluderas variabler över hur många personer som kliver på lokalbussen i närheten av bostadsområdet under ett år samt mängden barer och nattklubbar, och detta bidrar i analysen till en bättre förståelse för varför vissa bostadsområden har mer gatuvåld än andra. Gatuvåld i Malmö kan till stor del förstås som två delvis separata processer, det är mycket gatuvåld i centrum, kopplat till nattliv och stora mängder folk i rörelse, och det är relativt mycket gatuvåld i utsatta bostadsområden med låg kollektiv förmåga. Huruvida den bristande kollektiva förmågan faktiskt är en kausal orsak till gatuvåldet kan denna studie ej säga, men sambandet håller även när hänsyn tas till mängden gatuvåld under tidigare år. När det gäller anlagda bränder finns inte något signifikant samband med områdets nivå av kollektiv förmåga. Områden med mycket bränder tenderar att ha en låg kollektiv förmåga, men sambandet försvinner när hänsyn tas till ett områdes fattigdom och liknande. I teorin om kollektiv förmåga behandlas social och ekonomisk utsatthet samt etnisk heterogenitet som två viktiga variabler, men i Malmös fall visar det sig att dessa samvarierar så mycket att det inte går att separera dem. Områden där de boende kommer från många olika delar av världen är också områden där bland annat arbetslösheten och trångboddheten är hög. Dessa områden har också många anlagda bränder, inklusive bilbränder, men det förklaras inte av kollektiv förmåga på bostadsområdesnivå, utan av andra, okända, mekanismer. Avhandlingens andra huvudfrågeställning fokuserar på hur ett bostadsområde ska definieras. Det görs i två separata studier, en som berör hur stora områden som är lämpliga för att förstå den kollektiva förmågan, och en avseende hur områden bör definieras för att förstå anlagda bränder och kollektiv förmåga. När det gäller sammanhållning och gemensamt agerande för att hantera problem, kollektiv förmåga, noteras att boende som intervjuas i fyra bostadsområden framför allt har förväntningar kring detta på sin gård eller i sitt kvarter, inte i det betydligt större bostadsområdet. Detta bekräftas också av en statistisk analys av en boendeenkät i dessa fyra bostadsområden. Kollektiv förmåga verkar primärt ta plats på ganska små geografiska analysenheter med 1000 invånare eller mindre, snarare än de relativt stora bostadsområden som ofta är utgångspunkt för såväl akademiska studier som samhälleliga förebyggande insatser. Ett liknande fenomen noteras när det gäller anlagda bränder. Dessa förstås bäst genom att studera vad som finns på den specifika plats där det brinner, och bostadsområdets inflytande är som störst om vi utgår från mycket små bostadsområden. Såväl kollektiv förmåga som anlagda bränder förstås bäst utifrån små geografiska enheter.Det kan inte uteslutas att det på en sådan lägre nivå också finns en koppling mellan förekomst av anlagda bränder och nivån av kollektiv förmåga även om en sådan koppling alltså ej finns på bostadsområdesnivå. Sammanfattningsvis visar avhandlingen att vi bör fokusera på små geografiska enheter för att förstå brott, och att vi kanske då snarast bör prata om utsatta gator eller kvarter snarare än bostadsområden. När det gäller större geografiska enheter går det att förstå våldsbrott utifrån förekomsten av tillit och kollektiv förmåga i ett bostadsområde. Avhandlingens titel, ”Neighborhoods without community”, som översatt till svenska blir ”Bostadsområde utan gemenskap”, syftar på fyndet att bostadsområden inte består av ett socialt sammanhang, utan snarare av många mindre, och att den kollektiva förmågan i vissa områden är låg. Även om dessa områden också ofta präglas av stolthet och ett levande civilsamhälle dominerar problemen, att vända utvecklingen i dessa områden framstår som en av de viktigaste uppgifterna inom det kriminalpolitiska fältet i Sverige idag. Genom att fokusera på gatan, gården eller kvarteret snarare än stora bostadsområden och stärka de boendes kollektiva förmåga finns möjlighet att vända utvecklingen. I framtida forskning är det av vikt att gå vidare med mer detaljerade studier av brottsligheten, men även att undersöka om vi kan stärka den kollektiva förmågan, och om detta resulterar i minskad brottslighet.
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| 32. |
- González Arribas, Elena
(författare)
-
Flexible and transparent biological electric power sources based on nanostructured electrodes
- 2018
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Portabel medicinteknisk utrustning framträder alltmer som en av de mest lovande metoderna för vårdövervakning och personlig behandling. Förebyggande vård och hantering av kroniska sjukdomar är resurskrävande och en överföring av det konventionella sjukhuscentrerade sjukvårdssystemet till ett individcentrerat vårdsystem skulle vara samhällsekonomiskt gynnsam. I ett sådant scenario representerar bärbara mätenheter en teknik för övervakning av patienter på ett icke-invasivt och lättanvänt sätt. Denna teknik har möjlighet att tillhandahålla långsiktiga hälsostatusövervakningar och förmedla realtidsdata som läkare kan analysera för att ge patienterna återkoppling utan att behöva träffa patienterna lika ofta. Dessutom är många utan kroniska sjukdomar också intresserade av att övervaka kroppens hälsotillstånd för att förhindra sjukdomar och uppnå en högre livskvalitet. Dagens bärbara enheter integrerar elektronik med låg strömförbrukning och trådlös teknik, s.k. ”low power wireless technology”, för att överföra information från enheten till en mottagare. Elektronik behöver tillförlitliga strömkällor för att säkerställa funktionen, och biologiska kraftkällor är särskilt lämpliga alternativ att använda i bärbara enheter, eftersom de har hög prestanda när de används under fysiologiska förhållanden. Olika biologiska kraftkällor har tillverkats och testats i denna avhandling. Materialen som används för att tillverka dem är transparenta och flexibla. Dessa två egenskaper bidrar starkt till användarvänligheten och ökar därmed benägenheten att använda sådana kraftkällor. De biologiska kraftkällorna omvandlar kemisk energi till elektrisk energi genom att oxidera glukos och reducera syre under förhållanden som liknar dem som föreligger i mänsklig tårvätska. Detta arbete bidrar till att öka kunskapen om flexibla, transparenta och nanostrukturerade material som används för tillverkning av biologiska kraftkällor.
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| 33. |
- Grönvall, Ylva
(författare)
-
The Purchase of Sex : Perceptions, Experiences, and Social Work Practices
- 2024
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this study is to explore sex buyers’ perceptions and experiences of purchasing sex, and to study how the purchase of sex is constructed as a social problem in Swedish social work practice. The empirical material consists of interviews with 30 men with experiences of purchasing sex and with ten social workers conducting counselling or outreach work with men who purchase sex. The dissertation is a compilation thesis that consists of four papers, that have been published in international peer-review journals. The first paper focuses on how men who buy sex as one-time visitors navigate between commercialization and intimacy in a national context criminalizing their actions. The paper explores the construction of meaning and intimacy in commercial relationships for Swedish men buying sex, and how these men describe relational practices and strategies used when they purchased sex. The second paper explores the construction of intimacy among men engaged in longterm transactional relationships with women. The paper focuses on the meaning of transactions for intimacy in long-term paid sexual relationships. The third paper explores how men who purchase sex in a context in which their activities are criminalized understand and perceive risk. The paper focuses on individual assessments of risk in relation to experiences of crime, exploitation, and stigma. The fourth paper aims at exploring social workers’ understanding of the purchase of sex as a social problem. The study focuses on social workers’ approaches to the purchase of sex in relation to values, professional practices, and political goals, and how they navigate these aspects in their encounters with individuals who purchase sex. The four papers show how individual experiences are understood, navigated, and conceptualized in relation to social interaction and social norms. The participants in both sub-studies navigate between their own experiences and perceptions, moral values, and social norms in regard to the purchase of sex in Sweden. Both the sex buyers and the social workers conceptualize and make sense of the purchase of sex based on their individual experiences as sex buyers or as social workers meeting sex buyers, but they also relate to normative ideas about the purchase of sex and about ‘sex buyers’.
