| 1. |
- KC, Ashish, 1982-, et al.
(författare)
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Effect of a scaled-up neonatal resuscitation quality improvement package on intrapartum-related mortality in Nepal : A stepped-wedge cluster randomized controlled trial
- 2019
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Ingår i: PLoS Medicine. - : PUBLIC LIBRARY SCIENCE. - 1549-1277 .- 1549-1676. ; 16:9
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Tidskriftsartikel (refereegranskat)abstract
- Background Improving quality of intrapartum care will reduce intrapartum stillbirth and neonatal mortality, especially in resource-poor settings. Basic neonatal resuscitation can reduce intrapartum stillbirth and early neonatal mortality, if delivered in a high-quality health system, but there is a dearth of evidence on how to scale up such evidence-based interventions. We evaluated the scaling up of a quality improvement (QI) package for neonatal resuscitation on intrapartum-related mortality (intrapartum stillbirth and first day mortality) at hospitals in Nepal. Methods and findings We conducted a stepped-wedge cluster randomized controlled trial in 12 hospitals over a period of 18 months from April 14, 2017, to October 17, 2018. The hospitals were assigned to one of four wedges through random allocation. The QI package was implemented in a stepped-wedge manner with a delay of three months for each step. The QI package included improving hospital leadership on intrapartum care, building health workers' competency on neonatal resuscitation, and continuous facilitated QI processes in clinical units. An independent data collection system was set up at each hospital to gather data on mortality through patient case note review and demographic characteristics of women using semi-structured exit interviews. The generalized linear mixed model (GLMM) and multivariate logistic regression were used for analyses. During this study period, a total of 89,014 women-infant pairs were enrolled. The mean age of the mother in the study period was 24.0 +/- 4.3 years, with 54.9% from disadvantaged ethnic groups and 4.0% of them illiterate. Of the total birth cohort, 54.4% were boys, 16.7% had gestational age less than 37 weeks, and 17.1% had birth weight less than 2,500 grams. The incidence of intrapartum-related mortality was 11.0 per 1,000 births during the control period and 8.0 per 1,000 births during the intervention period (adjusted odds ratio [aOR], 0.79; 95% CI, 0.69-0.92; p = 0.002; intra-cluster correlation coefficient [ICC], 0.0286). The incidence of early neonatal mortality was 12.7 per 1,000 live births during the control period and 10.1 per 1,000 live births during the intervention period (aOR, 0.89; 95% CI, 0.78-1.02; p = 0.09; ICC, 0.1538). The use of bag-and-mask ventilation for babies with low Apgar score (<7 at 1 minute) increased from 3.2% in the control period to 4.0% in the intervention period (aOR, 1.52; 95% CI, 1.32-1.77, p = 0.003). There were two major limitations to the study; although a large sample of women-infant pairs were enrolled in the study, the clustering reduced the power of the study. Secondly, the study was not sufficiently powered to detect reduction in early neonatal mortality with the number of clusters provided. Conclusion These results suggest scaled-up implementation of a QI package for neonatal resuscitation can reduce intrapartum-related mortality and improve clinical care. The QI intervention package is likely to be effective in similar settings. More implementation research is required to assess the sustainability of QI interventions and quality of care.
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| 2. |
- KC, Ashish, 1982, et al.
(författare)
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Effect of a scaled-up neonatal resuscitation quality improvement package on intrapartum-related mortality in Nepal: A stepped-wedge cluster randomized controlled trial.
- 2019
-
Ingår i: PLoS medicine. - : Public Library of Science (PLoS). - 1549-1676 .- 1549-1277. ; 16:9
-
Tidskriftsartikel (refereegranskat)abstract
- Improving quality of intrapartum care will reduce intrapartum stillbirth and neonatal mortality, especially in resource-poor settings. Basic neonatal resuscitation can reduce intrapartum stillbirth and early neonatal mortality, if delivered in a high-quality health system, but there is a dearth of evidence on how to scale up such evidence-based interventions. We evaluated the scaling up of a quality improvement (QI) package for neonatal resuscitation on intrapartum-related mortality (intrapartum stillbirth and first day mortality) at hospitals in Nepal.We conducted a stepped-wedge cluster randomized controlled trial in 12 hospitals over a period of 18 months from April 14, 2017, to October 17, 2018. The hospitals were assigned to one of four wedges through random allocation. The QI package was implemented in a stepped-wedge manner with a delay of three months for each step. The QI package included improving hospital leadership on intrapartum care, building health workers' competency on neonatal resuscitation, and continuous facilitated QI processes in clinical units. An independent data collection system was set up at each hospital to gather data on mortality through patient case note review and demographic characteristics of women using semi-structured exit interviews. The generalized linear mixed model (GLMM) and multivariate logistic regression were used for analyses. During this study period, a total of 89,014 women-infant pairs were enrolled. The mean age of the mother in the study period was 24.0 ± 4.3 years, with 54.9% from disadvantaged ethnic groups and 4.0% of them illiterate. Of the total birth cohort, 54.4% were boys, 16.7% had gestational age less than 37 weeks, and 17.1% had birth weight less than 2,500 grams. The incidence of intrapartum-related mortality was 11.0 per 1,000 births during the control period and 8.0 per 1,000 births during the intervention period (adjusted odds ratio [aOR], 0.79; 95% CI, 0.69-0.92; p = 0.002; intra-cluster correlation coefficient [ICC], 0.0286). The incidence of early neonatal mortality was 12.7 per 1,000 live births during the control period and 10.1 per 1,000 live births during the intervention period (aOR, 0.89; 95% CI, 0.78-1.02; p = 0.09; ICC, 0.1538). The use of bag-and-mask ventilation for babies with low Apgar score (<7 at 1 minute) increased from 3.2% in the control period to 4.0% in the intervention period (aOR, 1.52; 95% CI, 1.32-1.77, p = 0.003). There were two major limitations to the study; although a large sample of women-infant pairs were enrolled in the study, the clustering reduced the power of the study. Secondly, the study was not sufficiently powered to detect reduction in early neonatal mortality with the number of clusters provided.These results suggest scaled-up implementation of a QI package for neonatal resuscitation can reduce intrapartum-related mortality and improve clinical care. The QI intervention package is likely to be effective in similar settings. More implementation research is required to assess the sustainability of QI interventions and quality of care.ISRCTN30829654.
