| 1. |
- Andersson, Lisa
(författare)
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Problematisk opioidanvändning : om opioidrelaterade dödsfall och LARO i södra Sverige
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Problematic opioid use constitutes an extensive global problem. Correspondingly, opioid-related mortality is high and has increased in several Western countries, including Sweden, during the 2000s. In Sweden, the most effective treatment method, opioid substitution treatment (OST), was for a long time limited with respect to the number of patients. The treatment was also characterized by strict rules and conducted in a high-threshold manner, which has meant that it has not been fully appealing to people with problematic opioid use. Therefore, in Skåne County in southern Sweden, patient choice of treatment provider was introduced for OST in 2014 with the intention to increase the number of treatment places and strengthen patient empowerment. The overall aims of this thesis are (1) to investigate opioid-related deaths in Skåne with a focus on contact with care-providing authorities and in relation to increased access to OST, and (2) to examine patients’ and clinic managers’ attitudes towards the introduction of the patient choice reform for OST and their views of the reform's objectives of increased accessibility to OST and strengthening patients' empowerment and influence over their treatment.The four papers in this thesis are based on two research projects with various empiric material. Paper I and II are based on data on opioid overdose deaths from a period of two years before and two years following the introduction of the patient choice reform. Forensic data regarding the presence of various substances and which opioid caused the death, as well as demographic data and information on contact with care-providing authorities (health care, social services, and the Prison and Probation Service), were collected. Paper I examines clinical background and contact with care-providing authorities of opioid-related fatalities, as well as differences with regard to which opioid caused the death. Paper II examines the possible impact of the intervention on the development of opioid-related deaths in the region. National mortality data were also used in this study to investigate the development in Skåne compared to the rest of Sweden. The second research project focused on stakeholders’ views on the implementation of the patient choice reform. Paper III includes interviews with 33 OST patients, and paper IV consists of interviews with the managers of all OST clinics in Skåne. The results from paper I show that of the 180 deceased in opioid overdose included in the study, almost 90 per cent had been in contact with one of the examined care-providing authorities during the year prior to death. Few differences appeared with regard to which opioid contributed to the death. Paper II indicates that there has been no significant change in opioid-related deaths in Skåne after the patient choice reform and increased access to OST. An analysis on national mortality data however showed a significant yearly decrease in drug-related deaths in Skåne compared to other Swedish counties in the years following the reform (2015–2017). No change was noted in deaths related to methadone or buprenorphine in Skåne. The proportion of deaths among patients in OST increased after the introduction of the reform. The third paper indicates that patients in OST in Skåne have gained increased empowerment and influence over their treatment since the patient choice reform was introduced. Patients especially appreciated the knowledge that they could make an exit and change clinics if they so wished, even if they so far had chosen not to. In paper IV, the clinic managers were largely positive to the trend towards increased influence for patients over their treatment situation. They were more critical of the fact that there was no major differentiation between treatment providers, and that the competition that arose after the patient choice reform mainly was related to prescribing benzodiazepines.Conclusions drawn from the papers in this thesis include that patient choice of treatment provider can be viewed as a means of empowerment for patients in OST, which was regarded as positive by both patients and treatment providers. The limitations of such a system for providing OST that emerged were lack of diversity between clinics and that the competition between treatment providers largely comprised of differing views on the prescription of benzodiazepines. Further, improved access to low-threshold OST in Skåne was not associated with an increased overdose death-rate. The result that people who died from opioid overdose to a very large extent are known to society’s care-providing authorities suggests that there are considerable opportunities to reach people with problematic opioid use for therapeutic and harm reducing measures such as low-threshold OST and take-home naloxone.