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| 34. |
- Gudmundsson, Petri
(författare)
-
Detection of Myocardial Ischemia using Real-Time Myocardial Contrast Echocardiography
- 2006
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Diagnostisering av syrebrist i hjärtmuskeln med hjälp av kontrastförstärkt ultraljudsundersökning av hjärtmuskelns genomblödning. Ultraljudsundersökning av hjärtat (ekokardiografi) används mycket inom hjärtsjukvården idag, oftast för att utreda hjärtats och hjärtklaffarnas anatomi och funktion. Ekokardiografi är en ofarlig och ganska enkel undersökning och apparaturen som används är förhållandevis billig och mobil om man jämför med andra bildgivande undersökningar av hjärtat, såsom röntgen, isotopundersökning eller magnetresonans tomografi. Syrebrist (ischemi) i hjärtmuskeln uppkommer genom att inte tillräckligt med syreförande blod når ett eller flera områden av hjärtmuskeln, vanligen pga. förträngningar i hjärtats kranskärl. Ischemi orsakar ofta, men inte alltid bröstsmärtor, vilket kallas "kärlkramp" i hjärtat. Utvärdering av ischemi i hjärtmuskeln rekommenderas för optimal behandling av patienter med misstänkt sjukdom i hjärtats kranskärl. Denna utvärdering kan göras med hjälp av olika typer av belastningstest. Metoder som finns att tillgå är arbets-EKG, isotopundersökning (99mTc-sestamibi single-photon emission computed tomography - SPECT) och stress-ekokardiografi. Liksom arbets-EKG utförs både SPECT och stress-ekokardiografi med olika typer av belastning. Belastning vid SPECT sker vanligen genom ergometercykling, men kan också utföras genom provokation med läkemedel (dobutamin, adenosin) som ger en belastning på hjärtmuskeln liknande den vid fysisk ansträngning. Vid stress-ekokardiografi görs belastningen vanligast med dobutamin (dobutamin-atropin stress-ekokardiografi - DSE) men kan också göras med ergometercykling eller adenosin. SPECT påvisar ischemi i hjärtmuskeln genom att jämföra genomblödningen (perfusionen) i hjärtmuskeln vid maximal belastning och vila. Minskad genomblödning under belastning är tecken på ischemi. Genomblödningen i hjärtmuskeln uppskattas vid SPECT genom att en radioaktiv isotop injiceras i patientens blod. Isotopen fördelas i hjärtmuskeln på samma sätt som blodet och strålarna från isotopen kan detekteras av en speciell detektor (gammakamera). Från områden utan eller med nedsatt genomblödning detekteras ingen eller nedsatt strålning och i dessa områden föreligger således ischemi. Vid DSE jämför man vanligen hjärtmuskelns förmåga att dra ihop sig (kontraktionsförmåga) i arbete och vila. Om kontraktionen minskar i någon del av hjärtmuskeln under belastning så talar det för ischemi i detta område. Både SPECT och DSE är väldokumenterade och bättre men dyrare än arbets-EKG. Att belasta hjärtat med dobutamin är ofta påtagligt obehagligt för patienten, medan belastning med adenosin ofta uppfattas som mindre obehaglig. Själva belastningen är dessutom oftast kortare än vid både ergometercykling och dobutamin-belastning. Till skillnad från sedvanlig stress-ekokardiografi räcker det dock inte att bedöma hjärtmuskelns kontraktion vid adenosin-belastning, utan det krävs även att genomblödningen bedöms. Genomblödningen i hjärtmuskeln har inte tidigare varit möjlig att värdera vid adenosin-stress-ekokardiografi (ASE). Det blev dock möjligt för några år sedan, då en typ av ny ultraljuds-kontrastmedel introducerades inom ekokardiografi. Kontrastmedlet för ultraljud som användes inom ramen för denna avhandling var Sonovue. En kombination av ny ultraljudsteknik (realtids perfusion - RTP) och kontrastmedel har gjort det möjligt att samtidigt bedöma genomblödningen i hjärtmuskeln och dess kontraktionsförmåga. Därigenom skulle RTP i kombination med ASE (RTP-ASE) kunna användas för att tillförlitligt detektera ischemi i hjärtmuskeln. Om RTP-ASE visar sig kunna detektera ischemi lika bra som en redan erkänd undersökning, exempelvis SPECT, kan RTP-ASE bli en bra alternativ undersökning. Jämfört med SPECT är RTP-ASE mer tillgänglig och utan radioaktiv strålning, jämfört med DSE är den snabbare och mindre obehaglig, och den är mera noggrann än arbets-EKG.
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| 35. |
- Guidi, Paolo
(författare)
-
Social work assessment of families with children at risk : similarities and differences in Italian and Swedish public services
- 2016
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The thesis aims at understanding and explaining social work assessment of families with children at risk, at the level of practice, considering social workers' role in their national welfare system.· The thesis embodies four articles and is informed by a comparative perspective between Sweden and Italy. The first three articles are based on a vignette study focusing on social workers' assessment of three cases of children at risk and the fourth article draws on a broad cross-national survey focusing on social workers' perception of power. The comparison shows great similarities in assessment and line of reasoning when it comes to cases involving infants and small children, while differences are more evident when it comes to adolescent behaviour. Italian social workers are in general more oriented to intervene than their Swedish counterparts. However, Swedish social workers perceive that they have greater power towards their · clients than their Italian colleagues. Differences in the assessment at level of practice are only partly explained by national welfare systems. Also local organisational structures, cultural understandings, and the role assumed by professionals in respect.to their mandate, seem to be influencing factors when it comes to soda! workers' assessment of families with children at risk.
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| 36. |
- Gustafsson, Anna
(författare)
-
Aspects on sepsis : treatment and markers
- 2012
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Sepsis is one of the greatest challenges in critical care medicine today, while the treatment of sepsis and evaluation of its severity is complicated. The first part of this thesis presents two approaches on the use of antimicrobial peptides in sepsis treatment, relying on both soluble and immobilized peptides. All peptides tested, truncated from human and non-human antimicrobial peptides, did neutralize LPS activity in a dose-dependent manner. Immobilization of the peptides did not inhibit their ability to bind LPS, therefore, the peptides can be considered for extracorporeal LPS removal in sepsis therapy. Interestingly, the soluble peptides inhibited LPS induced cytokine production but potentiated LTA induced cytokine production in human blood. Consequently, care should be taken when considering these peptides in treatment of Gram-positive infections. The second part of this thesis evaluates the inflammatory marker soluble urokinase plasminogen activator receptor (suPAR) in sepsis prognosis. Also, an investigation whether suPAR can be detected in human saliva was undertaken. The results indicate that plasma levels of suPAR are increased in sepsis patients compared to controls, but there was no significant difference between survivors and non-survivors. Plasma levels of suPAR did not correlate with other inflammatory markers, suggesting that suPAR reflects general activation of the immune system rather than exerting inflammatory actions. Moreover, suPAR can be detected in saliva and the levels are more than 10 times higher than the corresponding plasma levels in healthy individuals.
