| 1. |
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| 2. |
- Andersson, Maria L.E., et al.
(författare)
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Autoantibodies to Disease-Related Proteins in Joints as Novel Biomarkers for the Diagnosis of Rheumatoid Arthritis
- 2023
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Ingår i: Arthritis & Rheumatology. - : Wiley. - 2326-5191 .- 2326-5205. ; 75:7, s. 1110-1119
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Tidskriftsartikel (refereegranskat)abstract
- Objective. This study was undertaken to develop and characterize a multiplex immunoassay for detection of autoantibodies against peptides derived from proteins known to play a role in development of arthritis and that are also expressed in joints.Methods. We selected peptides from the human counterpart of proteins expressed in the joints, based on mouse models that showed these to be targeted by pathogenic or regulatory antibodies in vivo. Using bead-based flow immunoassays measuring IgG antibodies, we selected triple helical or cyclic peptides, containing the epitopes, to avoid collinear reactivity. We characterized the analytical performance of the immunoassay and then validated it in 3 independent rheumatoid arthritis (RA) cohorts (n = 2,110), Swedish age- and sex-matched healthy controls, and patients with osteoarthritis (OA), patients with psoriatic arthritis (PsA), and patients with systemic lupus erythematosus (SLE).Results. Screening assays showed 5 peptide antigens that discriminated RA patients from healthy controls with 99% specificity (95% confidence interval [CI] 98-100%). In our validation studies, we reproduced the discriminatory capacity of the autoantibodies in 2 other RA cohorts, showing that the autoantibodies had high discriminatory capacity for RA versus OA, PsA, and SLE. The novel biomarkers identified 22.5% (95% CI 19-26%) of early RA patients seronegative for anti-cyclic citrullinated peptide and rheumatoid factor. The usefulness of the biomarkers in identifying seronegative RA patients was confirmed in validation studies using 2 independent cohorts of RA patients and cohorts of patients with OA, PsA, and SLE.Conclusion. A multiplex immunoassay with peptides from disease-related proteins in joints was found to be useful for detection of specific autoantibodies in RA serum. Of note, this immunoassay had high discriminatory capacity for early seronegative RA.
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| 3. |
- Avby, Gunilla, 1965-, et al.
(författare)
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Samarbete bygger en stark primärvård
- 2017
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Ingår i: Dagens Nyheter 2017-08-17. - Stockholm : Dagens Nyheter. - 1101-2447.
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Tidskriftsartikel (populärvet., debatt m.m.)
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| 4. |
- Haghighi, Mona, et al.
(författare)
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A Comparison of Rule-based Analysis with Regression Methods in Understanding the Risk Factors for Study Withdrawal in a Pediatric Study
- 2016
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Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 6
-
Tidskriftsartikel (refereegranskat)abstract
- Regression models are extensively used in many epidemiological studies to understand the linkage between specific outcomes of interest and their risk factors. However, regression models in general examine the average effects of the risk factors and ignore subgroups with different risk profiles. As a result, interventions are often geared towards the average member of the population, without consideration of the special health needs of different subgroups within the population. This paper demonstrates the value of using rule-based analysis methods that can identify subgroups with heterogeneous risk profiles in a population without imposing assumptions on the subgroups or method. The rules define the risk pattern of subsets of individuals by not only considering the interactions between the risk factors but also their ranges. We compared the rule-based analysis results with the results from a logistic regression model in The Environmental Determinants of Diabetes in the Young (TEDDY) study. Both methods detected a similar suite of risk factors, but the rule-based analysis was superior at detecting multiple interactions between the risk factors that characterize the subgroups. A further investigation of the particular characteristics of each subgroup may detect the special health needs of the subgroup and lead to tailored interventions.
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| 5. |
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| 6. |
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| 7. |
- Höög, Elisabet, et al.
(författare)
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Developing an organizational change facilitating agency’s approach to system-wide development in health and social care
- 2013
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Konferensbidrag (refereegranskat)abstract
- PurposeThe important role of change agents as facilitators of organizational development processes is well recognized. Change interventions can address several levels: individuals, group/units or organizational systems. To facilitate system wide changes in complex health and social service organizations multiple facilitation approaches are needed. The purpose of this study was to examine an organizational change facilitating agency (OCFA) acquiring a new system wide facilitation approach.Design/MethodologyThe case study focuses on a regional support unit in Swedish health and social care, centered on care of the elderly and functionally impaired. Interviews, surveys, process diaries and observations of meetings provided data for qualitative content analyses.ResultsRespondents described a rocky journey and a learning loop providing insights on how to support development and learning for actors on multiple organizational levels. The OCFA learning process included meta levels of reflection and parallel work with organizational pilot cases. Respondents reported enhanced analytical and problem solving skills and the previously vague OCFA role was clarified and expanded. During the studied period the OCFA group clarified and enlarged their mission and organizational role in communication with stakeholders.LimitationsTo fully understand the potential of OCFA and system wide facilitation approaches further investigations are needed.Research/Practical ImplicationsOrganizational development requires adequate change process support. How to attain such support is less known. The provided description of a support function acquiring a system-wide facilitation approach can aid future development of the OCFA function.Originality/ValueThis study contributes to the knowledge on how to develop the approaches used by an OCFA to facilitate system-wide organizational development.
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| 8. |
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| 9. |
- Kjellström, Sofia, 1970-, et al.