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| 3. |
- KC, Ashish, 1982-, et al.
(författare)
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Scaling up quality improvement intervention for perinatal care in Nepal (NePeriQIP); study protocol of a cluster randomised trial
- 2017
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Ingår i: BMJ Global Health. - : BMJ. - 2059-7908. ; 2:3
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Nepal Perinatal Quality Improvement Project (NePeriQIP) intends to scale up a quality improvement (QI) intervention for perinatal care according to WHO/National guidelines in hospitals of Nepal using the existing health system structures. The intervention builds on previous research on the implementation of Helping Babies Breathe-quality improvement cycle in a tertiary healthcare setting in Nepal. The objective of this study is to evaluate the effect of this scaled-up intervention on perinatal health outcomes.METHODS/DESIGN: Cluster-randomised controlled trial using a stepped wedged design with 3 months delay between wedges will be conducted in 12 public hospitals with a total annual delivery rate of 60 000. Each wedge will consist of 3 hospitals. Impact will be evaluated on intrapartum-related mortality (primary outcome), overall neonatal mortality and morbidity and health worker's performance on neonatal care (secondary outcomes). A process evaluation and a cost-effectiveness analysis will be performed to understand the functionality of the intervention and to further guide health system investments will also be performed.DISCUSSION: In contexts where resources are limited, there is a need to find scalable and sustainable implementation strategies for improved care delivery. The proposed study will add to the scarce evidence base on how to scale up interventions within existing health systems. If successful, the NePeriQIP model can provide a replicable solution in similar settings where support and investment from the health system is poor, and national governments have made a global pledge to reduce perinatal mortality.TRIAL REGISTRATION NUMBER: ISRCTN30829654.
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| 4. |
- Malinovschi, Andrei, 1978-, et al.
(författare)
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Consequences of Using Post- or Prebronchodilator Reference Values in Interpreting Spirometry
- 2023
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Ingår i: American Journal of Respiratory and Critical Care Medicine. - : American Thoracic Society. - 1073-449X .- 1535-4970. ; 208:4, s. 461-471
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Tidskriftsartikel (refereegranskat)abstract
- RATIONALE: Post-bronchodilator (BD) spirometry is used for diagnosis of chronic obstructive pulmonary disease (COPD). However, pre-BD reference values are used for spirometry interpretation.OBJECTIVES: To compare the resulting prevalence rates of abnormal spirometry and study the consequences of using pre- or post-BD reference values generated within the Swedish CArdioPulmonary bioImage Study (SCAPIS) when interpreting post-BD spirometry in a general population.METHODS: SCAPIS reference values for post-BD and pre-BD spirometry were based on 10,156 and 1,498 never-smoking, healthy participants, respectively. We studied the associations of abnormal spirometry, defined by using pre- or post-BD reference values, with respiratory burden in the SCAPIS general population (28,851 individuals).MEASUREMENTS AND MAIN RESULTS: Bronchodilation resulted in higher predicted median and lower limit of normal (LLN) for FEV1/FVC ratio. The prevalence of post-BD FEV1/FVC < pre-bronchodilator LLN was 4.8% and that of post-BD FEV1/FVC < post-bronchodilator LLN was 9.9% for the general population. An additional 5.1% was identified as having an abnormal post-BD FEV1/FVC ratio and this group had more respiratory symptoms, emphysema (13.5% vs. 4.1%, p<0.001) and self-reported physician-diagnosed COPD (2.8% vs. 0.5%, p<0.001) than subjects with post-BD FEV1/FVC ratio > LLN for both pre- and post-bronchodilation).CONCLUSIONS: Pre- and post-bronchodilator spirometry reference values differ with regard to FEV1/FVC ratio. Use of post-bronchodilator reference values doubled the population prevalence of airflow obstruction; this was related to a higher respiratory burden. Using post-bronchodilator reference values when interpreting post-bronchodilator spirometry might enable identification of individuals with mild disease and be clinically relevant.
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| 5. |
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| 6. |
- Erikshammar, Jarkko, Teknologie doktor, 1971-, et al.
(författare)
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Dynamiska layouter i den tillfälliga fabriken
- 2023
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Ingår i: PLANs Forsknings- och tillämpningskonferens 2023. - Trollhättan : Högskolan Väst. ; , s. 222-238
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)
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| 7. |
- Eriksson, Helena, 1971, et al.
(författare)
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Cardiovascular mortality in a Swedish cohort of female industrial workers exposed to noise and shift work.
- 2021
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Ingår i: International Archives of Occupational and Environmental Health. - : Springer Science and Business Media LLC. - 1432-1246 .- 0340-0131. ; 94:2, s. 285-293
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to study mortality due to cardiovascular disease as well as total mortality, among female industrial workers, and the association to occupational noise and shift work.Women from cohorts of soft tissue paper mills (N=3013) and pulp and paper mills (N=1483) were merged into one cohort. Job exposure matrices were developed and used for classification of shift work and noise exposure. Every year was classified as shift work excluding nights or shift work including nights. Noise was classified into seven 5dB(A) bins from<75 to≥100dB(A). Mortality from cardiovascular diseases and total mortality during 1956-2013 was calculated as a standardized mortality ratio (SMR) with 95% confidence interval (CI) using the female general population as a reference.Fatal myocardial infarctions (N=144) were increased in the total cohort, SMR 1.20 (95% CI 1.01-1.41) but not total mortality. The SMR for myocardial infarction for women exposed to noise≥90dB(A) for>10years was 1.41 (95% CI 1.02-1.89) and for those exposed to night shifts>10years, 1.33 (95% CI 0.91-1.89). Shift workers without nights≤65years, with noise exposure≥90dB(A), had SMR 2.41 (95% CI 1.20-4.31) from myocardial infarction. There was no increased mortality from cerebrovascular disease.Female paper mill workers had an increased mortality from acute myocardial infarction, especially before retirement age, when exposed to noise≥90dB(A) and with long-time employment. Exposure to shift work and noise usually occurred concurrently.