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| 37. |
- Hamit Eminovski, Jildiz
(författare)
-
Interactions of Biopolymers and Metalcomplexes at Biological Interfaces
- 2011
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The present work concerns interaction between biopolymers at interfaces. Examples from real systems such as saliva and bacterial surfaces as well as model systems have been studied. Using atomic force microscopy (AFM), normal forces between the surface of the filamentous bacterium Microthrix parvicella and AFM-tips have been studied, before and after treatment with specific polyaluminium compounds used at wastewater treatment plants to control the growth of the bacterium. Measurements were performed using hydrophobized and hydrophilic tips in order to explore the interactive spectrum of the bacterium and also the changes of which, if any, on treatment with polyaluminium chloride. No preferential interaction was found to any of the tips. However, the studies revealed that long-range steric repulsion dominates the interaction on approach. It was also found that the steric repulsion is reduced by addition of polyaluminium compounds, indicating a compaction of the polymer layer on the surface of the bacterium.A mucin model system, i.e. Bovine Submaxillary Mucin (BSM), adsorbed at solid surfaces has been studied using ellipsometry and quartz crystal microbalance with dissipation (QCM-D). Using the optical method ellipsometry, time resolved data on the adsorbed amount per unit area and the average layer thickness of adsorbed BSM films were determined. From QCM-D measurements the Voigt mass per unit area and viscoelastic properties of an adsorbed BSM film (including coupled water) were determined. Combining these two methods the water content of BSM adsorbed at gold, hydrophobized, and hydrophilic silica surfaces was estimated. From the results structures for BSM adsorbed on gold, hydrophobized, and hydrophilic silica were proposed. Furthermore, effects by the addition of polyaluminium chloride of different hydrolysis ratio were investigated and compared to those of AlCl3 and a ferric chloride formulation. Hence, compaction of the BSM film was initiated at concentrations as low as 0.001 mM AlCl3. At higher concentrations, related to those used at wastewater treatment plants, addition of polyaluminium chloride formulations and AlCl3 induced an initial rapid decrease in thickness followed by an increase. An increasing adsorbed mass was also observed. Combining ellipsometry and QCM-D data it was determined that aluminium species precipitate in or on top of the pre-adsorbed BSM film and the ensemble swells over time. By rinsing the precipitate layer was removed, but with some fraction remaining associated to the film. The rate of removal was slow and proceeded over a period of tens of hours. Combining the data, the swelling of the precipitate was monitored and the water content calculated. It was obvious that the increase on adsorption and decrease on depletion is mainly related to swelling. The impact of surface characteristics was also investigated and surface charge influences in terms of electrostatic interactions between the surface and the cationic aluminium compound were inferred. Friction forces between hydroxyapatite surfaces coated with human whole salivary (HWS) films were measured and the friction coefficient of the salivary films was determined. Measurements were performed using AFM-colloidal probe using two hydroxyapatite spheres. The salivary film was found to show high compressibility and mechanical resistance. Treatment with an anionic surfactant, sodium dodecyl sulphate, however induced desorption and an irreversible structural change of the film.
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| 38. |
- Hellman, Peter
(författare)
-
Human dendritic cells : a study of early events during pathogen recognition and antigen endocytosis
- 2009
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The mononuclear phagocyte cell system includes monocytes, macrophages anddendritic cells which are important cells in order to recognize, ingest, destroyand also present part of a pathogen to T-lymphocytes in order to activate theadaptive immune system. Dendritic cells (DCs) stand out in their ability tostimulate T-lymphocytes and are also believed to be important to keeptolerance for “self-antigens”.Therefore DCs are of interest for use in immunotherapy studies. However inmost such studies to date, DC-like cells have been used, so called monocytederived dendritic cells (moDCs).The aim of this thesis was to investigate the early events following in vitroactivation of highly purified human DCs. In the first study we observed thatthe production of IL-8 and down regulation of CD128b preceded surfaceexpression of MHC class II and CD40, 80 and 86. We have in the followingstudies used and demonstrated the practical use of zeolite particles as ligandcarriers with the purpose to study the uptake mechanisms deployed byphagocytes. We show the advantage of using zeolite particles, due to theirability to bind various types of ligands i.e. proteins, oligonucleotides,lipophilic, and hydrophobic molecules. In addition, we have adsorbed biomolecules in sequential steps, which demonstrates the potential of coadsorbing ligands e.g. for targeting a specific endosomal compartmenttogether with molecules sensing the endosomal microenvironment.Coating zeolite particles with different biomolecules might provide furtherunderstanding of mechanisms involved in antigen sorting into endocyticcompartments.
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| 39. |
- Holmberg, Lena
(författare)
-
Communication in Palliative Home Care, Grief and Bereavement - A mother’s experiences
- 2007
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In this study a mother’s experiences of communication between her adult son dying in leiomyosarcoma and herself (the author), between his family and a palliative home care team and communication in the support of the mother in her parental grief and bereavement are described and analyzed. The mother’s experiences are captured in personal accounts, writings, during the year of her son’s illness with cancer and his palliative home care and during three years of grief and bereavement after her loss. The data analysis is carried out in four steps by the mother as a researcher: 1) Identification of events of experiences of communication and significant concepts in the writings 2) Construction of four narratives, illustrating the concepts and including excerpts from the writings 3) Interpretation, contextualization and validation of the narratives 4) Contextualization in broader contexts. The son’s hope and disavowal and the mother’s fear and despair emerged as important concepts in understanding the communication between them during his palliative home care. Recognition, acknowledgment and respect from the palliative home care team supported the mother. A network of supportive arrangements was made available to the son and his family. The team recognized the son’s and the family members’ emotional needs as well as the family members’ needs to do anything they could for their husband, father, brother and son. Trust was a key concept in the communication between the son and his family on one hand and the palliative home care team on the other. Trust seems to be a base for the empowerment of the family members. Main factors besides the team’s medical professionalism influencing trust were flexibility, accessibility and continuity. Information, control, friendship and shared experiences were important factors in supporting the mother in her first year of bereavement. The findings point to the necessity of customizing bereavement support, specifically for high risk mourners. In the short term perspective the mother found support in her pre school aged granddaughter, who had lost her father. These contacts provided breaks in the grief, actualized positive memories, established and sustained rituals. In the long term perspective confirmed family bonds helped the mother in her reconciliation process. Empathy, based on the welfare system, providing flexible structures in which the mother was recognized and acknowledged, felt trust, was looked upon as an individual, was empowered and finally was reached by support after her loss, was of substantial importance to her. Empathy based on compassion, shared experiences, shared loss and strengthened family bonds supported her. Empathy to self allowed her to make use of the support she received and was part of her reconciliation process.