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| 2. |
- Rafi, Jonas, 1985-
(författare)
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A Workplace Prevention Program for Problem Gambling
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Gambling is an activity that may involve harm for the gambler and others close to the gambler. Since workplaces may be negatively affected by employees who gamble during work or are at-risk problem gamblers, this setting has been proposed as a suitable arena for prevention. However, the potential effects of such initiatives have not been evaluated. This thesis explored the effects of a workplace prevention program for problem gambling. The program comprised gambling policy development and skill development training for managers.Study I used pre-intervention measures to explore gambling characteristics of employees (n=3629) in ten organizations, including both private and public sector organizations, and blue- and white-collar workers. About one in 20 employees knew someone who gambled during work, and this proportion was similar for both managers and subordinates. Another finding was that 3.5% of respondents were categorized as at-risk problem gamblers, with a higher prevalence among subordinates (3.8%) than managers (1.3%). A third finding was that 11.4% of employees stated that the organization had a gambling policy, and that this did not differ between managers and subordinates. Gambling policy knowledge was considerably lower than alcohol policy knowledge, as an alcohol policy was believed to exist by 94.3% of managers and 63.3% of subordinates. Lastly, in regression analyses, the two outcomes “knowing about a colleague who gambles during work” and “at-risk/problem gambling” were associated with each other, male gender, and young age. Taken together, the findings offer evidence that gambling may be an important topic to target in workplace settings, although more research is needed to pinpoint specific workplace harms and whether certain gambling types are associated with more workplace harms than others.Study II used a cluster-randomized design to investigate the effects of a prevention program. Ten organizations were randomized to an intervention group or a waitlist group. Individuals who were employed on any of three measurement occasions were eligible to participate. A total of n=490 (response rate 73%) managers and n = 4146 (response rate 43.3%) subordinates participated in the study by providing informed consent and responding to the survey at least once. The prevention program included two main components: policy development and skill development training for managers. The main outcome was managers’ inclination to act when worried about an employee regarding gambling or other harmful use (e.g., alcohol), together with a range of secondary outcome measures. The results showed that managers who participated in the skill development training significantly increased their inclination to act compared to the waitlist group, but this finding was not generalized to the whole intervention group. Thus, including managers in the intervention group who did not participate in the skill development training when calculating intervention effects resulted in non-significant effects. The results of secondary outcome measures showed that there were significant intervention effects regarding managers’ knowledge of a gambling policy, their confidence in how to act when concerned about an employee’s possible problem gambling or other harmful use, and the proportion of managers who had acted to provide support. Study III included semi-structured interviews with skill development participants (n=23) to inquire about their experiences of the prevention program. Interviews were transcribed and analyzed using qualitative content analysis, which yielded six distinct themes related to the participants, namely: 1) their expectations, 2) aspects of the skill development training they appreciated, 3) their experiences of PG, 4) their proposed areas of improvement, 5) whether they felt they had received a good basis for PG and other harmful use, and 6) their thoughts about the so-called “difficult conversation”. Taken together, the findings provide ideas for improving gambling-specific interventions for the workplace and corroborate earlier research findings on workplace interventions in general.To conclude, the thesis shows that a workplace preventive intervention for gambling can have positive effects on managers’ intended and performed actions to help an employee who they suspect has a problem with gambling or other harmful use. However, further program improvements and in-depth studies are needed to draw conclusions on explanations, robustness, and mechanisms of change.
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| 3. |
- Sundström, Johan, Professor, 1971-, et al.