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| 8. |
- Eriksson, Helena, 1971, et al.
(författare)
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Longitudinal study of occupational noise exposure and joint effects with job strain and risk for coronary heart disease and stroke in Swedish men.
- 2018
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 8:4
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Tidskriftsartikel (refereegranskat)abstract
- The aims were to investigate whether occupational noise increased the risk for coronary heart disease (CHD) and stroke and to elucidate interactions with stressful working conditions in a cohort of Swedish men.This is a prospective cohort study on CHD and stroke in Swedish men followed until death, hospital discharge or until 75 years of age, using Swedish national registers on cause of death and hospital discharges. Baseline data on occupation from 1974 to 1977 were used for classification of levels of occupational noise and job demand-control. Cox regression was used to analyse HRs for CHD and stroke.Swedish men born in 1915-1925.CHD and stroke.The participants of the study were men from the Primary Prevention Study, a random sample of 10 000 men born in 1915-1925 in Gothenburg. Subjects with CHD or stroke at baseline or were not employed were excluded. The remaining subjects with complete baseline data on occupation, weight, height, hypertension, diabetes, serum cholesterol and smoking constituted the study sample (5753 men).There was an increased risk for CHD in relation to noise levels 75-85 dB(A) and >85dB(A) compared with <75dB(A) (HR 1.15, 95% CI 1.01 to 1.31, and HR 1.27, 95% CI 0.99 to 1.63, respectively). Exposure to noise peaks also increased the risk for CHD (HR 1.19, 95%CI 1.03 to 1.38). Among those with high strain (high demands and low control) combined with noise >75dB(A), the risk for CHD further increased (HR 1.80, 95% CI 1.19 to 2.73). There was no significantly increased risk for stroke in any noise category.Exposure to occupational noise was associated with an increased risk for CHD and the risk further increased among those with concomitant exposure to high strain. None of the analysed variables were related to increased risk for stroke.
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| 9. |
- Eriksson, Helena, 1971, et al.
(författare)
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Mortality from cardiovascular disease in a cohort of Swedish seafarers
- 2020
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Ingår i: International Archives of Occupational and Environmental Health. - : Springer Science and Business Media LLC. - 0340-0131 .- 1432-1246. ; 93:3, s. 345-53
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of this study was to investigate whether Swedish seafarers have increased mortality from cardiovascular disease compared with the general population. Methods: Register-based longitudinal cohort study of 85,169 Swedish seafarers where all subjects with a minimum of 30days service registered in the Seafarers’ Register 1985–2013 were included. Mortality from coronary heart disease, cerebrovascular disease and total mortality for comparison were analysed by calculating standardised mortality ratios (SMRs), with 95% confidence intervals (CIs). Mortality was further analysed by gender, duty on board, type of vessel, and over time. Results: There was no increase in either mortality from cardiovascular disease or total mortality for seafarers, who had worked solely on passenger ferries. Mortality from coronary heart disease and cerebrovascular disease was increased for male seafarers < 46years old who had worked on different types of vessels, SMR 1.48 (95% CI 1.06–2.01) and SMR 1.93 (95% CI 1.16–3.02), respectively. Analysing the seafarers by duty showed significantly increased SMRs from coronary heart disease in males aged < 46 of the categories “deck crew” and “engine officer/crew (ever)”. The total mortality for seafarers who had worked on different types of vessels was increased; males SMR 1.05 (95% CI 1.02–1.09) and females SMR 1.17 (95% CI 1.04–1.30), but decreased over time. Conclusions: No increased mortality on passenger ferries but younger male seafarers on different types of vessels had increased mortality from cardiovascular disease. Reduction of hazardous occupational exposures onboard is important, such as shift work, stress and noise.
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| 10. |
- Eriksson, Helena, 1971, et al.
(författare)
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Psychosocial job exposure and risk of coronary artery calcification
- 2021
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Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 16:5
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The aim was to examine potential associations between psychosocial job exposures, evaluated with the Job Demand-Control-model, and presence of coronary artery calcium. Methods We performed a cross-sectional study using the Swedish CArdioPulmonary bioImage Study,(SCAPIS)pilot study. Coronary artery calcium was assessed through computed tomography of the coronary arteries and with coronary artery scoring, CACS. Main outcome was CACS >= 100 compared to CACS 0. Job demand and control was analysed according to the standard categorization of the two variables into: high strain, active, passive and low strain (reference). Associations between these variables and CACS were calculated with prevalence ratios (PR) using Cox regression with robust variance, 95% confidence intervals (CI) and adjusted for age, smoking, education, socioeconomic area and metabolic syndrome. Results In total 777 participants were used in our analyses, for which 20% of the men and 5% of the women had CACS >= 100, respectively. The PR of having CACS >= 100 was non-significantly elevated for men in high strain jobs 1.54 (95% CI 0.88-2.69) and in active jobs 1.67 (95% CI 0.92-3.06), adjusted for covariates. For women there was no association between exposure to high strain and having CACS >= 100 PR 1.02 (95% CI 0.24-4.31). Among women reporting passive job, the PR was non-significantly elevated, 2.40 (95% CI 0.83-6.92), adjusted for covariates. Conclusion The statistical power of the study was limited, but our results suggests the possibility that exposure to a high strain or an active job situation may increase the risk of CACS in men, while in women, it may rather be exposure to passive job.