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| 40. |
- Holst-Hansson, Annette
(författare)
-
On a journey for survival : everyday life during radiation therapy from the perspectives of women with breast cancer and their families
- 2018
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis focuses on women diagnosed with breast cancer and their familymembers. Since a breast cancer diagnosis and its subsequent treatment are astrenuous experience not only for the woman afflicted but also for her familymembers, this thesis aimed to explore the experiences of everyday life duringradiation therapy from the perspectives of the woman with breast cancer andher family, as well as exploring families’ experiences of participating in shortfamily health conversations (SFamHC).All included studies were interview studies (Papers I, II, III & IV), where 30women (20 in Paper I and 10 in Paper II) with breast cancer, 19 family membersincluding the women with breast cancer (Paper III) and 9 families (PaperIV) were interviewed. The data from the interviews was analysed using qualitativecontent analysis (Papers I & II), a hermeneutical phenomenologicalmethod (Paper III) and thematic analysis (Paper IV). The women’s experiences of breathing adapted radiation therapy (BART)(Paper I) were identified in an overall theme, The breath of life, as the womenexperienced the breathing as a way to influence their treatment andthus their survival. The overall theme could be divided into one main category:Participating in one’s treatment, for good or ill, with four subcategories:Knowing one has done something good, Getting an extra bonus –healthwise, The experience of being in control and Being in a hightechnologyenvironment.Women born in Iraq and the former Yugoslavia, diagnosed with breast cancerand living in Sweden, experienced their everyday life during radiation therapyas a narrow and challenging treatment road to survival (Paper II). Theirexperiences were structured into three categories: Strategies for survival, Keepingup appearances and Staying in control. More focus should be on acknowledgingthe woman behind the diagnosis, regardless of her origin, in order to develop individualised support programmes to help women cope with everydaylife during radiation therapy.The families’ lived experience when a family member is diagnosed withbreast cancer (Paper III) was described as a challenging endeavour to regain anordinary, safe life, hoping to reach a safe haven. The families felt that life as theyknew it had disappeared and they were fumbling in the dark and pursuing balanceby struggling to keep the family together and by maintaining a positive attitude.They were also struggling with guilt and inadequacy, due to their difficultiesin communicating emotional distress and to feeling abandoned by thehealth care professionals.Families’ experiences of participating in short family health conversations(SFamHC) (Paper IV) were identified in four key themes: Bringing everythingout in the open, Being confirmed as an individual and as a family, Gaining anunexpected insight and Timing and context matter. The findings from this thesis can deepen the understanding of what livingwith breast cancer is like, from the perspectives of the women with breast cancerand their families, as well as increasing the understanding of their needs.Their experiences could be described as a journey for survival, a journey thatstarts at the time of diagnosis and that they are still partaking in when concludingtheir radiation therapy treatment. The journey for survival sends themoff into the unknown, where they strive to regain control, balancing betweenhope and despair, experiencing their life as divided into an outer and innerworld and needing support from each other as well as from health care professionals.A possible way to support the women and their family members couldbe to offer them participation in short family health conversations (SFamHC),since these conversations provide them with an opportunity to verbalise andshare their feelings and thoughts. Those participants (Paper IV) who took partin SFamHC felt that their participation in the SFamHC helped them to moveforward and beyond the breast cancer diagnosis.
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| 41. |
- Holst, Marie, 1959-
(författare)
-
Self-care behaviour and daily life experiences in patients with chronic heart failure
- 2008
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Under min tid som kliniskt verksam sjuksköterska mötte jag många patienter sombesvärades av törst och som hade svårt att följa den vätskerekommendation på1,5L/dygn som gavs. Detta är upprinnelsen till denna avhandling vars syfte är att beskrivaoch utvärdera egenvårdsbeteendet samt att beskriva hur det dagliga livet upplevsav patienter med kronisk hjärtsvikt, med speciellt intresse riktat mot vätskeintaget.Kronisk hjärtsvikt är ett komplicerat kliniskt tillstånd som påverkar den drabbadeindividen på många sätt. Det finns ingen allmänt accepterad och heltäckande definitionav kronisk hjärtsvikt. En vanligt förekommande beskrivning är att de tecken/symtom som kännetecknar hjärtsvikt indikerar att hjärtat av någon anledning intekan förse kroppens vävnader och organ med den mängd syre och näring som behövs.Gemensamt för alla definitioner av kronisk hjärtsvikt är att den orsakas av en bakomliggandehjärtsjukdom. De vanligaste orsakerna till kronisk hjärtsvikt i Europa är högtblodtryck och hjärtkärlssjukdom, ofta i form av genomgången hjärtinfarkt. Andra orsakerkan vara rytmrubbningar i hjärtat, klaffsjukdom eller hjärtmuskelsjukdom. Cirkatvå till tre procent av befolkningen i Sverige (200 000-250 000 individer) har kroniskhjärtsvikt och det uppskattas att andelen personer som har en asymtomatisk ellerlatent hjärtsvikt är lika stor. Det stora flertalet av dessa personer är äldre; cirka 10procent av befolkningen över 80 år har kronisk hjärtsvikt. Förekomsten av kroniskhjärtsvikt har ökat under de senaste decennierna och anledningen anses vara att medellivslängdenhar ökat och behandlingen av akut hjärtinfarkt har förbättrats avsevärt,med förbättrad överlevnad som följd, men också till priset av att fler människor lever med nedsatt hjärtfunktion. Kostnaderna för vård och omsorg av personer med hjärtsviktär höga, cirka två procent av den totala hälso- och sjukvårdsbudgeten går tilldenna patientgrupp och majoriteten av kostnaderna är för slutenvård. Prognosen förpatienter med kronisk hjärtsvikt är beroende av svårighetsgraden. Vid mild hjärtsviktberäknas den årliga dödligheten till fem procent och vid uttalad hjärtsvikt uppskattasden årliga dödligheten till 40-50 procent. Detta innebär att prognosen vid uttalad kroniskhjärtsvikt i genomsnitt är sämre än vid våra vanligaste cancersjukdomar.Kronisk hjärtsvikt påverkar patienten både fysiskt och psykiskt. De dominerandefysiska symtomen och tecknen är trötthet, andfåddhet samt vätskeansamling i kroppen.Försämrad kognitiv förmåga, depression och sömnstörningar är också vanligt. Pågrund av de begränsningar som patienter med kronisk hjärtsvikt upplever är deras hälsorelateradelivskvalitet låg. I de intervjustudier som finns är det tydligt att den nedsattafysiska kapaciteten påverkar patienten med kronisk hjärtsvikt mycket. Detta innebäratt patienten inte kan göra det han/hon vill samt att beroendet av närstående ellerandra vårdgivare ökar. Diagnosen ställs på de typiska symtom eller fynd som förekommervid kronisk hjärtsvikt samt objektiva tecken på rubbad hjärtfunktion, företrädesvismed ultraljudsundersökning av hjärtat (ekokardiografi). Behandlingen av kroniskhjärtsvikt ska inriktas på såväl symtomlindring som den bakomliggande orsaken.Hjärtsviktsbehandling omfattar både farmakologisk och icke-farmakologisk behandling.Målet för den farmakologiska behandlingen är att förbättra hjärtats funktion ochatt minska den stresshormonella aktiveringen som föreligger vid kronisk hjärtsvikt,men också att lindra symtom och därigenom öka livskvalitet och arbetskapacitet, samtatt förbättra överlevnad. I riktlinjer från både Europa och USA rekommenderas, beroendeav hjärtsviktens svårighetsgrad, en kombination av ACE-hämmare eller angiotensinreceptor