(författare)
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Leadership as a driver for work motivation : a study of well-functioning primary healthcare centers in Sweden
- 2017
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Konferensbidrag (refereegranskat)abstract
- Introduction: Little is known about how, why, or under which circumstances work motivation is formed and linked to reforms and interventions.Aim: The aim of this study is to explore work motivation among professionals at well-functioning primary healthcare centers subject to a national healthcare reform which include financial incentives.Material & method: Five primary healthcare centers in Sweden were purposively selected for being well-operated and representing public/private and small/large units. Forty-three interviews were completed with different medical professions and qualitative deductive content analysis was conducted.Results: Work motivation exists for professionals when their individual goals are aligned with the organizational goals and the design of the reform. The centers’ positive management was due to a unique combination of factors, such as clear direction of goals, a culture of nonhierarchical collaboration, and systematic quality improvement work. Social processes where professionals work together as cohesive groups, and provided space for quality improvement work is pivotal in addressing how alignment is created. The units expressed a collective capacity to produce direction, alignment and commitment.Conclusions: The design of the reforms and leadership are essential preconditions for work motivation. Leaders need to consistently translate and integrate reforms with the professionals’ drives and values. This is done by encouraging participation through teamwork, time for structured reflection and quality improvement work. The values of the study consist of showing how a range of aspects combine for primary healthcare professionals to successfully manage external reforms, and how professionals collectively produce leadership.
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| 10. |
- Kjellström, Sofia, 1970-, et al.
(författare)
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Work motivation among healthcare professionals: A study of well-functioning primary healthcare centers in Sweden.
- 2017
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Ingår i: Journal of Health Organization and Management [1477-7266]. - : Emerald Group Publishing Limited. - 1477-7266 .- 1758-7247. ; 31:4, s. 487-502
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Purpose – The purpose of this paper is to explore work motivation among professionals at well-functioningprimary healthcare centers subject to a national healthcare reform which include financial incentives. Design/methodology/approach – Five primary healthcare centers in Sweden were purposively selectedfor being well-operated and representing public/private and small/large units. In total, 43 interviews werecompleted with different medical professions and qualitative deductive content analysis was conducted. Findings – Work motivation exists for professionals when their individual goals are aligned with the organizational goals and the design of the reform. The centers’ positive management was due to a unique combination of factors, such as clear direction of goals, a culture of non-hierarchical collaboration, and systematicquality improvement work. The financial incentives need to be translated in terms of quality patient care to provide clear direction for the professionals. Social processes where professionals work together as cohesive groups, and provided space for quality improvement work is pivotal in addressing how alignment is created. Practical implications – Leaders need to consistently translate and integrate reforms with the professionals’ drives and values. This is done by encouraging participation through teamwork, time for structured reflection, and quality improvement work. Social implications – The design of the reforms and leadership are essential preconditions for work motivation. Originality/value – The study offers a more complete picture of how reforms are managed at primary healthcare centers, as different medical professionals are included. The value also consists of showing how a range of aspects combine for primary healthcare professionals to successfully manage external reforms.
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| 11. |
- Nyström, Monica E., et al.
(författare)
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Exploring the potential of a multi-level approach to improve capability for continuous organizational improvement and learning in a Swedish healthcare region
- 2018
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Ingår i: BMC Health Serv Res. - : Springer Science and Business Media LLC. - 1472-6963. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- Background: Eldercare and care of people with functional impairments is organized by the municipalities in Sweden. Improving care in these areas is complex, with multiple stakeholders and organizations. Appropriate strategies to develop capability for continuing organizational improvement and learning (COIL) are needed. The purpose of our study was to develop and pilot-test a flexible, multilevel approach for COIL capability building and to identify what it takes to achieve changes in key actors' approaches to COIL. The approach, named "Sustainable Improvement and Development through Strategic and Systematic Approaches" (SIDSSA), was applied through an action-research and action-learning intervention. Methods: The SIDSSA approach was tested in a regional research and development (R&D) unit, and in two municipalities handling care of the elderly and people with functional impairments. Our approach included a multilevel strategy, development loops of five flexible phases, and an action-learning loop. The approach was designed to support systems understanding, strategic focus, methodological practices, and change process knowledge-all of which required double-loop learning. Multiple qualitative methods, i.e., repeated interviews, process diaries, and documents, provided data for conventional content analyses. Results: The new approach was successfully tested on all cases and adopted and sustained by the R&D unit. Participants reported new insights and skills. The development loop facilitated a sense of coherence and control during uncertainty, improved planning and problem analysis, enhanced mapping of context and conditions, and supported problem-solving at both the individual and unit levels. The systems-level view and structured approach helped participants to explain, motivate, and implement change initiatives, especially after working more systematically with mapping, analyses, and goal setting. Conclusions: An easily understood and generalizable model internalized by key organizational actors is an important step before more complex development models can be implemented. SIDSSA facilitated individual and group learning through action-learning and supported systems-level views and structured approaches across multiple organizational levels. Active involvement of diverse organizational functions and levels in the learning process was facilitated. However, the time frame was too short to fully test all aspects of the approach, specifically in reaching beyond the involved managers to front-line staff and patients.
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| 12. |
- Nyström, Monica, et al.
(författare)
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Framtidens välfärdstjänster: Nya arbetssätt för innovativ serviceutveckling inom vård och omsorg : Future wellfare services : New approaches to innovative service development in health and social care (Engelska)
- 2014
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- En växande andel äldre i befolkningen i kombination med en minskande andel arbetskraft ställer allt tuffare krav på utveckling av vård och omsorg. För att klara dessa utmaningar och utveckla framtidens välfärdtjänster krävs nya innovativa arbetssätt. Vi arbetar nu med ett projekt som handlar om verksamhets- och serviceutveckling inom området äldre och vuxna med funktionsnedsättning. Projektet drivs i samarbete med ett tvärvetenskapligt forskarteam från Karolinska institutet, Göteborgs universitet och Luleå tekniska universitet och pågår från november 2009 till och med december 2012. Syftet med projektet är att i regionen Sörmland utveckla och testa arbetssätt som kan stödja innovativ verksamhets- och serviceutveckling inom området äldre och vuxna med funktionsnedsättning. Projektet involverar flera organisatoriska nivåer och huvudmän, inklusive landsting och kommuner. Den teoretiska basen bygger på lärdomar från kvalitets-utveckling, organisatoriskt lärande, innovationsforskning och organisatorisk kreativitet. Upplägget ger förutsättningar för lärande och snabb återkoppling över organisatoriska gränser. Resultaten kan bidra till kunskap om hur olika förutsättningar påverkar lärande, kreativitet och innovationsutveckling inom vård och omsorg, vilket i sin tur underlättar beslut kring strategiska satsningar och ökad kvalitet i vården. Projektet förväntas ge ny kunskap kring organisationers lärandeprocess som kan användas även för andra utvecklingssatsningar.