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| 11. |
- Eriksson, Helena, 1971
(författare)
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Work-related cardiovascular disease
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to study occupational risk factors for cardiovascular disease, particularly, occupational noise, job strain and shift work. Incidence of cardiovascular disease was analysed in a general population sample, the Primary Prevention Study, in relation to exposure to noise and job strain. The results indicated that exposure to noise increased the risk of developing coronary heart disease. Simultaneous exposure to job strain further increased the risk. We could not demonstrate an increased risk of stroke. Female workers in the paper industry exposed to shift work and noise were analysed regarding mortality from cardiovascular disease in a longitudinal cohort study. Female workers exposed to noise >90 dB(A) or the combination of shift work and noise had an increased mortality from acute myocardial infarction but not from stroke. A cohort study of Swedish seafarers was performed. There was no increased mortality for seafarers who had worked on passenger ferries only. However, seafarers who had worked on different types of vessels had an increased total mortality and in addition an increased mortality from cardiovascular disease among relatively younger seafarers. The association between exposure to job strain and presence of coronary calcium was studied in the SCAPIS pilot study, a general population sample. The power of the study was limited, but exposure to high strain job or active job could potentially increase the risk in men, but not in women, where it could rather be exposure to passive job, however the results were insignificant. The results of the thesis strengthen earlier observations of a health hazardous effect from exposure to noise, job strain and shift work. The results are also in parity with international studies on increased mortality among seafarers.
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| 12. |
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| 13. |
- Forsell, Karl, et al.
(författare)
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Cancer incidence in a cohort of Swedish merchant seafarers between 1985 and 2011
- 2022
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Ingår i: International Archives of Occupational and Environmental Health. - : Springer. - 0340-0131 .- 1432-1246. ; 95:5, s. 1103-1111
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Lung cancer, mesothelioma and several lifestyle-associated cancer forms have been reported more common in merchant seafarers. However, few studies reflect recent occupational settings and women seafarers are usually too scarce for meaningful analyses. We conducted a study on cancer incidence between 1985 and 2011 in a Swedish cohort consisting of male and female seafarers.METHODS: All seafarers in the Swedish Seafarers' Register with at least one sea service between 1985 and 2011 and a cumulated sea service time of ≥ 30 days (N = 75,745; 64% men, 36% women; 1,245,691 person-years) were linked to the Swedish Cancer Register and followed-up until 31 December 2011. Standardized incidence ratios (SIR) were calculated with the general population as reference.RESULTS: There were 4159 cancer cases in total, with 3221 among men and 938 among women. Male seafarers had an increased risk of total cancer (SIR 1.05; 95% CI 1.01-1.09), lung cancer (SIR 1.51; 95% CI 1.35-1.67) and urinary bladder cancer (SIR 1.17; 95% CI 1.02-1.33). Several lifestyle-associated cancer forms were more common in men. Previous work on tankers was associated with leukaemia (SIR 1.41; 95% CI 1.00-1.86). The risk of cancer decreased with a start as a male seafarer after 1985, with a significant trend for total cancer (P < 0.001), lung cancer (P = 0.001) and, for tanker seafarers, leukaemia (P = 0.045). Women seafarers had an increased risk of lung cancer (SIR 1.54; 95% CI 1.23-1.87) but the risk of total cancer was not increased (SIR 0.83; 95% CI 0.78-0.89).CONCLUSIONS: In this cohort of merchant Swedish seafarers 1985-2011, the risk of total cancer was increased in men but not in women compared to the general population. Lung cancer was increased in both genders. The risk of cancer seems to decrease over the last decades, but better exposure assessments to occupational carcinogens and longer observation times are needed.
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| 14. |
- Forsell, Karl, et al.
(författare)
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Work environment and safety climate in the Swedish merchant fleet
- 2017
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Ingår i: International Archives of Occupational and Environmental Health. - : Springer Science and Business Media LLC. - 0340-0131 .- 1432-1246. ; 90:2, s. 161-168
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To get knowledge of the work environment for seafarers sailing under the Swedish flag, in terms of safety climate, ergonomical, chemical and psychosocial exposures, and the seafarers self-rated health and work ability.METHODS: A Web-based questionnaire was sent to all seafarers with a personal e-mail address in the Swedish Maritime Registry (N = 5608). Comparisons were made mainly within the study population, using Student's t test, prevalence odds ratios and logistic regressions with 95% confidence intervals.RESULTS: The response rate was 35% (N = 1972; 10% women, 90% men), with 61% of the respondents working on deck, 31% in the engine room and 7% in the catering/service department (1% not classifiable). Strain on neck, arm or back and heavy lifting were associated with female gender (p = 0.0001) and younger age (below or above 30 years of age, p < 0.0001). Exposures to exhausts, oils and dust were commonly reported. Major work problems were noise, risk of an accident and vibrations from the hull of the ship. The safety climate was high in comparison with that in land-based occupations. One-fourth had experienced personal harassment or bullying during last year of service.CONCLUSIONS: Noise, risk of accidents, hand/arm and whole-body vibrations and psychosocial factors such as harassment were commonly reported work environment problems among seafarers within the Swedish merchant fleet.
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| 15. |
- Hedefalk, Maria, 1971-, et al.
(författare)
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Five year Olds in between Sharing and Division
- 2022
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Ingår i: Philosophy of Mathematics Education Journal. - 1465-2978. ; 39
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Tidskriftsartikel (refereegranskat)abstract
- Sharing and division are two concepts that have overlapping properties, and both are connected to the interpretation of fairness. In the present study, we study preschool children’s work with a case where eight biscuits were shared between soft toys. The focus is onthe different arguments that the children express. The results show that children use both ethical arguments and mathematical arguments in their solutions. Some of the arguments can be categorised as ‘Fair sharing related to number of pieces only’ or ‘Fair sharing employing ad hoc attempts at equal size’. The arguments that were coded as sharing not associated with mathematical sense of fairness were either classified as ethical reasoning or play. In the discussion, we raise the need of the combination of ethical reasoning and mathematical arguments if we want to create situations for children to develop critical thinking.
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| 16. |
- Hedefalk, Maria, 1971-, et al.