blockerare, beta-blockerare, diuretika och aldosteronhämmare. Denicke-farmakologiska behandlingen är till stor del inriktad på att motivera till livsstilsförändringaroch modifikation av riskfaktorer. I detta är patientutbildning en viktigdel. Utbildningen bör innehålla information om orsaker till hjärtsvikt, vad hjärtsviktinnebär och varför symtom uppträder, samt den farmakologiska behandlingens verkanoch biverkningar. Det är viktigt att motivera till monitorering av symtom såsom andfåddhet,trötthet och ödemutveckling med t.ex. dagliga viktkontroller för att patiententidigt ska kunna upptäcka en försämring av hjärtsvikten. Andra områden som omfattasär rekommendationer om salt- och vätskerestriktion, fysisk träning, anpassning avenergiintaget (främst näringstillskott vid malnutrition), måttlig alkoholkonsumtionsamt infektionsprofylax i form av influensa och pneumokock vaccination. Ämnensom också bör beröras är sömnsvårigheter och sexuell aktivitet. I Sverige bedrivsmycket av denna utbildning på sjuksköterskebaserade hjärtsviktsmottagningar. Sjuksköterskorna som driver hjärtsviktsmottagningar arbetar ofta självständigt och harofta delegeringar för att titrera och justera läkemedel såsom diuretika, ACE-hämmareoch beta-blockerare. Arbetet bedrivs med stöd av kardiologer med särskilt intresse förpatienter med hjärtsvikt och på vissa sjukhus är också sjukgymnaster, dietister, kuratorer,arbetsterapeuter och farmaceuter involverade. Hjärtsviktsmottagningarna harvisat sig leda till en effektivare läkemedelsanvändning, högre hälsorelaterad livskvalitetoch förbättrad egenvårdsförmåga. Dessutom har man kunnat visa att hjärtsviktsmottagningarleder till förbättrad överlevnad samt kostnadseffektivitet, beroende påett minskat behov av inläggning på sjukhus.Förutom de vanliga symtomen är törst något som patienter med kronisk hjärtsviktofta uttrycker som besvär. Orsaken till detta kan vara flera; den vätskedrivande behandlingenär en, den stresshormonella aktiveringen en annan och den vätskerestriktionsom patienterna är rekommenderade kan vara den tredje. I gällande riktlinjer rekommenderasen vätskerestriktion på 1,5-2 l vätska per dygn men denna rekommendationbygger inte på någon vetenskaplig kunskap. Förutom törst är muntorrhet ettproblem som i sin tur kan leda till förändrat smaksinne, försämrad munhälsa och ivärsta fall svårigheter att tala. Torr hud och klåda är också symtom som kan kopplassamman med en strikt vätskerestriktion. Kroppens behov av vätska anges i litteraturenvara mellan 25 och 35 ml/kg kroppsvikt/dygn. Räknat på 30 ml/kg kroppsvikt/dygnskulle 1,5 l täcka behovet för en person som väger 50 kg och för en person som väger80 skulle gällande riktlinjer innebära ett dagligt underskott på nästan 1 liter. När denfarmakologiska behandlingen för kronisk hjärtsvikt inte var så utvecklad som den äridag var vätskerestriktion en naturlig och motiverad åtgärd, men med dagens effektivafarmakologiska behandling bör behovet av denna vätskerestriktion omprövas eftersomden medför obehag för patienterna.Syftet med denna avhandling var att beskriva och utvärdera egenvårdsbeteendetsamt att beskriva hur det dagliga livet upplevs av patienter med kronisk hjärtsvikt,med speciellt intresse riktat mot vätskeintaget. Syftet med delstudie I var att beskrivaegenvårdsbeteendet hos patienter med kronisk hjärtsvikt inom primärvården under ettår efter en patientutbildning. Studien var en analys gjord på interventionsgruppen i enstörre randomiserad studie. Interventionen bestod av ett utbildningstillfälle i hemmetgenomförd av en sjuksköterska från primärvården. Uppföljningen skedde sedan viatelefon varje månad under ett år, förutom månad tre och tolv då uppföljningen skeddei hemmet. Sextio patienter utvärderades och resultaten visade ingen förändring iegenvårdsbeteende, avseende viktkontroller, salt- och vätskerestriktion under uppföljningstiden.Inget samband sågs mellan hälsorelaterad livskvalitet och egenvårdsbeteende. Det fanns inga könsskillnader i egenvårdsbeteende eller i sambandet mellanhälsorelaterad livskvalitet och egenvårdbeteende. Resultaten indikerar att det interäcker med ett utbildningstillfälle för att förbättra egenvårdsbeteendet och den hälsorelateradelivskvaliteten.Delstudie II var en randomiserad cross-over studie, vilket innebär att alla patienterdeltar i båda de interventioner som studien omfattar. Varje patient blir därmed sinegen kontroll. Under intervention 1 fick patienterna inte dricka mer än 1,5L/dag ochunder intervention 2 baserades rekommendationen om det maximala vätskeintaget påkroppsvikten; 30ml vätska per kg kroppsvikt/dygn. Sjuttiofyra patienter randomiseradesoch syftet var att utvärdera effekterna av vätskeintaget på hälsorelaterad livskvalitet,fysisk kapacitet, törst och sjukhusinläggning hos patienter med stabil kroniskhjärtsvikt. Resultatet visade ingen skillnad mellan interventionerna avseende hälsorelateradlivskvalitet, fysisk kapacitet eller inläggning på sjukhus. Upplevd törst ochsvårigheter att hålla vätskerekommendationen var dock signifikant mindre i gruppensom hade en individuellt anpassad vätskerekommendation. Resultatet antyder att enmindre strikt vätskerekommendation är både säker och fördelaktig för patienter medstabil kronisk hjärtsvikt, vilket aldrig tidigare visats.Delstudie III bestod i en sekundäranalys av data från delstudie II. Syftet var att beskrivapatienternas uppgivna vätskeintag samt dess effekter på kroppsvikt, symtom,diuretikaanvändande, hälsorelaterad livskvalitet och fysisk kapacitet. Data från 63 patienteringick i analysen. Gruppindelningen baserades på medianen (19ml/kg kroppsvikt/dygn) av intagen vätska för hela studieperioden. Medelvärdet av intagen vätska i”under median gruppen” var 16 ml/kg kroppsvikt/dygn, medan det var 24 ml/kgkroppsvikt/dygn i ”över median gruppen”. Inga skillnader mellan grupperna sågs förutomen signifi
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| 42. |
- Hulusjö, Anna
(författare)
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The multiplicities of prostitution experience : narratives about power and resistance
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis is not primarily about ‘the rights and wrongs of prostitution’, at least not as they are conveyed in the prostitution debate, rather it aims to shift the focus from what prostitution is (work or violence, empowerment or exploitation), the topic of most prostitution debate, to how prostitution operates. That is, how power relations, knowledges, discourses and practices interconnect in making particular forms of prostitution and particular ways of making sense of prostitution experience possible. The study is situated on the feminist narrative field and is constituted of interviews with twenty women with prostitution experience. With a genealogical approach to narrative analysis the participants’ narratives are not treated as reflections of an assumed prostitution ‘reality’, but rather there is an exploration of what the participants do as they narrate their experience, how they, through their narratives, construct their identities and make sense of their experiences and their lives. By engaging with the participants’ narratives, the power and domination of the institution of prostitution and the multitude of tactics that the participants employed in order to negotiate, resist and destabilize power and domination were explored. The participants’ narratives were both entangled with and positioned against dominant narratives about prostitution and ‘the prostitute’. They contained complexities, contradictions and multiple meanings; prostitution was described as both enabling and constraining, as a means of resistance and as an effect of power. The participants spoke of how the institution of prostitution produced different experiences of being constituted as a ‘commodified body’, an ‘appropriate target for violence/undeserving victim’ and a stigmatized identity. 8 Depending on their social location and personal biography the participants were more or less able to manage the emotional and physical risks that prostitution involved. The narratives revealed how prostitution, as it currently operates, is conditioned by intersecting structures of social inequality.