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| 13. |
- Nyström, Monica, et al.
(författare)
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Locally based research and development units as knowledge brokers and change facilitators in health and social care of older people in Sweden
- 2015
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Ingår i: Evidence & Policy. - : Policy Press. - 1744-2648 .- 1744-2656. ; 11:1, s. 57-80
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Tidskriftsartikel (refereegranskat)abstract
- This article investigates the role of locally based research and development units (R&Ds) focusing on health and social services. Nearly 300 Local R&Ds are funded by the Swedish government with the intention to facilitate knowledge transfer and development of high quality and effective health and social care organisations. Based on analyses of archival data on aims, activities and outputs of R&Ds focusing on care for older people the authors argue that Local R&Ds have potentials to act as knowledge brokers, change agents and researchers, but these overlapping roles need clarified strategies and enactment of a variety of skills.
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| 14. |
- Schoville, Sean D., et al.
(författare)
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A model species for agricultural pest genomics : The genome of the Colorado potato beetle, Leptinotarsa decemlineata (Coleoptera: Chrysomelidae)
- 2018
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Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 8
-
Tidskriftsartikel (refereegranskat)abstract
- The Colorado potato beetle is one of the most challenging agricultural pests to manage. It has shown a spectacular ability to adapt to a variety of solanaceaeous plants and variable climates during its global invasion, and, notably, to rapidly evolve insecticide resistance. To examine evidence of rapid evolutionary change, and to understand the genetic basis of herbivory and insecticide resistance, we tested for structural and functional genomic changes relative to other arthropod species using genome sequencing, transcriptomics, and community annotation. Two factors that might facilitate rapid evolutionary change include transposable elements, which comprise at least 17% of the genome and are rapidly evolving compared to other Coleoptera, and high levels of nucleotide diversity in rapidly growing pest populations. Adaptations to plant feeding are evident in gene expansions and differential expression of digestive enzymes in gut tissues, as well as expansions of gustatory receptors for bitter tasting. Surprisingly, the suite of genes involved in insecticide resistance is similar to other beetles. Finally, duplications in the RNAi pathway might explain why Leptinotarsa decemlineata has high sensitivity to dsRNA. The L. decemlineata genome provides opportunities to investigate a broad range of phenotypes and to develop sustainable methods to control this widely successful pest.
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| 15. |
- Yu, Daniel, et al.
(författare)
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Development of a logic regression-based approach for the discovery of host- and niche-informative biomarkers in Escherichia coli and their application for microbial source tracking
- 2024
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Ingår i: Applied and Environmental Microbiology. - : American Society for Microbiology. - 0099-2240 .- 1098-5336.
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Tidskriftsartikel (refereegranskat)abstract
- Microbial source tracking leverages a wide range of approaches designed to trace the origins of fecal contamination in aquatic environments. Although source tracking methods are typically employed within the laboratory setting, computational techniques can be leveraged to advance microbial source tracking methodology. Herein, we present a logic regression-based supervised learning approach for the discovery of source-informative genetic markers within intergenic regions across the Escherichia coli genome that can be used for source tracking. With just single intergenic loci, logic regression was able to identify highly source-specific (i.e., exceeding 97.00%) biomarkers for a wide range of host and niche sources, with sensitivities reaching as high as 30.00%–50.00% for certain source categories, including pig, sheep, mouse, and wastewater, depending on the specific intergenic locus analyzed. Restricting the source range to reflect the most prominent zoonotic sources of E. coli transmission (i.e., bovine, chicken, human, and pig) allowed for the generation of informative biomarkers for all host categories, with specificities of at least 90.00% and sensitivities between 12.50% and 70.00%, using the sequence data from key intergenic regions, including emrKY–evgAS, ibsB–(mdtABCD-baeSR), ompC–rcsDB, and yedS–yedR, that appear to be involved in antibiotic resistance. Remarkably, we were able to use this approach to classify 48 out of 113 river water E. coli isolates collected in Northwestern Sweden as either beaver, human, or reindeer in origin with a high degree of consensus—thus highlighting the potential of logic regression modeling as a novel approach for augmenting current source tracking efforts.
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| 16. |
- Abrahamssom, Peter, et al.
(författare)
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Onlay bone grafting of the mandible after periosteal expansion with an osmotic tissue expander : an experimental study in rabbits
- 2010
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Ingår i: Clinical Oral Implants Research. - : Wiley. - 0905-7161 .- 1600-0501. ; 21:12, s. 1404-1410
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Objectives: To evaluate the space-maintaining capacity of a titanium mesh or a bioresorbable mesh after periosteal expansion and to assess bone formation under a titanium mesh or a bioresorbable mesh on the lateral border of the mandible by qualitative and quantitative histological analysis. Material and methods: In 13 rabbits, a self-inflatable soft tissue expander was placed intraorally, bilaterally under the mandibular periosteum via an extra oral approach. After 2 weeks, the expanders were removed and a particulated onlay bone graft was placed and covered by a titanium mesh or a bioresorbable mesh. After 3 months, the animals were sacrificed and specimens were collected for histology. Results: The osmotic soft tissue expander created a subperiosteal pocket and a ridge of new bone had formed at the edges of the expanded periosteum in all sites. After the healing period of 3 months, soft tissue dehiscence was recorded in two of the sites with bioresorbable meshes. The mean bone fill was 65% under the titanium mesh and 85% under the bioresorbable mesh (P<0.05). There was no significant difference between the titanium mesh and the bioresorbable mesh regarding the height of the meshes, mesh area and mineralized bone area. Scanning electron microscopy shows that new bone is growing in direct contact with the resorbable mesh and the titanium mesh. Conclusion: This study confirms that an osmotic soft tissue expander creates a surplus of periosteum and soft tissue and that new bone can be generated under a titanium mesh or bioresorbable mesh.