(författare)
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Matematiska och etiska resonemang i förskolan : didaktisk modellering som intervention
- 2024
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Ingår i: Forskning om undervisning och lärande. - : Lärarstiftelsen. - 2000-9674 .- 2001-6131. ; 12:2, s. 68-84
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Tidskriftsartikel (refereegranskat)abstract
- The article examines didactic choices in teaching where mathematics and sustainable development meet. The purpose of the teaching was to encourage preschool children to reason collectively about distribution problems. It was the children's reasoning about possible solutions that was in focus, not a correct answer. The preschool teacher's role was to create opportunities for agency: enable childrens own contributions to knowledge, pit different conflicting perspectives on sustainable solutions against each other and discuss the solutions. Based on the didactic modeling method, researchers and preschool teachers discussed the teaching based on different expertise. Documentation created during these meetings was analysed, in order to investigate if the didactic what and how questions could help the preschool teachers create agency in teaching. The result shows how reflection on the didactic issues created opportunities for agency in relation to organization of time and environment, of pairing children for collective work and language development work.
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| 17. |
- Lagerlöf, Helena, 1976, et al.
(författare)
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Organizing implementation in healthcare: Balancing orders of worth.
- 2024
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Ingår i: Social Science and Medicine. - 0277-9536. ; 340
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Tidskriftsartikel (refereegranskat)abstract
- In this paper we direct attention to unavoidable conflicts between disparate value systems co-existing within organizations. Drawing on John Law's concept of ordering and Boltanski and The ' venot's orders of worth, we understand incompatibilities inherent in implementation and governance as competing orders. In extracting and articulating competing orders from our abductive analysis of semi-structured interviews with primary care managers (n = 32) in a Swedish county council, we hope to enable actors to utilise and address them as they engage in implementation work. The potential of such an approach is exemplified by analysing a regional case of health promotion implementation pursued in 2019, in a Swedish county council. Early approaches to implementation and governance have entailed linear models emphasizing program fidelity. Critics have broadened this view by calling for optimization of multiple values and more room for professional judgment. We seek to add to this development by attending to how healthcare practices often entail different and at times conflicting configurations of patients, professionals and priorities. The county council in our case study attempted to steer primary care providers towards health promotion work. To capture the realities of the organization that primary care managers described, we propose that three competing orders can be discerned in primary care: the order of immediate care, focusing on professional judgments of the most pressing needs of patients; the order of accessible care, in which patients themselves define what needs should be cared for; and the order of future health emphasizing prevention of health in the future population. Each order enacts a specific prioritization between patients and a vision of what is or should be primary in primary care. Organizing implementation, we suggest, requires a balancing of orders of worth.
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| 18. |
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| 19. |
- Lundström, Sofie, 1971-
(författare)
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Hälsa, levnadsvanor och erfarenheter av förändring av levnadsvanor hos personer med psykossjukdom – hälsofrämjande aspekter inom psykiatrisk omvårdnad
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund: Personer med psykossjukdom har ofta sämre fysisk hälsa jämfört med befolkningen i övrigt, delvis relaterat till ohälsosamma levnadsvanor såsom låg fysisk aktivitet, ohälsosam kost, tobaksbruk och riskfull alkoholkonsumtion. Trots att hälsofrämjande insatser har framhållits som betydelsefullt för att minska ojämlikheten i hälsa har inte det hälsofrämjande arbetet fått en given plats inom psykiatrisk vård. Ökad kunskap behövs dels om vilka levnadsvanor som påverkar hälsan, dels om vilka aspekter som påverkar möjligheten till förändring av levnadsvanor för personer med psykossjukdom.Syfte: Det övergripande syftet med avhandlingen var att utforska hälsorelaterade levnadsvanor och upplevd hälsa, samt erfarenheter av förändring av levnadsvanor och främjande aspekter för förändring, hos personer med psykossjukdom.Metod: Avhandlingen består av fyra delstudier. Delstudie I var en kvantitativ tvärsnittsstudie med syftet att kartlägga hälsorelaterade levnadsvanor och upplevd hälsa hos personer med psykossjukdom samt att undersöka könsskillnader och skillnader utifrån känsla av sammanhang (SOC). Data samlades in från personer med psykossjukdom som deltog i en hälsofrämjande levnadvaneintervention (n = 65). Beskrivande och jämförande analyser genomfördes på data, insamlad före interventionens start för att kartlägga självskattad hälsa, livskvalitet, BMI och levnadsvanor. För delstudie II som hade en kvalitativ design genomfördes narrativa intervjuer med personer med psykossjukdom som deltagit i en hälsofrämjande levnadsvaneintervention (n = 10). Syftet var att belysa innebörden av den levda erfarenheten av förändring av levnadsvanor hos personer med psykossjukdom. En fenomenologisk hermeneutisk metod användes för att analysera intervjutexterna. Deltagare i delstudie III bestod av sjuksköterskor som arbetade på olika psykiatriska öppenvårdsmottagningar (n = 15). Semistrukturerade intervjuer genomfördes för att beskriva deras erfarenheter av aspekter som främjar fysisk hälsa och stödjer hälsosamma levnadsvanor för personer med psykossjukdom. Intervjutexterna analyserades med kvalitativ innehållsanalys. Delstudie IV var en kvantitativ uppföljningsstudie och bestod av insamlad data från personer med psykossjukdom som deltagit i en hälsofrämjande levnadsvaneintervention (n = 54). Data, som bestod av självskattningar, kliniska mått och blodprover, samlades in före interventionens start, efter 12 månader och efter 24 månader. Flernivåanalys användes som metod för att undersöka hälsorelaterade förändringar efter deltagande i en hälsofrämjande levnadsvaneintervention.Resultat: Resultatet i delstudie I visade att personer med psykossjukdom hade högre BMI, lägre självskattad hälsa och livskvalitet, var mer stillasittande och rökte mer jämfört med befolkningen i övrigt. Personer med stark SOC skattade sin livskvalitet bättre och rökte mindre jämfört med de med svag SOC. Kvinnor konsumerade mer frukt och grönsaker än män. I delstudie II beskrevs innebörden av levnadsvaneförändringar, av personer med psykossjukdom: som en kamp med inre och yttre begränsningar, att det var något som måste göras på egen hand men tillsammans med andra och att längtan efter ett liv i harmoni kan motivera till förändringar. I resultatet av delstudie III framhöll