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| 43. |
- Hylén, Mia, 1975-
(författare)
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Pain in intensive care : assessments and patients’ experience
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of the thesis was to translate, psychometrically test, and further develop the Behavioral Pain Scale for pain assessment in intensive care and to analyze if any other variables (besides the behavioral domains) could affect the pain assessments. Furthermore, the aim was to explore the patients’ experience of pain within the intensive care.The Behavioral Pain Scale (BPS), consisting of the domains “facial expression,” “upper limbs,” and “compliance with ventilator/vocalization,” was translated andculturally adapted into Swedish and psychometrically tested in a sample of 20 patients(study I). The instrument was then further developed within one of the domains and tested for inter-rater reliability, discriminant validity, and criterion validity (study II). The method for analysis in both study I and II was a method specifically developed for paired, ordered, and categorical data. To describe and analyze the process of pain assessment, a General Linear Mixed Model was used to investigate what variables, besides the behaviors, could be associated with the observers’ own assessment of the patients’ pain (study III). Further, the patients’ experiences of pain when being cared for in intensive care were explored (study IV) through interviews with 16 participants post intensive care. Qualitative thematic analysis with an inductive approach was used for the analysis.The first psychometric tests of the BPS (study I) showed inter-rater reliability with agreement of 85%. For the discriminant validity, all domains, except “compliance with ventilator,” indicated discriminant validity.Therefore, in study II, a developed domain of “breathing pattern” was tested alongside the original version. The BPS showed discriminant validity for both the original and the developed version and an inter-rater reliability with agreement of 76-80%. Wheninspecting the respective domains there was a difference in discriminant validity between the original domain of “compliance with ventilation” and the developed domain of “breathing pattern,” showing higher values on the scale for the developed domain during turning. For criterion validity, the BPS showed a higher sensitivity than the observers, who on the contrary had a higher specificity.The General Linear Mix Model (study III) showed that heart rate could be associated with the observers’ assessments of pain. For the behavioral signs, the result indicated that breathing pattern was most associated with the observers’ pain assessment, whilst facial expression did not show any impact on the observers’ assessments.The patients’ experiences of pain (study IV) in intensive care were described as generating a need for control; they experienced a lack of control when pain was present and continuously struggled to regain control. The experience of pain was not only related to the physical sensation but also to psychological and social aspects, along with the balance in the care given, which was important to the participants.In conclusion, the translated and developed version of the Swedish BPS showed promising psychometric results in assessing pain in the adult intensive care patients. Still, other signs, besides behavioral, is possibly used when pain assessing and therefore information about and training in pain assessment are needed to enhance the assessments that are made. Also, the patients’ own experiences highlight the importance of individualizing and adapting pain assessment and treatment to the needs of each patient. Making them a part of the team could enhance their feeling of control, thereby supporting them in facing the experience of pain.
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| 44. |
- Incel, Anil
(författare)
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Amino acid sequence and side chain specific synthetic receptors targeting protein phosphorylation
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Antibodies have become a critical component of many diagnostic assays and are used for therapeutic purposes. Nevertheless they often fail to meet the strict performance demands raised in industry and in the clinic (e.g. stability, reproducibility, selectivity, affinity). These issues are especially notable for assays targeting post translational modifications (PTM) of proteins (phosphorylation, glycosylation, sulfation etc.). Antibody-based technologies suffer from problems of a more general nature associated with the analytical use of biological receptors i.e.: i) limited stability requiring cold chain logistics, ii) high production costs, iii) batch to batch variability. The above emphasizes the need for alternative robust, reproducible and low cost “binders” and assays. The aim in this thesis is to design, develop and test molecularly imprinted polymers (MIPs) which were synthesized epitope and stoichiometric imprinting approaches targeting phosphorylation as a PTM. Protein phosphorylationis one of the most common PTM, which is based on covalent attachment of phosphate group to particular amino acids. Misregulation of phosphorylation process is found related with diseases such as cancer, diabetes, and neurodegeneration. MIPs are synthesized through copolymerization of functional monomers and crosslinkers in the presence of N- and C- terminal protected templates. The key recognition element employed in developed synthetic receptors was 1,3-diaryl urea functionalmonomer 1. This monomer is a potent hydrogen bond donor forming strong cyclichydrogen bonds with oxyanions. Amino acid sequence specific and side chain imprinted binders were prepared targeting phosphorylation on tyrosine (pTyr) and on histidine (pHis). pHis MIP-based approach is proposed as a solution to enrich pHis peptides in the presence of other phosphoesters such as phosphoserine (pSer) in complex mixture without pre-treatment like β-elimination. In pTyr, ZAP-70 (zeta associated 70 kDa protein), which is prognosticator for chronic lymphocytic leukemia (CLL), and pTyr-sequence specific motif Src-SH2 domain were chosen as targets to evaluate regio- or stoichiometric selectivity performance of imprinted polymers. The synthesized polymers are used as effective enrichment tools for target phosphorylated peptides from complex mixture prior to mass spectrometry. Overall, the results demonstrate unique proteomics enrichment tools that link with personalized medicine relying on diagnostic coupled cancer treatment strategies based on kinase inhibitors.
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| 45. |
- Ingvarsdotter, Karin
(författare)
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Mental ill health and diversity : Researching human suffering and resilience in a multicultural context
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The general objective of this dissertation was to study the putative underutilisation of mental health services in a multicultural context. The method followed a qualitative interview-based naturalistic approach, and the interview format was primarily semi-structured. Special attention in the method section has been given to the role of the interpreter in research. For some time the research areas of underutilisation of mental health care among immigrants, and that of children of immigrant parents suffering from mental illness, have been dominated by a vulnerability approach. Results from the present thesis show that this one-dimensional picture of immigrants as a category associated with psychopathology ought to be balanced with that of strength and resilience. It was also found in the studied group that underutilisation of mental health care is partly due to the perception of mental conditions as normal life crises, rather than illnesses. Thus, instead of focusing on health care resources, interviewees conveyed their need for greater social and financial support. The results of this study suggest that there is a lack of extended possibilities, for both adults and children of immigrant background, to express their own needs outside a predefined context. Investigating aspects of resilience in future research on mental ill health in multicultural contexts would challenge the focus on vulnerability, and perhaps so promote resilience.