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| 17. |
- Abrahamsson, Peter, et al.
(författare)
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Periosteal expansion of rabbit mandible with an osmotic self-inflatable expander
- 2009
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Ingår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery. - : Informa Healthcare. - 0284-4311 .- 1651-2073. ; 43:3, s. 121-125
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Tidskriftsartikel (refereegranskat)abstract
- We aimed to evaluate a new technique for intraoral expansion of soft tissue with a self-inflatable expander in rabbits. We placed a self-inflatable soft tissue expander bilaterally in eight rabbits under the periosteum of the mandible through an extraoral approach. The expander was left to self-inflate for two weeks, after which the animals were killed and specimens collected for histological examination. The self-inflatable soft tissue expanders expanded the periosteum. There were no dehiscences or infections. Histological observations showed no signs of any inflammatory reaction and there was no evidence of bony resorption. New bone had formed at the edges of the expanded periosteum. In the control area no new bone had formed. The osmotic soft tissue expander model for intraoral soft tissue and periosteal expansion suggests a promising way of creating a surplus of soft tissue that can be used to cover bone grafts.
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| 18. |
- Ademuyiwa, Adesoji O., et al.
(författare)
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Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries
- 2016
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Ingår i: BMJ Global Health. - : BMJ Publishing Group Ltd. - 2059-7908. ; 1:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally.Methods: Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression.Results: This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed.Conclusions: Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas.
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| 19. |
- Agelii, Monica Leu, et al.
(författare)
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Misdiagnosis of Rheumatoid Arthritis in a Long-Term Cohort of Early Arthritis Based on the ACR-1987 Classification Criteria
- 2022
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Ingår i: Open Access Rheumatology: Research and Reviews. - 1179-156X. ; 14, s. 187-194
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Correct diagnosis of early rheumatoid arthritis (RA) is essential for optimal treatment choices. No pathognomonic test is available, and diagnosis is based on classification criteria, which can result in misdiagnosis. Here, we examined the differences between actual and misdiagnosed RA cases in a long-term cohort of patients included based on the ACR-1987 classification criteria. Methods: Patients in the BARFOT (Better Anti-Rheumatic PharmacOTherapy) cohort (n=2543) with at least four follow-up visits during the initial 5 years from enrolment were assessed, and a change in diagnosis was reported by the treating rheumatologist. The groups were analysed with respect to the individual classification criteria, antibodies to citrullinated proteins (ACPA), disease activity (DAS28) and radiographic changes from inclusion up to 2 years. Results: Forty-five patients (1.8%) were misdiagnosed (RA-change group). When compared to those in the RA-change group, the patients who kept their diagnosis (RA-keep) were more often RF positive (64% vs 21%, p<0.001) or ACPA positive (59% vs 8%, p<0.001). They were also more likely to fulfil more than four ACR-1987 criteria (64% vs 33%, p<0.001) and to have radiographic changes at inclusion (RA-keep 27% vs RA-change 12%, p=0.04). The groups had a similar evolution of DAS28 and its components as well as of radiological joint destruction. Conclusion: Diagnosis of RA according to the ACR-1987 criteria had a high precision in this long-term cohort. A diagnosis of RA should be re-evaluated in patients who do not fulfil more than four ACR-1987 criteria especially in patients negative for RF.
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| 20. |
- Aguilar, Mónica García, et al.
(författare)
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Governance challenges and opportunities for implementing resource recovery from organic waste streams in urban areas of Latin America: insights from Chía, Colombia
- 2022
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Ingår i: Sustainable Production and Consumption. - : Elsevier. - 2352-5509. ; 30, s. 53-63
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Tidskriftsartikel (refereegranskat)abstract
- Across the globe, there is increasing interest in implementing circular approaches to urban sanitation and waste management to mitigate environmental challenges and promote sustainable business opportunities. In Latin America where 80% of the population live in urban areas, there is limited investigation into the enabling factors and governance barriers that are critical to implementing circular economy strategies in urban areas. This paper aims at assessing the governance capacity to implement resource recovery from organic waste streams in the municipality of Chía, Colombia, through applying the Governance Capacity Framework in a participatory process with local stakeholders. The findings highlight the importance of local initiatives for resource recovery that allow experimentation, raise awareness and foster collaboration, as well as mechanisms available for public participation in decision-making processes as enabling factors. Meanwhile, the inadequate monitoring and assessment of environmental strategies and policies, inadequate sharing of information among stakeholders and the relative low awareness of potential benefits of recovering resources from organic waste streams, especially among public sector actors, emerge as key barriers. Beyond Chía, the results provide insights on crucial factors for ensuring sufficient governance capacity in other urban areas in low- and middle-income countries which are considering circular approaches to urban sanitation and waste management. The findings also provide an empirical basis to advance the understanding of the governance conditions necessary for implementing resource recovery from organic waste streams, upon which further applications of the governance capacity framework along with participatory aspects in other similar urban contexts could build.
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| 21. |
- Ahlmén, Monica, 1937, et al.
(författare)
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Rheumatology outcomes: the patient's perspective. A multicenter focus group inteview study of Swedish rheumatoid arthritis patients.