(författare)
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Risk factors for subarachnoid haemorrhage : a nationwide cohort of 950 000 adults
- 2019
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Ingår i: International Journal of Epidemiology. - : Oxford University Press. - 0300-5771 .- 1464-3685. ; 48:6, s. 2018-2025
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Subarachnoid haemorrhage (SAH) is a devastating disease, with high mortality rate and substantial disability among survivors. Its causes are poorly understood. We aimed to investigate risk factors for SAH using a novel nationwide cohort consortium.METHODS: We obtained individual participant data of 949 683 persons (330 334 women) between 25 and 90 years old, with no history of SAH at baseline, from 21 population-based cohorts. Outcomes were obtained from the Swedish Patient and Causes of Death Registries.RESULTS: During 13 704 959 person-years of follow-up, 2659 cases of first-ever fatal or non-fatal SAH occurred, with an age-standardized incidence rate of 9.0 [95% confidence interval (CI) (7.4-10.6)/100 000 person-years] in men and 13.8 [(11.4-16.2)/100 000 person-years] in women. The incidence rate increased exponentially with higher age. In multivariable-adjusted Poisson models, marked sex interactions for current smoking and body mass index (BMI) were observed. Current smoking conferred a rate ratio (RR) of 2.24 (95% CI 1.95-2.57) in women and 1.62 (1.47-1.79) in men. One standard deviation higher BMI was associated with an RR of 0.86 (0.81-0.92) in women and 1.02 (0.96-1.08) in men. Higher blood pressure and lower education level were also associated with higher risk of SAH.CONCLUSIONS: The risk of SAH is 45% higher in women than in men, with substantial sex differences in risk factor strengths. In particular, a markedly stronger adverse effect of smoking in women may motivate targeted public health initiatives.
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| 4. |
- Forsström, David, 1981-
(författare)
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The use and experience of responsible gambling tools : An explorative analysis of user behavior regarding a responsible gambling tool and the consequences of use
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Responsible gambling tools are an intervention that is designed to decrease gambling among individuals with an at-risk gambling behavior. Studies have indicated that responsible gambling tools can decrease gambling behavior, but little is known about how this intervention is used by gamblers. The aim of the present thesis was to explore different facets of the use, experience and functions of these tools. Study I used descriptive statistics and latent class analysis (LCA) combined with multinomial regression to explore the use of the responsible gambling tool Playscan among 9528 gamblers (regular and at-risk gamblers). The participants had volunteered to use the tool. The functions of the tool had a high rate of initial use but a low rate of repeated use. The LCA identified five user classes. Two of the classes (self-testers and multifunctional users) were defined as high users of the tool and had a higher risk of developing gambling problems according to multinomial regression. The multifunctional users were characterized by an extensive use of all the functions while the other high usage class had an extensive use of the self-test. The three other classes were as follows: those who did not use the tool, those who visited the tool but did not engage in any of the functions, and those who only used the tool’s advice on how to decrease their gambling. Participants’ reasons for use and non-use of the tool were attributed to their degree of need of the tool and its functions. The tool’s most widely used function was the self-test that investigated the level of negative consequences faced by a user due to his or her gambling. Study II was a qualitative study investigating participants’ views, experiences and their reasons for using the tool. The study was conducted by interviewing 20 volunteer users of the tool. These semi-structured interviews were analyzed by thematic analysis. The results showed that the users had a positive attitude towards the tool and understood its purpose. The self-test was the most widely used function in this sample as well. However, the participants’ positive attitude toward the tool did not effectively encourage them to use it; they displayed low use of the tool’s functions. This paradox was explained by lack of feedback and the fact that some participants did not understand that they had registered to use the tool. Providing more feedback and tailoring the feedback to individual users were seen as ways of bridging the paradox. Study II also found that participants used the gambling website (which Playscan was linked to) in an analogue way, preparing their bets before placing them online. This limited the time they spent on the site and inhibited their use of Playscan. Study III was motivated by the extensive use of the self-test among users in Study I and Study II. The aim of Study III was to investigate the psychometric properties of the self-test (known as GamTest) to better understand how it could be used with Playscan in the most efficient way. Two thousand two hundred and thirty four respondents answered the questionnaire, along with instruments measuring depression, anxiety and another instrument measuring problems due to gambling. Factor analysis, parallel analysis, Cronbach’s alpha, and correlations were used to establish the tool’s psychometric properties. The results yielded a three-factor model, excellent reliability, and high correlation with the Problem Gambling Severity Index (PGSI), endorsing the validity of the self-test. The results also indicated that the questionnaire could be effectively shortened. Overall, the studies show that the tool has an initial high use, low repeated use and that the self-test is the most used feature. In addition, the self-test had good psychometric properties.