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| 46. |
- Isma, Gabriella E
(författare)
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Overweight and obesity in young children : preventive work in child health care with fokus on nurses´ perceptions and parental risk factors
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Childhood obesity is a global public health threat correlated with several comorbidities and increased mortality in adult life. Heredity and physical development concomitant with environment culture and lifestyle habits are contributing key factors for the onset of overweight. Non-genetic components related to unhealthy dietary and activity patterns shared in families, are environmental factors that are possible to prevent before habits are set. Research indicates that there are several barriers against the proper management of this often long-term condition, where preschool children are an understudied group. This thesis aims to investigate how the Child Health Care (CHC) nurses pursue the preventive work on childhood overweight and obesity in CHC and further, to explore parental risk factors in relation to overweight and obesity in children. In the first study (Paper I), 18 nurses at 17 CHC centers in the southern part of Sweden were interviewed using semi-structured interviews with a phenomenographic approach. This study aimed to elucidate the conceptions of childhood overweight, including obesity, among nurses working in CHC. The analysis yielded 11 different conceptions from which emerged four categories of description; “Perception of childhood overweight changes”, “Overweight in younger children, a neglected concern”, “Overweight, a delicate issue” and “The importance of family lifestyle”. The results show that CHC nurses conceived overweight and primarily obesity in children to be an extensive and serious health problem, mainly due to parent’s lifestyle. Childhood overweight during infancy and their preschool years was conceived as a minor concern and further nurses perceived it as a provoking and sensitive issue that was difficult to define. Despite there being an adaption towards the acceptance of larger children, childhood overweight and obesity were considered to be undesirable by both the CHC and the Swedish society in general. Both nurses and parents were more concerned about the children’s appearance and the risk of their being bullied than about the children’s health. Nurses conceived that it was important to protect the parent-nurse relationship. Therefore in order not to jeopardize this relationship; the subject of childhood obesity was avoided. The second study (Paper II) aimed to elucidate the CHC nurses conceptions of their preventive work with childhood overweight and obesity in CHC. Study II was conducted at 17 CHC units using semi-structured interviews with 18 CHC nurses in the southern part of Sweden. The interviews had a phenomenographic approach which elucidated seven conceptions, from which emerged two categories of description; “internal obstacles to nurses’ work with overweight in children” and “external obstacles to the management of overweight in children”. The results show that the CHC nurses work was conceived to be complicated and constrained by several obstacles. Nurses’ preventive work was affected by factors linked to personal traits, lack of sufficient knowledge and lack of several resources affecting their ability to conduct preventive work. The third and the fourth study (Paper III and IV), were based on a crosssectional survey with a questionnaire administered to a stratified and randomized selection of parents to preschool children registered at CHCs in the southern part of Sweden. In total, 598 parents participated in the study, divided into 255 fathers and 343mothers to 372 children, i.e. 372 families. The third study (Paper III), examined socio- and demographic parental risk factors for overweight and obesity in children and the frequency of overweight and obesity in the context of child health care. Descriptive analyses were used to present the frequency of parental and childhood overweight and obesity, and logistic regression was used to estimate the relation between parental socio- and biodemographic factors and children’s risk for overweight or obesity. Our results show that the frequency of overweight and obesity was 14.5 % in children, 56.0 % in fathers and 36.5 % in mothers. A distressed financial situation in fathers (OR 2.85, CI 1.06-7.69) was associated with increased risk for overweight and obesity in children. After adjusting for potential confounders in mutually adjusted models, the aggregated results for both parents showed that mothers and fathers born outside of Sweden (OR 4.50, CI 1.55-13.12 and OR 4.94, CI 1.72-14.20) was the strongest risk factor for overweight and obesity in children.The fourth and final study (Paper IV) aimed to investigate parental lifestyle habits as risk factors for overweight and obesity in children. The relation between parental lifestyle habits and children’s risk for overweight and obesity was analyzed using logistic regression. Our results show that there might be a trend indicating an increased risk for children to develop overweight and obesity if the father is a daily smoker (OR 4.11, CI 1.45-11.68) and the mother is physically inactive (OR 2.33, CI 1.11-4.90). This thesis comprises four studies of both qualitative and quantitative character, with focus on nurses’ preventive work with childhood overweight and obesity in CHC and parental risk factors. Our findings identify multiple levels of barriers to the prevention work on childhood overweight. Nurses’ lack of sufficient knowledge, nurses’ negative conceptions of families with overweight problems, parents’ lack of awareness and the sensitive nature of the issue are circumstances that complicate nurses’ work. Additionally, society’s adaption to the increased proportion of children with overweight has led to an acceptance of excess weight in children. Further, parental risk factors were also identified. Parents being born outside Sweden was associated with increased risk of childhood overweight and obesity, as well as financial distress within the family. Further, the findings show a trend that indicates that paternal smoking and maternal physical inactivity might be factors associated with enhanced risk of overweight and obesity in younger children. We conclude that there exists a need to supplement the existing nurse education in child health care by putting the accent on intensifying education related to childhood overweight and weight assessment, with emphasis on the younger child. Further, this thesis implies that there is a need to better prepare specialist nurse student’s clinical skills related to their encounters with families and children at risk for overweight and obesity, through raising their awareness of their own perceptions of overweight in young children. Childhood overweight should be recognized and prioritized in CHC, further, the implementation of research results needs to be prioritized in the clinical work. The identification of risk factors may help health care personnel to identify and target children in risky family environments.
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| 47. |
- Ivert, Anna-Karin
(författare)
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Adolescent mental health and utilisation of psychiatric care : the role of parental country of birth and neighbourhood of residence
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The studies included in this thesis aim to illustrate different aspects of mentalhealth and the utilisation of psychiatric care among Swedish children andadolescents, with the overarching aim being to improve the existingknowledge on how the neighbourhood of residence and parental country ofbirth influence adolescents’ mental health and their pathways into andutilisation of psychiatric care.The first study investigates referral pathways to child and adolescentpsychiatric clinics, directing a special focus at how these pathways differ onthe basis of parental country of birth and neighbourhood of residence. Theresults show that parental country of birth plays an important role in howchildren and adolescents are referred to the child and adolescent psychiatricsector. Children and adolescents with Swedish-born parents appear more oftento have been referred by their families, whereas by comparison with childrenand adolescents with Swedish-born parents, those with foreign-born parentshad more often than been referred by someone outside the family, such as thesocial services or their school. Neighbourhood of residence was found to playa significant role in relation to family referrals; children and adolescents livingin neighbourhoods with low levels of socioeconomic deprivation were morelikely to have been referred by their families by comparison with those frommore deprived neighbourhoods.The second study investigates how parental country of birth and individualgender are associated with the utilisation of psychiatric care. The findingsfrom the study indicate that adolescents whose parents were born in middleorlow-income countries present lower levels of psychiatric outpatient careutilisation than those with Swedish-born parents. Initially, no associations7were found between parental country of birth and inpatient care. Followingadjustment for socio-demographic variables, it was found that adolescentswhose parents were born in low-income countries were also less likely toutilise inpatient care. Girls were more likely to have utilised psychiatric care,but controlling for possible interactions revealed that this was true primarilyfor girls with parents born in Sweden or other high-income countries.In the third study, psychiatric care utilisation patterns are analysed in relationto the neighbourhood of residence. In part the aim was to investigate thevalidity of the neighbourhood when it comes to understanding variations inadolescents’ utilisation of psychiatric care, but the study also examineswhether neighbourhood socioeconomic deprivation is associated withindividual variations in the utilisation of psychiatric care. The results indicatethat the neighbourhood of residence has little influence on the utilisation ofpsychiatric care, only 1.6 % of the variance was found at the neighbourhoodlevel. No clear association between the neighbourhood level of socioeconomicdeprivation and levels of psychiatric care utilisation was found in the study.The final study investigates how adolescents’ perceptions of the socialcharacteristics of their neighbourhood are related to their self-reported mentalhealth, while controlling for the socioeconomic structure of theneighbourhood. The results show that adolescents’ perceptions of theirneighbourhood are associated with their self-reported mental health,particularly their perceptions of social disorder. However, these associationsdiffer between girls and boys, and between adolescents with Swedish- andforeign-born parents.In conclusion, the results presented in the thesis show that parental country ofbirth is an important factor when it comes to understanding differences inreferral patterns and in the utilisation of psychiatric care. However, the role ofthe neighbourhood of residence appears to be more complex.