- 2005
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Ingår i: Rheumatology. - : Oxford University Press (OUP). - 1460-2172 .- 1462-0324 .- 1462-0332. ; 44:1, s. 105-110
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. Patients with rheumatoid arthritis (RA) and clinicians have different views about benefits from treatments. More knowledge is needed about how patients assess outcomes in order to update current measurements. Methods. Focus group interviews were performed at four Swedish rheumatology clinics. A total of 25 patients with RA were included, representing a wide range of ages and disease duration. Predetermined topics relating to important outcomes from and satisfaction/dissatisfaction with RA treatments were discussed. Results. The participants’ initial outcome assessments included physical and psychosocial items, which comprised overall treatment goals such as impairment in social roles, fatigue, daily activities and self-confidence. The identified themes were ‘Normal life’, ‘Physical capacity’, ‘Independence’ and ‘Well-being’. Satisfaction with treatment was associated with the quality of communication between staff and the patient. The participants assumed this as a prerequisite for a treatment to work. Patients wanted to be accepted as experts on their own bodies, and expected all clinicians to be experts on RA. This made it possible for patients to ‘take charge’ of their life situation. Good resources for and access to rheumatology care were desired. Conclusions. Suggesting a holistic approach to rheumatology care, the study results indicate that the illness and outcomes have to be evaluated within an individual RA patient's total life situation, described in the identified themes: ‘Normal life’, ‘Physical capacity’, ‘Independence’ and ‘Well-being’. Development and validation of measurements covering these issues is suggested. More research is needed about communication and how patients experience their roles in the rheumatology clinic.
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| 22. |
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| 23. |
- Andersson, Anna-Karin, et al.
(författare)
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Triage in the emergency department : A qualitative study of the factors which nurses consider when making decisions
- 2006
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Ingår i: Nursing in Critical Care. - 1362-1017 .- 1478-5153. ; 11:3, s. 136-145
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Tidskriftsartikel (refereegranskat)abstract
- Triage, as a concept, is relatively new in Sweden and means 'sorting'. The triage process was developed to grade patients who needed immediate care. Triage is currently important for the emergency treatment system, and nurses are expected to work with it professionally. The aim of this study is to describe how nurses implement triage when patients arrive at the emergency department of a county hospital, situated in a rural area of Sweden, as well as to highlight the factors considered when prioritizing, in connection with nurses' decision-making. The method used was observations of 19 nurses, with minimal disturbance in their triage work, followed by a short tape-recorded interview, during which the nurses were asked to reflect upon their decision of priorities. Qualitative content analysis of data has been used. The results were divided into two areas, internal factors and external factors. The internal factors reflect the nurse skills and personal capacity. The external factors reflect work environment, including high workload and practical arrangements, and should always be perceived and taken into consideration. Using these factors as a basis, the patients' clinical condition, clinical history, various examinations and tests form an assessment, which subsequently results in a prioritization.
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| 24. |
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| 25. |
- Andersson Bäck, Monica, 1969
(författare)
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Callcenter + omvårdnad = sjukvårdsrådgivning – det bästa av två världar?
- 2008
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Ingår i: Telefonrådgivning inom Hälso- och sjukvård/red Inger Holmström. - Lund : Studentlitteratur. - 9789144047768 ; , s. 163-186
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Telefonrådgivning inom hälso- och sjukvård ger en bred översikt över olika aspekter av telefonrådgivnings-verksamhet i Sverige. Innehållet fokuserar på samtal som arbetsverktyg snarare än på medicinska bedömningar och symtom. Några av kapitlen tar upp organisatoriska aspekter medan andra utgår från sjuksköterskans respektive uppringarens perspektiv. Med hjälp av illustrativa exempel visar författarna på såväl samtalets olika faser som etiska dilemman vid specifika samtal i t.ex. en akut situation. Boken vänder sig främst till dem som arbetar med eller vill börja arbeta med hälso- och sjukvårdsrådgivning per telefon samt till studerande i olika vårdutbildningar. Den lämpar sig även för andra yrkesgrupper som arbetar med rådgivning per telefon, t.ex. apotekspersonal, sjukgymnaster, barnmorskor, allmänläkare och kuratorer.
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| 26. |
- Andersson Bäck, Monica, 1969
(författare)
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Conceptions, conflicts and contradictions in the introduction of a Swedish Health Call Centre
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Call centres have been called the industrialisation of the service sector, characterised by mon¬o¬¬tonous, highly controlled work and standardised procedures performed in an old-fashion¬ed, Tayloristic spirit. Stress and work intensification are known implications of such work. Healthcare on the other hand, is based on bureaucracy, but has professional staff. Nurses describe their occupation in terms of caring, cherishing, educating the sick, being de¬dicat¬ed and genuinely concerned for the patient, while assessing and treating individual reactions to health problems. But what happens in a health call centre (HCC)? The call centre is aimed at mass-production, the monitoring of work, performance targets and control. The overall aim of the thesis regards how can this be combined with the nursing profession and the consciousness of taking care of people in vulnerable states of pain and anxiety? The thesis draws on a study of an HCC in western Sweden, covering the period from 2002 to 2006, based on more than 80 semi-structured interviews with key actors, 400 struc¬tur¬ed interviews with care-seekers, repeated observations, written documents and other sources. The results shows how HCC work and work organisation are concieved based on social relations, which are shaped and influenced by institutions and social actors. In a Swedish context, the organisation of HCCs have been introduced on a broad scale since the late 1990s, and it catches the characteristics of the Swedish healthcare system in the horns of a dilemma, i.e. the ambition to simultanously address (1) equality (2) high quality (3) effic¬¬iency and cost control and (4) freedom of choice. Designed to solve healthcare problems HCCs imply new ways to organis¬e work within healthcare, based on new techno¬logy, a kind of Swedish New Public Management practices and rethoric, control mechanisms and new work relations. Yet the HCC strongly emphasises the continuity of Swedish health¬care connected to overall institutional features in political, economic, regulatory and cultural terms. Accordlingly, the case-study also shows a process of tensions, conflicts and resistance. Visualised as operating in a battlefield, the actors expressed strong and divergent concep¬tions towards the HCC. The tensions consider focus on primary care versus resources to secon¬dary care, meeting demands for access and immediate care versus steering healthcare, adapting versus changing demands, the responsible care-seeker versus the exigent healthcare consumer, rationalising human service versus more calls on the phone, control versus coordi¬na¬tion. For the telenurses the contradictions are also to full¬fill both quantity and quality imperatives and to work in line with ethics and socialised convictions, while wanting care-seekers as well as physicians to be satisfied. The HCC confirms both a positive and negative picture of call centres embracing contradictions such as control versus autonomy, participation versus exclusion, professional responsibility versus professional vulnerability, upskilling versus deskilling, younger versus older nursing generations, work intensification versus less physical work, isolation versus freedom and different aspects of emotional labour. The concept of HCC might be interpreted as a movement in the direction of a more liberal, Anglo-Saxion model of economy, but with distinct tendency toward divergency characterised by Swedish industrial relations and work organisation for the healthcare sector and related to the continuous professionalisation project within nursing.