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| 5. |
- Holmberg, Sara, 1967-
(författare)
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Musculoskeletal Disorders among Farmers and Referents, with Special Reference to Occurence, Health Care Utilization and Etiological Factors : A Population-based Study
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objectives. To study the prevalence of musculoskeletal symptoms among farmers as compared to rural referents and to evaluate the effects of physical work exposures, psychosocial factors, lifestyle and comorbidity.Material and methods. A cross-sectional population-based survey of 1013 farmers and 769 matched referents was performed. Data on various symptoms, consultations and sick leave and information on primary health care and hospital admissions were obtained along with information on physical workload, psychosocial factors and lifestyle. Results. The farmers reported higher lifetime prevalence of symptoms from hands and forearms, low back and hips as compared to the referents. However, the farmers did not seek medical advice more often than the referents, and they reported significantly fewer sick leaves. After adjustment for the influence of physical work exposure, farmers still had a excess rate of low back pain (LBP) and hip symptoms as compared with the referents, while a lower rate of neck-shoulder symptoms was revealed. Several of the psychosocial variables were associated with LBP but the difference in LBP prevalence between farmers and referents could only be explained to some extent. LBP was associated with musculoskeletal symptoms other than LBP and with chest discomfort, dyspepsia, symptoms from mucous membranes, skin problems, work-related fever attacks, and primary care for digestive disorders. Presence of both respiratory and digestive disorders doubled the LBP prevalence.Conclusions. Symptoms from hips and low back were more frequent among farmers than among referents, but farmers did not seek more health care and reported fewer sick leaves than referents. Physical work exposure and psychosocial factors did not explain the differences in low back and hip symptoms between the two groups. Significant associations between LBP and digestive and respiratory disorders might indicate that these disorders may have etiological factors in common.
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| 6. |
- Håkansson, David, 1978-
(författare)
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Syntaktisk variation och förändring : en studie av subjektslösa satser i fornsvenska
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The topic of this thesis is subjectless clauses in Old Swedish (1225–1526). The thesis focuses on referential subjects, and addresses the problem of why the possibilities to leave out such subjects have been reduced during the history of Swedish. The dissertation consists of three main parts, divided into eight chapters. In the first part, chapters 1–3, the aims are presented and a theoretical background to the research on diachronic syntax is given. Furthermore, a brief overview presents the main trends in scientific work in this area, in which two main directions crystallize: on the one hand theories that have related subject omission to morphological factors and on the other hand theories that regard contextual aspects as crucial. Chapter 4 presents the second part of the thesis and consists of an empirical study of subjectless clauses in the history of Swedish. A corpus of about 193,400 words was collected from 12 Old Swedish texts, and on the basis of a random sample, a variable rule analysis was carried out. Although the investigations show that subjectless clauses occur most frequently in Early Old Swedish (1225–1375), the most striking change in the use of subjectless clauses during Old Swedish seems to be related to the subject position (Spec, IP): whereas referential subjects could be omitted from this position in Early Old Swedish, corresponding subjectless clauses are uncommon in Late Old Swedish. Since this change takes place before the loss of person agreement, it seems reasonable to assume that this syntactic change cannot be related to deflection. The central task of the third part of the thesis, presented in chapters 5–8, is to explain why subject omission from Spec, IP has been limited in Swedish. It is argued that omission of subjects in verb second main clauses and subordinate clauses is an effect of movement strategies. Whereas the movement to Spec, IP is syntactically determined in Modern Swedish, the corresponding move is pragmatically determined in Early Old Swedish. Within the framework of Principles and Parameters, a formalized description of this difference is given. It is assumed that the uninterpretable subject feature in the I-domain in Early Old Swedish does not carry EPP and therefore can be eliminated without visible movement, whereas this feature carries EPP in Modern Swedish and therefore must be removed by a visible movement of the subject to Spec, IP. The change from a pragmatically to a syntactically determined movement to Spec, IP is related to a change in frequency patterns, in turn triggered by the loss of OV word order in Swedish.