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| 48. |
- Jakobsson, Jenny
(författare)
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The process of recovery after colorectal cancer surgery : patients' experiences and factors of influence
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to describe and compare how patients recovering from different forms of colorectal cancer surgery experience their postopera-tive recovery, general health, and anxiety, up to six months after surgery. In addition, the aim was to describe the influence of patient- and surgery-related factors on patient-reported recovery. Data was collected through questionnaires containing instruments measuring general health, trait and state anxiety, and recovery. Recruitment was made consecutively. In total, 176 patients chose to participate and received the questionnaires before surgery, on the day of discharge, and one and six months after surgery. In addition, information concerning patient character-istics and factors related to surgery were retrieved from the patients’ medical journals. Data was also collected through in-depth interviews one and six months after surgery with ten purposefully included patients. Postoperative recovery after colorectal cancer surgery was described as a pro-gressive process. Experiences of physical powerlessness, difficulties with food intake, altered bowel function, and dependence on others, were prominent and changed from being intense in the beginning of the process to gradually disappearing as time went by. On the day of discharge, no patient was considered fully recovered or almost fully recovered. Thereafter, it could be seen that patients after colonic resec-tion improved regarding the majority of symptoms connected to recovery al-ready during the first month after surgery, while patients after abdominoper-ineal resection deteriorated somewhat. Patients after rectal resection recovered better during the first month than those after an abdominoperineal resection but not as well as patients after colonic resection. Health was shown to be generally good preoperatively. One month after surgery, patients recovering from abdominoperineal resection and rectal resection had a temporary reduc-tion in health, while patients after a colonic resection had improved. Six months after surgery, health had improved to better than preoperative values without any differences between groups of patients. Regarding anxiety, both as a trait and as a state, this was shown to be low, without any differences between groups. Once at home from hospital, the patients experienced a continued difficulty with food intake, and the physical powerlessness made them initially de-pendent on relatives or friends in order to manage everyday life. The bowel function as well as the practical management of a possible stoma caused feel-ings of insecurity and concern. During the period from one month to six months after surgery, improvements were seen in symptoms connected to re-covery for all patients and especially after abdominoperineal resection. How-ever, it was also clear that patients after a rectal resection had not recovered to the same extent as those after an abdominoperineal or colonic resection. Some factors related to patient characteristics and surgery were shown to be associated with the odds for a good recovery one and six months after sur-gery. Those factors were age, grade of ASA, EQ VAS, EQ index, BMI, dura-tion of surgery, APR procedure, presence of stoma, LoS, and postoperative treatment. In addition, the dimensional levels of recovery could to a great ex-tent predict recovery in corresponding dimensions. The result of this thesis showed a diverse pattern of recovery. Nevertheless, there were also some similarities. This illustrates the complexity of postoper-ative recovery. In order to avoid unnecessary concerns, it is important for health care professionals to provide the patients with appropriate infor-mation and support throughout the whole recovery period and to design in-dividual follow-up strategies.
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| 49. |
- Jankovskaja, Skaidre
(författare)
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Non-invasive monitoring of low molecular weight biomarkers relevant to skin inflammation and cancer
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Development of skin inflammation and cancer in viable epidermis and dermis involve slow molecular weight (LMW) metabolites. We hypothesize that these LMW compounds can be collected on the surface of the skin and used for non-invasive diagnostics of skin disorders. Keeping in mind that substantial transdermal penetrationis achieved only for molecules of < 500 Da, we focused on topical monitoring of LMW biomarkers. In this thesis we investigated non-invasive, topical methods for monitoring LMW biomarkers by relevant in vitro and in vivo experiments. The LMW biomarkers were:- reactive oxygen species (ROS), specifically, hydrogen peroxide, H2O2- amino acids and their derivatives, i.e., tryptophan (Trp), kynurenine (Kyn; a Trpderivative), phenylalanine (Phe), and tyrosine (Tyr; a Phe derivative).Initially, we have carried out in vitro experiments using dermatomed porcine skin and cell cultures. We characterized permeability of the biomarkers through skin and assessed methods of their monitoring. By using Prussian white particles, deposited on porcine skin, we demonstrated that hydrophilic biomarkers, such as H2O2, permeate the skin mainly through hair follicle pathways (Paper I). In paper II, we have showed that the enzymes transforming Trp to the inflammation and cancer biomarker Kyn, are expressed in the basal layer of epidermis. The magnitude of changes of the Trp/Kyn ratio in the cell culture model was assessed. In paper III, we have characterized Trp and Kyn permeability through skin in vitro, concluding that their permeabilities through stratum corneum are comparable. By in vivo experiments outlined in Paper IV, we have demonstrated the feasibility of topical, non-invasive sampling of Trp and Kyn, in relation to other amino acids. Kyn detection was compromised by its low abundance on the skin. In paper V, we performed a proof-of-concept study in vivo and confirmed that non-invasive sampling of Trp and amino acids of similar abundance, such as Phe and Tyr, is more robust. We concluded that Phe/Trp ratio might be equally good biomarker of skin disorders as a predicted Trp/Kyn ratio. Summarizing, the results of this thesis provide basic knowledge for deeper clinical studies of non-invasive, topical sampling of hydrophilic LMW biomarkers of skin inflammation and cancer.
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| 50. |
- Kisch, Annika M
(författare)
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Allogeneic stem cell transplantation : patients’ and sibling donors’ perspectives
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Allogeneic haematopoietic stem cell transplantation (hereafter HSCT) is an established treatment which offers a potential cure for a variety of diseases, mainly haematological malignancies. However, the treatment is also associated with significant risks of acute complications and late side effects, including mortality. The donor is either a relative, most often a sibling, or an unrelated registry donor. Methods for donating stem cells are bone marrow harvesting or peripheral blood stem cell collection. The most common and transient side effects from stem cell donation are fatigue, headache, bone and muscle pain. Major side effects are rare but there is a small risk of fatalities and serious adverse events. To facilitate the provision of adequate information and care of patients undergoing HSCT and their sibling donors there is a need to explore and study their situations and experiences. This thesis aims to investigate patients’ and sibling donors’ perspectives of HSCT.The first study investigated changes in the patients’ quality of life (QoL) from before HSCT to 100 days and 12 months after the transplantation, and identified factors associated with the changes. The study was completed by 40 patients who answered the questionnaires (FACT-BMT and FACIT-Sp) on all three occasions. The majority of the dimensions covered in QoL deteriorated from before and up to 100 days and 12 months after HSCT, except for the emotional well-being which improved. The factors associated with reduced QoL over time were significant infections, female gender and transplantation with stem cells from a sibling donor. Factors associated with improved emotional well-being over time were absence of significant infections and marital status ‘other than married/cohabiting’.In the second study an information and care model (IC model) for potential sibling stem cell donors was evaluated. A questionnaire survey was answered by 148 siblings who had been informed about and asked to undergo HLA typing by the IC model. The majority of the potential sibling donors were satisfied with the information and care they had received. However, areas for improvement were highlighted, such as a wish to have the results from the HLA typing conveyed through personal contact and that the complicating influence of health professionals and relatives on their decision to undergo HLA typing and possible donation could be prevented.In the third study ten HSCT patients were interviewed immediately before transplantation regarding their experiences of having a sibling as donor. The results, with the main theme Being in no man’s land, show that the patients are in a complex situation before transplantation, experiencing a mixture of emotions and thoughts. In the fourth study ten sibling donors, where the recipients were the participants in Study III, were interviewed regarding their experiences before donation of being a stem cell donor for a sick sibling. The main theme, Being a cog in a big wheel, in the results shows that the sibling donors go through a complex process before donation, a situation they have not volunteered for but have got into accidently, experiencing a mixture of emotions and thoughts. The results also show that the sibling donors do not usually reveal their thoughts and emotions about being a donor to anyone. The patients’ and sibling donors’ experiences can be seen to be connected to each other, however, they have not usually talked to each other about their emotions and thoughts. To conclude, HSCT patients’ overall QoL and the majority of the dimensions of QoL deteriorated from before until 100 days and 12 months after HSCT, while their emotional well-being improved. The privacy and free choice of potential sibling donors have to be respected and the information and care of patients and their sibling donors should be kept separate. Health professionals should bear in mind that both patients with a sibling as donor and sibling donors are in complex situations before transplantation and donation, experiencing a mixture of emotions and thoughts. Further, it is important to individualize the information and care for HSCT patients and their sibling donors in a supportive and professional manner.
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