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| 27. |
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| 28. |
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| 29. |
- Andersson Bäck, Monica, 1969, et al.
(författare)
-
Do middle managers have room for manoeuvre in Swedish human service organisations?
- 2015
-
Ingår i: 33rd Annual International Labour Process Conference, Athens, Greece 13-15 April 2015.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Middle managers in Swedish human service organisations are responsible for implementing the many goals and visions of government as formulated in policy. Since the 1980’s there is a growing expectation that these goals should be materialized through HRM strategies. In the wake of New Public Management (NPM), HRM has become significant in human service organisations as expressed in proliferation in the numbers and specializations of managers, a development of management rhetoric and particularly investments in managerialism and managers as a way of achieving change. This paper reports on the contradictory positions that arise for middle managers, in human service organizations where HRM is integral part of managerial repertory. The aim is to examine how the role of middle manager is impacted as a result of this increasing organizational complexity and governance. As part of the middle-layer, middle managers must balance the various aspects of their work from a weak power base, and act as a buffer between their staff and their seniors. As a result, inconsistencies between the expectations of the organization and the individual employees they manage create tension, conflict and feelings of powerlessness that may result in increased inefficiency - the opposite of the organizational intention. This research is based on interviews and observations of 30 Swedish middle managers from human service organisations over a period of two years. We use qualitative text analyses to analyse our data. We expect to find that middle managers use different types of strategies to give meaning to the work they do and create room for manoeuvre in everyday practice.
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| 30. |
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| 31. |
- Andersson Bäck, Monica, 1969, et al.
(författare)
-
Identity work of successful primary care managers and competing institutional logics
- 2017
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Ingår i: EGOS 2017, Copenhagen.
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- AbsThis paper rests on bourgeoning research that has awakened a strong interest among organizational scholars, considering self-reflexive identity work linked to the processes of revealing, effectuating, and reflecting change of institutional logic. We combine two strands of theories, the one related to institutional logics perspective with theory of identity work. Based on a qualitative case study and against the background of change in Swedish primary healthcare, we aimed to explore institutionalization processes related to micro-social interactions of five primary care managers, who were handling a multiplicity of institutional logics – competing, co-existing and complementing – while working their identity in relation to significant actors. The findings showed mechanisms of change, and as a result new constellations of logics. The constellations varied however from primary care center to center, and from manager to manager, visualizing individual variation in influencing institutional logics as well as being influenced. The findings demonstrated managers’ identity work as a process in which the managers strive to work managerial ideas, self-perceptions, and experiences, as well as expectations and views held by significant others.
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| 32. |
- Andersson Bäck, Monica, 1969, et al.
(författare)
-
Lofty ideals and lowly troubles among nursing home managers
- 2018
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Ingår i: The Management of Wicked Problems in Health and Social Care. - New York, NY : Routledge, 2019. | Series: Routledge studies in health management : Routledge. - 9781138103627 - 9781351592536 ; , s. 62-74
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Bokkapitel (refereegranskat)
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| 33. |
- Andersson Bäck, Monica, et al.
(författare)
-
Medical manager hybrids for handling institutional complexity and change in primary care
- 2017
-
Konferensbidrag (refereegranskat)abstract
- Introduction: This article deals with hybrid persons combining medical professionalism and management for handling institutional complexity and change in primary care. Primary care and identity are in transition in many western countries, in Sweden emphasized by the 2007 reform for patient choice and competition. Research has shown that embedded hybrid actors, familiar and socialized in a field and to its logics, tend to be influential for handling complexity and change. Yet hydrids and their enactment in primary care is an underexplored area.Aim: The aim is to contribute to our understanding of hybrid persons and how they are combining medical professionalism and management in primary care, while managing complexity and change.Material and methods: In a case study of six successful primary healthcare centers, public and private, covering 56 interviews and observations with various professions, two medical managers ‘hybrids’ showed to be particularly interesting. These were analyzed in-depth, including analysis of staff’s and colleagues’ experiences and contrasted by other managers and hybrids. For the analysis we draw on institutional logic perspective (Thornton, Occasion & Lounsbury 2012) in order to capture preconditions as well as enactment of such change agents.Results/conclusions: The hydrids contributed to innovation, creativity and learning in their primary care centres. At their workplace, coherence and a good ambience coexisted with feelings of high work pace and lacking role clarity among the multidisciplinary staff. Categorized in line with McGivern and colleagues(2015) term as ‘willing hybrids’, the persons studied revealed high ambitions to challenge existing institutional order giving professionalism new forms, while seeking to innovate practices and division of work among healthcare staff in primary care. By doing so the hybrids integrated professionalism and managerialism and were influential in reframing problems and solutions, which aligned several logics at play. However several obstacles related to professional as well as bureaucratic issues appeared along the way.