sjuksköterskor aspekter som kan främja hälsa och hälsosamma levnadsvanor för personer med psykossjukdom. Sjuksköterskornas erfarenheter var: att ha ett hälsofrämjande fokus i varje möte, att stödja med varje persons förutsättningar i åtanke och att ta ansvar för hälsofrämjande insatser på varje nivå inom organisationen. Resultatet i delstudie IV visade en positiv förändring av fysisk aktivitet. Förändringen var associerad med antal tillfällen personen hade deltagit i hälsogrupp. Förändring av självskattad hälsa var positivt associerad med känslan av sammanhang. Således kan det antas att hälsofrämjande insatser som genomförs i grupp kan förbättra fysisk aktivitet, och att känslan av sammanhang bör stärkas för en bättre upplevd hälsa hos personer med psykossjukdom. Konklusion: Det finns såväl individuella aspekter som relationella, organisatoriska och samhälleliga aspekter som påverkar möjligheten till förändring av levnadsvanor. Inre styrka, en positiv självbild och positiva erfarenheter är individuella aspekter som tillsammans med relationella aspekter såsom stöd och att få ingå i en gemenskap, kan främja förändringar hos personer med psykossjukdom. På en organisatorisk och samhällelig nivå är samverkan, ansvarsfördelning samt kunskap och kompetens viktiga ingredienser för att främja det hälsofrämjande arbetet inom psykiatrisk vård. Det hälsofrämjande arbetet bör, tillsammans med insatser såsom utbildning och praktiskt stöd, fokusera på insatser som kan öka personens känsla av sammanhang och stärka resurser. Sjuksköterskan inom psykiatrisk vård har en nyckelposition för att utveckla den hälsofrämjande omvårdnaden, där fysisk och psykisk hälsa integreras, och där personens egen förmåga till förändring främjas. Ett salutogent och personcentrerat förhållningssätt, kan bidra till en hälsofrämjande omvårdnad, men för att kunna utveckla det hälsofrämjande arbetet inom psykiatrisk vård behöver individuella, relationella samt organisatoriska och samhälleliga aspekter beaktas. Således behöver det i samverkan tas ett gemensamt ansvar för hälsa och hälsosamma levnadsvanor, och organisatoriska strukturer behöver utvecklas för att möjliggöra en personcentrerad vård och för att utveckla de hälsofrämjande insatserna för personer med psykossjukdom.
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| 20. |
- Lundström, Sofie, 1971-, et al.
(författare)
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The Meaning of the Lived Experience of Lifestyle Changes for People with Severe Mental Illness.
- 2017
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Ingår i: Issues in Mental Health Nursing. - Philadelphia, PA : Informa UK Limited. - 0161-2840 .- 1096-4673. ; 38:9, s. 717-725
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to elucidate the meaning of the lived experience of lifestyle changes as perceived by people with severe mental illness (SMI). People with SMI who have experience in managing lifestyle changes were interviewed (n = 10). The interviews were analyzed with a phenomenological hermeneutic approach. The findings reveal three themes: (1) struggling with inner and outer limitations, (2) on one's own but together with others and (3) longing for living a life in harmony. The meaning of lifestyle changes can be understood as a person's internal and external endeavors to make well-considered decisions about lifestyle changes. Support should focus on strengthening the person's self-efficacy and should be based on the person's experiences.
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| 21. |
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| 22. |
- Neitzel, R. L., et al.
(författare)
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Development of a Job Exposure Matrix for Noise in the Swedish Soft Tissue Paper Industry
- 2018
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Ingår i: Annals of Work Exposures and Health. - : Oxford University Press (OUP). - 2398-7308 .- 2398-7316. ; 62:2, s. 195-209
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Noise exposure is a common occupational hazard, but has not been sufficiently characterized in paper mills. We developed a job-exposure matrix (JEM) for noise exposure for use in estimating exposures among Swedish soft tissue paper mill workers.& para;& para;Methods: We used a combination of area and personal dosimetry noise exposure measurements made at four soft tissue paper mills by industry and research staff between 1977 and 2013 to estimate noise exposures by department, location, and job title. We then utilized these estimates, in conjunction with information on process and facility changes and use of hearing protection collected via focus groups, to create a seven-category, semi-quantitative JEM for all departments, locations, and job titles spanning the years 1940-2010.& para;& para;Results: The results of the 1157 area and personal dosimetry noise measurements indicated that noise levels have generally declined in Swedish paper mills over time, though these changes have been neither uniform nor monotonic within or across the four mills. Focus group results indicated that use of hearing protection has generally increased over time. The noise JEM totals 1917 cells, with each cell representing a unique combination of operation, job title, and single year. We estimated that -50% of workers at the four mills assessed were exposed at or above the Swedish 8-h average noise exposure limit of an 85 dBA at the conclusion of the study period in 2010.& para;& para;Conclusions: Our results highlight the continuing need for hearing loss prevention and noise control efforts at these and similar mills, and the completed JEM now represents a tool for use in epidemiological studies of noise-related health outcomes.
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| 23. |
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| 24. |
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| 25. |
- Sumpter, Lovisa, et al.
(författare)
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Fair sharing and division – mathematical reasoning regarding integers and fractions in preschool and preschool class.
- 2023
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Ingår i: <em>Proceedings of the Thirteenth Congress of the European Society for Research in Mathematics Education (CERME13)</em>.. - : Alfréd Rényi Institute of Mathematics; ERME. - 9789637031045
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Konferensbidrag (refereegranskat)abstract
- This paper identifies and discusses children’s mathematical reasoning in preschool and preschool class when they work with a fair sharing case. The case came from a selection of cases designed to promote collective mathematical as well as ethical reasoning. Data comes from six children’s work when sharing four paper biscuits between three soft toys, first when the children were five years old and then, a year later, when they were six years old. The results show that their reasoning, both when they were five and six, used mathematical and ethical arguments. In preschool class, the students were able to use each other’s arguments in collective reasoning to identify, predict, and verify their reasoning. The students began to measure the fraction parts of a remainder but could not evaluate the conclusion with respect to what is aspects for division? equal numbers and equal size. The results also signal that teacher’s input, of posing evaluating questions, appears to stimulate the reasoning.