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| 7. |
- Håkansson Lindqvist, Marcia, 1962-
(författare)
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Conditions for Technology Enhanced Learning and Educational Change : a case study of a 1:1 initiative
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The uptake and use of digital technologies continues to increase in schools throughout the world. In many schools the uptake and use of digital technologies takes place in One-to-One (1:1) initiatives in which teachers and students have their own laptops. In this thesis the uptake and use of digital technologies is studied from the student, teacher and school leader perspectives in order to through this gain knowledge regarding the conditions for Technology Enhanced Learning (TEL) and educational change in K-12 schools. In the Unos Umeå research project the uptake and use of digital technologies in two schools, an upper secondary school and a compulsory school, was studied. A research design involving a case study approach (Yin, 2003, 2009) was used to study a 1:1 initiative. The methods of data collection were surveys, interviews and classroom observations. To explore, identify and describe conditions for TEL and educational change the data collected were used to map the initial expectations regarding the uptake and use of digital technologies from the start of the initiative as well as to follow the development of teaching and learning activities related to the uptake and use of digital technologies in the 1:1 classroom over a period of two years. The Ecology of Resources Model (Luckin, 2010) was used as a theoretical framework including the use of the concept of filters. Regarding the conditions for TEL, the results show that the uptake and use of digital technologies provides possibilities for new forms of teaching and learning in the 1:1 classroom. Students reported increased motivation, engagement and variation in schoolwork. Teachers described new forms of teaching as well as possibilities for collaboration, sharing of materials and continued professional development. For school leaders possibilities were found in collaboration, administrative support and follow-up of students and teachers, creating a unified vision of the work with digital technologies, and collaboration and sharing within the schools as an ecology of resources. The challenges seen from the student, teacher and school leader perspectives were related to use, technical support and optionality. If the possibilities are to be achieved, there is a need for continued professional development for teachers and school leaders. Further, clear directives through policy will be of importance. In the short term, the practical implications of the uptake and use of digital technologies, specifically in 1:1 initiatives, seem to be strongly connected to sustainability in schools. In the long term, if sustainable conditions for TEL and educational change in the 1:1 classroom can be created and upheld, the practical implications may for example be teachers’ improved skills to integrate a thought-through student use of laptops in their teaching practices and an increase in equality of digital competence between students, between schools and between classrooms in the same school.
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| 8. |
- Nordin, Sara, 1972-
(författare)
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Relational Destination Development : Case Studies on the Significance of Tourism Networks
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Destination development has become a key issue in local and regional development. In particular, many governments recognize the industry's potential for fostering economic growth and development. The tourist destination is often conceptualized as a complex network with several levels of interaction – both networks of actors within the destination, but also networks linking it to its surrounding environment with potential and actual customers, other destinations, government bodies and so on. It is hence the assumption here that we cannot fully understand destination development in a particular community unless we have a good understanding of how the key stakeholders interact.By applying different network approaches that are based upon and united by a relational economic geography perspective to the study of destination development, we can widen our understanding of why some destinations struggle to survive and often decline, others maintain a threshold of success as tourist visiting areas, whereas there are still others, which exhibit a high level of competitiveness with local entrepreneurial milieus characterized by growth and long-term development.More generally, this thesis deals with a traditional core issue in economic geography, i.e., to explain what it is that makes a place or region characterized by growth and development. This thesis explores this issue, and expands our knowledge on the links between various types of network structures and growth in a destination context, as demonstrated by case studies of two successful tourism areas. These studies of the Swedish mountain resort of Åre, and of Icehotel in northern Sweden, explore relational destination development and the significance of tourism networks.