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| 34. |
- Andersson Bäck, Monica, 1969, et al.
(författare)
-
Mellan två stolar
- 2016
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Ingår i: Makt och inflytande i arbetslivet. - Stockholm : PremissFörlag. - 9789186743536 ; , s. 117-168
-
Bokkapitel (refereegranskat)abstract
- I det här kapitlet har vi fokuserat på hur mellanchefer vidtar olika typer av strategier för att hantera krav och förväntningar på dem och deras arbete. Vi har valt att tolka mellanchefarnas strategier i termer av makt respektive frånvaro av makt.
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| 35. |
- Andersson Bäck, Monica, 1969
(författare)
-
Motivation och finansiella incitament - En litteraturöversikt över de komplexa drivkrafterna inom vård och omsorg
- 2015
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Rapporten syftar till att ge en sammanfattande översikt över aktuella studier och teorier på området och hur dessa omsätts i praktiken i hälso- och sjukvården samt omsorgen, både i Sverige och internationellt. Sammantaget utmanas vårdens och omsorgens ledning och styrning enligt de vårdprofessionellas egna logiker och värderingar av nya och utifrån kommande drivkrafter och tekniker för ledning och styrning. Komplexiteten i verksamheterna förutsätter att man möter utvecklingen genom kunskapsområde för drivkrafter och incitament, vilket säkerställs genom en flervetenskaplig ansats.
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| 36. |
- Andersson Bäck, Monica, 1969
(författare)
-
Nurses’ Pay formation in Swedish Health Call Centres: the influence of union organization, economic and professional factors.
- 2009
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Ingår i: Gender, work and organization. - : Wiley. - 0968-6673 .- 1468-0432. ; 16:5, s. 579-599
-
Tidskriftsartikel (refereegranskat)abstract
- This article analyses the pay formation process for nurses in the new organizational form of health call centres (HCCs) in Sweden. It finds that HCC tele-nurses have gained a better labour market position than both the average call centre employees in other sectors and some other nurses. This specialization of the nursing occupation may thus have importance for gendered pay formation in public healthcare. In evaluating pay formation, the article draws on case studies carried out by the author. It analyses the shift from centralized bargaining towards more decentralized and individualized pay formation and the importance of union organization, economic and professional factors that have contributed to relatively higher pay for these workers. The article concludes with a discussion of the implications of this process for the gender pay gap in the state sector and limitations to future gains.
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| 37. |
- Andersson Bäck, Monica, 1969
(författare)
-
Risks and Opportunities of Reforms Putting Primary Care in the Driver’s Seat. Comment on “Governance, Government, and the Search for New Provider Models”
- 2016
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Ingår i: International Journal of Health Policy and Management. - : Maad Rayan Publishing Company. - 2322-5939. ; 5:8, s. 511-513
-
Tidskriftsartikel (refereegranskat)abstract
- Recognizing the advantages of primary care as a means of improving the entire health system, this text comments on reforms of publicly funded primary health centers, and the rapid development of private for-profit providers in Sweden. Many goals and expectations are connected to such reforms, which equally require critical analyses of scarce resources, professional trust/motivation and business logic in the wake of freedom and control of ownership and management. In line with Saltman and Duran, this article calls for research and a methodologically developed approach to capture everyday practice in-depth and how regulation, market incentives and patient demands are met by professionals and primary care leaders.
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| 38. |
- Andersson Bäck, Monica, 1969, et al.
(författare)
-
The Norrtaelje model: a unique model for integrated health and social care in Sweden
- 2015
-
Ingår i: International Journal of Integrated Care. - 1568-4156. ; 15:Special Issue: SI, s. 1-11
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Tidskriftsartikel (refereegranskat)abstract
- Many countries organise and fund health and social care separately. The Norrtaelje model is a Swedish initiative that transformed the funding and organisation of health and social care in order to better integrate care for older people with complex needs. In Norrtaelje model, this transformation made it possible to bringing the team together, to transfer responsibility to different providers, to use care coordinators, and to develop integrated pathways and plans around transitions in and out of hospital and from nursing homes to hospital. The Norrtaelje model operates in the context of the Swedish commitment to universal coverage and public programmes based on tax-funded resources that are pooled and redistributed to citizens on the basis of need. The experience of Norrtaelje model suggests that one way to promote integration of health and social care is to start with a transformation that aligns these two sectors in terms of high level organisation and funding. This transformation then enables the changes in operations and management that can be translated into changes in care delivery. This “top-down” approach must be in-line with national priorities and policies but ultimately is successful only if the culture, resource allocation and management are changed throughout the local system.
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| 39. |
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| 40. |
- Andersson Bäck, Monica, 1969
(författare)
-
Vad anser Transportarbetarförbundets medlemmar om individualiserade löneförhandlingar?
- 2011
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Ingår i: Tarifflöner och individuell lönesättning. - Stockholm : Nätverket för Jämställda löner. - 9789163389221
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Studien omfattar fyra avtalsområden inom transportsektorn; Tidningsdistribution, Bevakning och säkerhetsföretag, Landtransporter och Bensinstationer/bilvård. Sex kollektivavtal som reglerar löner och anställningsvillkor har analyserats. Studien innehåller intervjuer med arbetsgivar- och fackliga företrädare på lokal och central nivå. Materialet baseras dessutom på en enkät som besvarats av medlemmar i Transportarbetareförbundet, analys av lönedata samt genomgång av lönekartläggningar i en JämO granskning.