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| 26. |
- Sumpter, Lovisa, et al.
(författare)
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The Tension Between Division and Fair Share.
- 2024
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Ingår i: <em>Teaching Mathematics as to be Meaningful – Foregrounding Play and Children’s Perspectives.</em>. - Cham : Springer. - 9783031376658 - 9783031376634 - 9783031376627 ; , s. 69-79
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Bokkapitel (refereegranskat)abstract
- This study focuses on sharing, both in equal parts (groups) or unequal parts. Children at age five attending preschool, are faced with two different tasks working in pairs. The analysis focus on the mathematical properties in the reasoning, or when mathematical arguments were replaced with an ethical reasoning. When performing division, different strategies were used, and the norm of fair share was often expressed. It was easier for the children to allocate resources when the dividend was larger than the divisor, and when dealing with a fraction, the cardinality of the number of parts appeared to be a prominent property compared to property ‘equal size’ of the parts. There were also indications of ethical reasoning where the child used different claims to convince their peer. There was a tension between the norm of equal sharing and solutions with unequal parts. One implication is that if wanting to challenge children’s mathematical reasoning in a division task, it could be fruitful to look at fractions instead of repeating tasks where the dividend is larger than the divisor.
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| 27. |
- Söderberg, Mia, 1977, et al.
(författare)
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En rapport om studiemiljö, stress och hälsa bland Sahlgrenska akademins studenter
- 2017
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Rapporter från både Göteborgs universitets Akademihälsa och Sahlgrenska akademin Studentkår har uppmärksammat en hög förekomst av överbelastning och psykisk ohälsa bland studenter vid Sahlgrenska akademin. Därför beslöt Sahlgrenska akademins dåvarande dekan Olle Larkö, att utföra en studie om upplevd stress, studiemiljö och hälsa bland Sahlgrenska akademins studenter. Uppdraget att genomföra studien tilldelades Avdelningen för Arbets- och miljömedicin, Institutionen för medicin, Sahlgrenska Akademin & Göteborgs universitet. Det övergripande syftet var att undersöka studiemiljöns betydelse för studenternas grad av upplevd stress och hälsa som underlag för förebyggande åtgärder. Övriga frågeställningar var om det fanns skillnader avseende sådana variabler mellan könen eller mellan studenter på olika program. Frågeställningarna undersöktes via en webenkät som skickades till alla studenter som under HT-2016 aktivt studerade vid något grundutbildningsprogram vid Sahlgrenska akademin. Enkäten mätte företrädelsevis olika psykosociala aspekter i studiemiljön, såsom studieintensitet, möjligheter till inflytande, socialt klimat och hur man upplevde föreläsare och kursledare. Som utfall utvärderades grad av utmattning, ångest- och depressionssyndrom, om man sökt vård pga. sina studier eller starkt övervägt att avbryta sin utbildning. Utav 3961 tillfrågade, besvarades enkäten av 2398 studenter, vilket innebär en svarsfrekvens på 61%. Svarsfrekvenserna skiljde sig mycket mellan olika program, vilket man bör ha i åtanke när man tolkar resultaten för enskilda program. De deskriptiva resultaten visade att de flesta studenter var stolta över sitt framtida yrkesval, blev stimulerade av sina studier och kände att man blev väl förberedd för sin yrkesroll. Det var också tydligt att det fanns en god och stöttande social stämning studenter emellan. Ungefär en tredjedel av alla studenter upplevde dock en anspänd studiesituation, dvs. stor arbetsbelastning, men med begränsade möjligheter att påverka sin studiesituation, en typ av psykosocial miljö som är starkt kopplat till psykisk ohälsa. Många kände också en hög grad av oro inför framtida höga stressnivåer och stort ansvar inom det blivande yrket. Det fanns en utbredd förekomst av psykisk ohälsa, ungefär en tredjedel rapporterade nivåer över de standardiserade cut-off värdena för hög grad av utmattning eller ångestsymtom som kan indikera en ångeststörning. Andel personer som sökt vård pga. studierelaterad ohälsa låg på 15%, och ungefär en tredjedel av alla studenter hade någon gång starkt övervägt att avbryta sina studier. Vid jämförelse med andra grupper som besvarat samma typ av frågeformulär går det att se att Sahlgrenska akademins studenter rapporterar högre grad av utmattning, ångest- och depressionssymtom, än t.ex. svenska lärarstudenter eller unga vuxna i den svenska allmänbefolkningen. Noterbara skillnader fanns även mellan könen. Resultaten visade t.ex. att kvinnor lade fler studietimmar per vecka på sina studier och i högre utsträckning hade en anspänd studiesituation, jämfört med männen. Kvinnor rapporterade också en högre förekomst av psykisk ohälsa, avseende både grad av utmattning och ångestsymtom. Det fanns även skillnader mellan olika utbildningsprogram, där de stora programmen, apotekar-, läkar-, tandläkare- och sjuksköterskeprogrammen, utmärker sig avseende variabler såsom hög arbetsbelastning och förekomst av psykisk ohälsa. Den högsta andelen personer som sökt vård pga. studierelaterad ohälsa återfanns bland de kvinnliga läkarstudenterna (27%). Detta kan jämföras med vårdbehov hos manliga läkarstudenter (9%) eller den grupp av kvinnliga studenter med näst högst reliabel förekomst av vårdbehov, kvinnliga tandläkarstudenter (15%). Sambandsanalyserna visade att en av de starkaste riskfaktorerna för utmattning, vårdsökande och övervägandet att avbryta sina studier, var en anspänd studiemiljö (höga krav och låg kontroll). En sådan studiesituation var förknippad med en tredubbelt så hög risk för hög grad av utmattning och dubbelt så högt vårdbehov, jämfört med de som hade låga studiekrav och högt inflytande. Brister från fakulteten, såsom otydliga kursmål eller bristande feedback, var också associerat till en fördubblad risk för hög grad av utmattning och övervägande att avbryta sina studier. Därutöver var oro inför framtida kapacitet och