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- Christiansen, Mats, 1972-
(författare)
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Patient experiences and the influence on health literacy and self-care using mHealth to manage symptoms during radiotherapy for prostate cancer
- 2019
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Prostate cancer is a diagnosis that can affect the men’s quality of life both due to the symptoms related to the disease and the treatment the men receive. Treatment with radiotherapy for prostate cancer in Sweden takes place at outpatient clinics, where the patient visits daily for radiotherapy and then returns home. Most of the time the patient is experiencing the symptoms and side-effects at home without health-care professionals easily accessible. To facilitate person-centered care and improve clinical management when hospital care is moving to outpatient care, the app (Interaktor) for smartphones and tablets was developed. Using patient-reported outcomes (PRO), the app was intended to identify symptoms early, assess them in real time, and provide symptom-management support during radiotherapy for prostate cancer. Aims: The overall objective of the intervention described in this thesis, was to facilitate symptom management for patients with prostate cancer assisted with an interactive app during radiotherapy treatment.Methods: The two studies included in this thesis come from one trial. A descriptive investigation evaluated the intervention group’s use and perception of the using the app, and a quasi-experimental investigation compared those using the app with a historical control group not using the app to evaluate the effect on health literacy and self-care agency. The patients (n=130) were recruited consecutively from two university hospitals in Sweden between April 2012 and October 2013. The intervention group (n=66) had access to the app during 5-7 weeks of radiotherapy and three additional weeks. The intervention group’s use of the app was logged. Health literacy was measured using the Swedish Functional Health Literacy Scale (FHL) and the Swedish Communicative and Critical Health Literacy Scale (CCHL), and the Appraisal of Self-care Agency scale, version A (patient’s assessment) (ASA-A) for self-care agency. Transcribed notes from phone or face-to-face interviews about participants’ experiences of using and reporting in the app were analyzed.Results: In the intervention group using the app, adherence to daily reports was 87% (Md 92%, 16-100%), and generated 3,536 reports. All listed symptoms were used, where the most common being: urinary urgency, fatigue, hot flushes, and difficulties in urinating. A total of 1,566 alerts were generated, with 1/3 being severe (red alert). The app was reported in the interviews as easy to use, the reporting became routine; to report facilitated reflection over symptoms, the symptoms were relevant although some found that nuancing severity was hard. Using the app was reported as providing a sense of security. Substantial portions of the participants showed inadequate FHL and CCHL at baseline for both groups. CCHL changed significantly for the intervention group from baseline to three months after ended treatment (p = 0.050). Functional health literacy and self-care agency did not reveal any statistically significant differences over time for either group. Conclusions: The conclusions to draw from this thesis are that an mHealth intervention, the app Interaktor, served as a supportive tool for the patients to assess and manage symptoms during the radiotherapy for prostate cancer. The intervention provided the patients with a sense of safety, increased awareness of own well-being and a significant improvement in communicative and critical health literacy was found. The portions of inadequate levels of health literacy reported leave substantial groups of patients more vulnerable in assessing and managing symptoms when treated with radiotherapy for prostate cancer. Although health literacy levels include notable portions of patients in this study that have inadequate levels of both functional and communicative and critical health literacy, the adherence of using the app was high.
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| 2. |
- Styf, Maria, 1974-
(författare)
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Pedagogisk ledning för en pedagogisk verksamhet? : Om den kommunala förskolans ledningsstruktur
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis is a total coverage survey of the municipal preschool management structure. In the late 90's the preschool in Sweden became the first step in the overall educational system. It became a pedagogical activity similar to school with respect to form and content. Although the focus was on education, political voices reclaimed the unique nature of preschool i.e. educare. It became a preschool in transition between its own tradition and modernization. The idea is that the educational management structure should support a pedagogical leadership that directs the pedagogical activity towards preschool objectives. The local authority sets the structure for management in pre-school; a municipality that in itself is an institution with its own goals and objectives. These objectives can place the municipalities in the cross pressure between their own objectives and the ones for preschool. The question in this respect is; How is the management structure formed and why? Is it a structure formed with the intention of creating educational management for the local preschool or are there other factors that guide the design? A framework based on the historical background of the preschools and theoretical terms such as steering, leading, management, pedagogical leadership, educational activity, etc. was constructed. Results are based on an online questionnaire survey. 180 municipalities out of 290 answered the questionnaire, which gives a response rate at 62 %. The response rate is evenly distributed across municipal categories, categories that the municipalities were aggregated into, formed by The Swedish Association of Local Authorities and Regions. The categories were handled as survey units, to support a part of the analysis and to allow a comparison between the municipalities by municipality size, both demographic and geographic. The material was analysed using the SPSS statistical program and compiled and reported with descriptive statistics. Descriptive statistics were used to demonstrate the material's characteristics and the central tendency. The results show that the municipalities’ structure of management is varied. Different municipal categories do not change this varied picture of the management landscape significantly. Although the management structure varies regarding how many levels with formal titles and which positions and functions they should have, there is a consistency in which title that the formal leader for the preschool have. The municipalities primarily utilisea principalship with mixed responsibility for both preschool and school. In light of these results, do municipalities mould a structure for the educational management for the pedagogical activities in preschool? Yes and no: the municipalities do not form a structure for preschool alone. Results show that the municipalities' main purpose is not to create a line of management specifically for the preschool. The municipalities form a management structure for educational purposes dealing with an educational activity from preschool to elementary school. The new Education Act (2010:800), is a step toward distinguishing preschool leadership from school leadership and turns the leadership of preschools into a title solely for the position and function of preschool educational activities.