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| 41. |
- Andersson Bäck, Monica, 1969, et al.
(författare)
-
What are the effects of financial incentives for health, social care and their professionals?
- 2014
-
Ingår i: The 7th Nordic Working Life Conference, Göteborg, Sweden, Stream: Nordic management and organization – now and in the future. .June 11-13 2014..
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Financial incentives, such as managerial system for pay-for-performance, compensation system for reaching specific goals and bonuses, have become popular interventions to boost performance and quality in health and social care based on beliefs that they stimulate professionals to work hard and do the right things. Theories about professions, public service motivation, and economic incentives provide however different explanations for the behaviour and performance of health and care staff. Many debates concern professional duties in conflict with financial incentives and motivational scholars conclude a mismatch between what is done in practice and what research demonstrates effective. Based on a literature review, this paper seeks to discuss financial incentives and its intended as well as unintended effects. The multidisciplinary review embraces a forty studies and metastudies mainly from the US, the UK, Netherlands and Denmark combined with studies from the Nordic countries in general and Sweden in specific. The central focus is the state of art considering financial incentives and its relation to efficiency, quality, professionals’ behaviors, working conditions and environment.
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| 42. |
- Andersson Bäck, Monica, 1969
(författare)
-
Who Cares about the Carer? New Public Management in Sweden - the case of Health Call Centres
- 2011
-
Ingår i: Precarious Employment in Perspective. Old and New Challenges to Working Conditions in Sweden.. - Brussels : P.I.E. Peter Lang. - 9789052017303 ; , s. 165-194
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Monica Andersson Bäck analysed how call centre organisation and technology affect working life and are reflecting the fundamental conflicts of new ways of managing public sector organisations inspired by private business with commercial objectives, also mentionned as New Public Managment (NPM). Like call centres in general, the health call centre is built on the attempt to acheive fundamental as well as contradictory goals simultaneously: a routinisation and standardisation aimed at rationalisation and cost-efficiency, and a more accessible, comprehensive, user-friendly and reliable health care service day and night, all year around. It is worth noticing that the precariousness in the health care service ressembles precariousness in retailing, In both sectors the consumers are privileged. This previlige is based on the consumers being part of an employment system that requires a certain service level in society, a service level that should be offered by someone. This highlights the problems of how precariousness creates different employment systems for different groups of employees. At the same time, the health call centre reflects an opposite picture to the general call centre, requiring flexibility, problem-solving and tailored relations with the care-seeker. Theoretical or a higher-order contextual knowledge, as well as social and analytical skills, are needed in order to identify symptoms, solve problems and give advice. Health call centre means controlled work that is also borderless, requiring the telenurses to set the definitive frontiers of their duty, if possible?
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| 43. |
- Andersson, Carin, et al.
(författare)
-
Combining Overall equipment Efficiency (OEE) and productivity measures as drivers for production improvements
- 2011
-
Ingår i: ; , s. 20-29
-
Konferensbidrag (refereegranskat)abstract
- To compete on a globalized market companies need to constantly improve the performance in their manufacturing systems. Production performance measures can be used for different purposes, by practitioners they are commonly used for follow-up and reporting purposes. Two of the most commonly used performance measures are Overall Equipment Efficiency (OEE) and productivity. Between these two productivity exhibits the far most variety in definition. Even if OEE and productivity are strongly affected by improvement work, they are seldom used to drive the improvement efforts. The purpose of this paper is to present definitions of productivity suitable as improvement drivers, and to discuss the need for a combined set of performance measures to drive productivity improvements. Finally some experiences from industrial improvement work are viewed.
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| 44. |
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| 45. |
- Andersson, Carin, et al.
(författare)
-
Managing Production Performance with Overall Equipment Efficiency (OEE) - Implementation Issues and Common Pitfalls
- 2011
-
Ingår i: Proceedings of the 44th Conference on Manufacturing Systems (CIRP). - Wisconsin, US.
-
Konferensbidrag (refereegranskat)abstract
- In the current global competitive environment it is of immense importance for manufacturing companies tokeep track of, and improve the production performance of their production systems. One of the most widelyused performance measures is OEE, a powerful tool for production development if used correctly. Based ona theoretical analysis and a case study within a manufacturing company in the automotive industrychallenges associated with the implementation of OEE are identified and analyzed. Furthermore, the paperpresents conclusions of how to utilize the OEE measure for efficient management of improvement inproduction performance.
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| 46. |
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| 47. |
- Andersson, Carin, et al.
(författare)
-
On the complexity of using performance measures : Enhancing sustained production improvement capability by combining OEE and productivity
- 2015
-
Ingår i: Journal of manufacturing systems. - : Elsevier BV. - 0278-6125 .- 1878-6642. ; 35, s. 144-154
-
Tidskriftsartikel (refereegranskat)abstract
- The global speed of change within the manufacturing industry forces companies to constantly improve production performance. In that effort, performance measures are critical for driving and managing production improvements. Two of the most commonly used measures in operations are productivity and overall equipment efficiency (OEE). However, the potential of using these measures as improvement drivers is not fully utilized in industry today due, for example, to ambiguities in definitions and their interpretation. A study of available theory indicates a gap between these implications from a theoretical perspective vs. the industrial perspective. Bridging this theory-practice gap implies great potential for competitiveness and growth in manufacturing, since the latent production capacity that could be utilized is tremendous. Even if a high degree of complexity in definition and calculation when applied in operational conditions might be perceived, this paper will show that a systematically used combined set of OEE and productivity measures can successfully drive production improvements. Also, two new productivity measures for driving improvements at the shop floor level are proposed. The empirical findings are based on a two-year case study within a manufacturing company in the automotive industry using an interactive research approach.
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| 48. |
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| 49. |
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| 50. |
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