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| 9. |
- Matsson, Ingvar, 1963-
(författare)
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Studies of Nuclear Fuel Performance Using On-site Gamma-ray Spectroscopy and In-pile Measurements
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Presently there is a clear trend of increasing demands on in-pile performance of nuclear fuel. Higher target burnups, part length rods and various fuel additives are some examples of this trend. Together with an increasing demand from the public for even safer nuclear power utilisation, this implies an increased focus on various experimental, preferably non-destructive, methods to characterise the fuel.This thesis focuses on the development and experimental evaluation of such methods. In its first part, the thesis presents a method based on gamma-ray spectroscopy with germanium detectors that have been used at various power reactors in Europe. The aim with these measurements is to provide information about the thermal power distribution within fuel assemblies in order to validate core physics production codes. The early closure of the Barsebäck 1 BWR offered a unique opportunity to perform such validations before complete depletion of burnable absorbers in Gd-rods had taken place. To facilitate the measurements, a completely submersible measuring system, LOKET, was developed allowing for convenient in-pool measurements to be performed.In its second part, the thesis describes methods that utilise in-pile measurements. These methods have been used in the Halden test-reactor for determination of fission gas release, pellet-cladding interaction studies and fuel development studies.Apart from the power measurements, the LOKET device has been used for fission gas release (FGR) measurements on single fuel rods. The significant reduction in fission gas release in the modern fuel designs, in comparison with older designs, has been demonstrated in a series of experiments. A FGR database covering a wide range of burnup, power histories and fuel designs has been compiled and used for fuel performance analysis. The fission gas release has been measured on fuel rods with average burnups well above 60 MWd/kgU. The comparison between core physics calculations (PHOENIX-4/POLCA-7) and the in-pool measurements of thermal power indicates that the nodal power can generally be predicted with an accuracy within 4% and the bundle power with an accuracy better than 2%, expressed as rms errors.In-pile experiments have successfully simulated the conditions that occur in a fuel rod following a primary debris failure, being secondary fuel degradation. It was concluded that massive hydrogen pick-up takes place during the first few days following the primary failure and that a pre-oxidized layer does not function as a barrier towards hydriding in an environment with a very high partial pressure of hydrogen. Another series of in-pile experiments clearly indicate that increased UO2 grain size is an effective way of suppressing fission gas release in LWR fuel up to the burnup level covered (55 MWd/kgUO2).
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| 10. |
- Sundqvist, Kristina, 1973-
(författare)
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Beyond Recreational Gambling : a Psychological Perspective on Risk- and Problem Gambling
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The general aim of this thesis was to examine risk gambling in the general population from a psychological perspective. This was done in three studies targeting personality, risky alcohol habits and gambling motives, respectively. Initially, 19 530 randomly assigned Swedish citizens were screened for problem gambling via telephone using the two questions in the Lie/Bet questionnaire. This sample constitutes the basis for one of the studies in the thesis. For the other studies, individuals answering yes to one of the questions in the Lie/Bet questionnaire and agreeing to participate further were sent a postal questionnaire. The questionnaire included questions about gambling, personality and gambling motives. Some of the main results showed that:Negative consequences of gambling were associated with higher levels of impulsivity and negative affectivity.Risk gamblers reported lower levels of negative affectivity compared to the general population.Compared to non-risk gamblers, twice as many of the risk gamblers reported weekly binge drinking during the past 12 months. This association, however, seemed to be explained by shared demographic characteristics, rather than by the risk gambling causing binge drinking.High risk gamblers more often reported that they gambled for the challenge and for coping reasons, compared to low risk gamblers.High risk gamblers had overall stronger motives for gambling.The results also indicated that the level of risk gambling was highly intertwined with gambling motives and could explain some differences in gambling motives between, for example, women/men and younger/older gamblers.One of the focal points in the discussion was that higher levels of negative affectivity may be a cause of elevated problems rather than a cause of risk gambling. Another issue discussed was that the level of risk- /problem gambling may be important to consider when comparing gambling motives across subgroups of gamblers.
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