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| 3. |
- Hägglund, Maria, 1982-
(författare)
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Characterization of Amino Acid Transporters in the Brain : Molecular and Functional Studies of Members within the Solute Carrier Families SLC38 and SLC6
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Solute carriers (SLCs) comprise the largest group of transporters in humans and there are currently 52 SLC families. They are embedded in cellular membranes and transport numerous molecules; defects in many of the genes encoding SLCs have been connected to pathological conditions, and several SLCs are potential drug targets.The SLC38 family has in total eleven members in humans and they encode transporters called SNATs. In paper I and paper II, we reported molecular and functional characterization of Slc38a7 and Slc38a8, two of the previous orphan members in the family which we suggested to be named SNAT7 and SNAT8, respectively. Using in situ hybridization and immunohistochemistry, these transporters showed similar expression pattern and localized to neurons in the brain For functional characterization proteins were overexpressed in X. laevis oocytes and an Uptake Assay and electrophysiological recordings showed preferred transport of L-glutamine, L-histidine, L-alanine, L-asparagine, L-aspartate and L-arginine for SNAT7. A similar pattern was seen for SNAT8 in a slightly different order of affinities. We classified SNAT7 as a system N transporter and SNAT8 as belonging to system A, and suggests that SNAT7 and SNAT8 could play a role in the glutamine/glutamate(GABA) cycle (GGC) in the brain.Furthermore, we studied the vesicular B0AT3 (Slc6a17) transporter in paper III, and the sodium-coupled amino acid transporter B0AT2 (Slc6a15) in paper IV. Tissue expression studies showed similar localization of Slc6a17 and Slc6a15 mRNA using in situ hybridization and real-time PCR. In paper III, vesicular localization of B0AT2 was shown in both excitatory and inhibitory neurons. When challenging the monoaminergic system with drugs both Slc6a17 and Slc6a15 were upregulated. Suggested roles for the transporters are thereby in synaptic remodeling by regulating the availability of free amino acids used as precursors needed in neurotransmitter synthesis. Moreover, in paper IV, immunohistochemistry showed B0AT3 localization to neurons, astrocytes and epithelial cells of the choroid plexus. Leucine injections caused a smaller reduction of food intake as well as higher neuronal activation in the paraventricular hypothalamic nucleus in Slc6a15 KO mice, compared with wild type mice. This suggests B0AT2 involvement in the anorexigenic effects of leucine.
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| 4. |
- Hägglund, Maria, Lektor, 1975-
(författare)
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Sharing is Caring : Integrating Health Information Systems to Support Patient-Centred Shared Homecare
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In the light of an ageing society with shrinking economic resources, deinstitutionalization of elderly care is a general trend. As a result, homecare is increasing, and increasingly shared between different health and social care organizations. To provide a holistic overview about the patient care process, i.e. to be patient-centred, shared homecare needs to be integrated. This requires improved support for information sharing and cooperation between different actors, such as care professionals, patients and their relatives.The research objectives of this thesis are therefore to study information and communication needs for patient-centered shared homecare, to explore how integrated information and communication technology (ICT) can support information sharing, and to analyze how current standards for continuity of care and semantic interoperability meet requirements of patient-centered shared homecare.An action research approach, characterized by an iterative cycle, an emphasis on change and close collaboration with practitioners, patients and their relatives, was used. Studying one specific homecare setting closely, intersection points between involved actors and specific needs for information sharing were identified and described as shared information objects. An integration architecture making shared information objects available through integration of existing systems was designed and implemented. Mobile virtual health record (VHR) applications thereby enable a seamless flow of information between involved actors. These applications were tested and validated in the OLD@HOME-project. Moreover, the underlying information model for a shared care plan was mapped against current standards. Some important discrepancies were identified between these results and current standards for continuity of care, stressing the importance of evaluating standardized models against requirements of evolving healthcare contexts.In conclusion, this thesis gives important insights into the needs and requirements of shared homecare, enabling a shift towards patient-centered homecare through mobile access to aggregated information from current feeder systems and documentation at the point of need.
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