emotionella krav på verksamhetsförlagd utbildning kopplat till psykisk ohälsa. Ett annat intressant resultat var att könsdiskriminering var associerat till att man sökte vård, däremot fanns det inga signifikanta samband mellan att söka vård, och utmattning eller ångest. Mindre förvånande var att den starkaste faktorn för att överväga att avbryta sina studier, var ett bristande engagemang för sin utbildning och kommande yrket. Resultaten visade även samband till viktiga friskfaktorer. Som tidigare påvisats i flera studier, var fysisk aktivitet kopplat till lägre nivåer av utmattning. En annan betydelsefull faktor, som var associerad till både minskad utmattning och ångestsymtom, var tid till återhämtning, vilket också är konsekvent med tidigare forskning. Sammanfattningsvis, trots många positiva aspekter såsom engagemang, stimulans och bra social gemenskap, rapporterade Sahlgrenska akademins studenter en hög förekomst av krävande och stressande studieförhållanden och en utbredd psykisk ohälsa. Studenterna vid Sahlgrenska akademin går på krävande utbildningar som ska förbereda dom för yrken med högt tempo och stort ansvar gentemot andra människor. Detta kräver god stresstålighet, men också att man kan känna igen mekanismer som kan orsaka stress och att man har kunskap om hur man kan skydda sin hälsa. Idag läggs stort ansvar för den egna hälsan på studenterna själva. Man bör diskutera huruvida inte universitet bör ha en tydligare och mer ansvarstagande roll i att minska förekomst av skadliga studieförhållanden och stärka studenternas förmåga att hantera krävande förhållanden och därmed bättre förbereda dom inför arbetslivet. Förslagna åtgärder bör därför fokusera på utökad tillgång till stresshanteringsprogram, förändra kulturer där stress och att må psykiskt dåligt ses som en svaghet, schemaläggning som gynnar tid för återhämtning och lyfta positiva och hälsofrämjande aspekter av fysisk aktivitet.
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| 28. |
- Söderberg, Mia, 1977, et al.
(författare)
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Psychosocial job conditions and biomarkers of cardiovascular disease: A cross-sectional study in the Swedish CArdioPulmonary bioImage Study (SCAPIS).
- 2023
-
Ingår i: Scandinavian journal of public health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 51:6, s. 843-852
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate associations between psychosocial work exposure and the presence of biological and imaging biomarkers of cardiovascular disease.This cross-sectional study was conducted in a sub-cohort of the Swedish CArdioPulmonary bioImage Study (SCAPIS). Psychosocial exposure was evaluated with the job demand-control model, and analysed according to the standard categorization: high strain, active, passive and low strain (reference). Biomarkers (blood pressure, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, coronary artery calcification (CAC) and metabolic syndrome) were measured, or derived through measurements, from clinical examinations. Gender-specific prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated with regression models and adjusted for age, education, smoking, physical activity, general life stress and body mass index (BMI).The analyses included 3882 participants (52.5% women). High strain (high demands-low control) was linked to increased PR for low HDL cholesterol in women, adjusted for all covariates (PR 1.76; 95% CI 1.25-2.48). High strain was also related to moderately increased PR for metabolic syndrome in men, after adjustments for all covariates except BMI (PR 1.25; 95% CI 1.02-1.52). In addition, passive work (low demands-low control) was associated with diastolic hypertension in women (fully adjusted: PR 1.29; 95% CI 1.05-1.59). All relationships between psychosocial factors and LDL cholesterol or CAC (both genders), or hypertension (men), were non-significant.Poor psychosocial job conditions was associated with the presence of low HDL cholesterol and diastolic hypertension in women, and metabolic syndrome in men. These findings contribute to the knowledge of potential pathways between stressful work and coronary heart disease.
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| 29. |
- Torén, Kjell, 1952, et al.
(författare)
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Cancer incidence among workers in soft paper mills:A cohort study
- 2023
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Ingår i: American Journal of Industrial Medicine. - 0271-3586 .- 1097-0274. ; 66, s. 728-735
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: To elucidate whether occupational exposure to soft paper dust increases the incidence of cancer. Methods: We studied 7988 workers in Swedish soft paper mills from 1960 to 2008, of whom 3233 (2 187 men and 1046 women) had more than 10 years of employment. They were divided into high exposure (>5 mg/m3 for >1 year) or lower exposure to soft paper dust based on a validated job-exposure matrix. They were followed from 1960 to 2019, and person-years at risk were stratified according to gender, age, and calendar-year. The expected numbers of incident tumors were calculated using the Swedish population as the reference, and standardized incidence ratios (SIR) with 95% confidence intervals (95% CI) were assessed. Results: Among high-exposure workers with more than 10 years of employment, there was an increased incidence of colon cancer (SIR 1.66, 95% CI 1.20−2.31), small intestine cancer (SIR 3.27, 95% CI 1.36−7.86), and thyroid gland cancer (SIR 2.68, 95% CI 1.11−6.43), as well as lung cancer (SIR 1.56, 95% CI 1.12−2.19). Among the lower-exposed workers there was an increased incidence of connective tissue tumors (sarcomas) (SIR 2.26, 95% CI 1.13−4.51) and pleural mesothelioma (SIR 3.29, 95% CI 1.37−7.91). Conclusion: Workers in soft paper mills with high exposure to soft paper dust have an increased incidence of large and small intestine tumors. Whether the increased risk is caused by paper dust exposure or some unknown associated factors is unclear. The increased incidence of pleural mesothelioma is probably linked to asbestos exposure. The reason for increased incidence of sarcomas is unknown.
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