| 1. |
- Danielsson, Ulla EB, 1947-
(författare)
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Träffad av blixten eller långsam kvävning : genuskodade uttryck för depression i en primärvårdskontext
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Depression is a common mental health problem in primary health care. One third of the Swedish population is expected to experience depression at some point in their lives. The understanding of depression has expanded, both from a lay and primary health care perspective. The number of persons considering themselves as depressed, receiving the diagnosis, and getting treatment for it has increased steadily over the last decades. Unchanged, however, is that depression is diagnosed twice as often in women as in men, while twice as many men as women commit suicide. These gender differences appear in adolescence. In earlier research biomedical, psychological, and social-cultural explanations of gender differences have been discussed. Patient’s own perspectives have more seldom stood in focus, and men’s narratives in particular are still scarce. In this thesis, gender, i.e. how to be a woman or a man, is considered as a construct, formed and negotiated in social interaction. The aim of the study is to explore the gendered face of depression from a patient perspective: How is depression expressed and explained by patients in primary health care, by women and men, adults and adolescents? How are depressed women and men portrayed in the media? How do patient and media accounts of depression compare with the perspective offered in medical research articles? Method and material The analyses are based on data from three different sources: patient narratives, newspaper portrayals and scientific medical articles. – 37 in-depth interviews were undertaken with primary health care patients diagnosed with depression. Informants were chosen to include both men and women, grown-ups (Studies I + II) and young adults (Study V) of varying occupational and social class backgrounds. Data were analyzed according to grounded theory. – 26 articles portraying lay informants with depression (Study III) were drawn from three major Swedish daily newspapers by a search of database Mediearkivet 2002. The articles were analyzed by qualitative content analysis. –82 scientific articles concerning depression in relation to gender were identified in a PubMed search 2002. The understanding of depression in these articles was explored and compared with findings in the grown-up patient narratives and in the media portrayals by means of discourse analysis (Study IV). Findings Study I captured women’s and men’s formulations of their experiences of depression. To be marked with demands constituted a central experience for both women and men, but the outward manifestations differed in relation to gender as well as to class. Home and work had different priority. Men talked more about physical distress (often chest pain) than about emotions. Women readily verbalized emotional distress – shame and guilt – while physical symptoms were vague and secondary (often about the stomach). Men dealt with insecurity by aggrandizing their previous competence, women by self-effacement. Study II disclosed gendered trajectories into depression. Four symbolic illness narratives were identified: struck by lightning, nagging darkness, blackout and slowly suffocating. Most of the men considered their bodies suddenly “struck” by external circumstances beyond their control. The stories of women in the study were more diverse, reflecting all four illness narratives. However, the women had a tendency to blame their own personality and to describe depression as insidious and originating from the inside. The women expressed feelings of guilt and shame but also conveyed a personal responsibility and concern with relationships. Study III identified four themes in media portrayals of depression: displaying a successful facade, experiencing a cracking facade, losing and regaining control and explaining the illness. The mediated image of depression both upheld and challenged traditional gender stereotypes. The women’s stories were more detailed, relational, emotionally oriented and embodied. The portrayal of men was less emotional and expressive, and described a more dramatic onset of depression. Study IV revealed gaps in how depression in relation to gender is understood by the patients, the media, and the medical research establishment. There were differences in recognition, in understanding of the reasons, and in contextualization of depression. Although women and men described different symptoms and reasons for falling ill, in scientific articles these gendered differences were conceptualized mainly in terms of hormones and other biological markers. Study V elucidated the impact of gender on adolescent depression. The young women and men were all striving to be normal, influenced by demanding media images, confronted by identity trouble, and overwhelmed by feelings. They had dreams of an ordinary family and described normative expectations. Getting a safety net of friends and other adults was a way out. Both the young women and men were eager to communicate their distress when given the opportunity. This seemed especially important to some of the young men, who in talking about their emotional problems transgressed gender norms. Conclusions Patient perspectives enrich the understanding of gendered expressions of depression by making visible transgressions of and breaks with stereotype gender norms. Gender awareness is an important key in clinical consultation. To recognize gendered narratives of illness might have a salutary potential, making depression more visible among men, and relieving self-blame among women. By re-evaluating restrictive gender patterns, the clinician might encourage development of healthier practices of how to be a man or a woman, a development especially important for adolescents. An integrated model for understanding biological, gender and cultural aspects of depression has yet to be developed. As general practitioners we have a unique possibility to see and to study the whole individual in her social and cultural context.
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| 2. |
- Fhärm, Eva, 1955-
(författare)
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Treatment of cardiovascular risk factors in type 2 diabetes : time trends and clinical practice
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objectives Patients with type 2 diabetes are at much greater risk of developing cardiovascular diseases (CVD), including coronary heart disease (CHD), compared to non-diabetics. The lowering of glucose, blood pressure, and plasma lipid levels has been shown to reduce CHD risk, and treatment goals for these risk factors are now part of clinical practice guidelines. However, the incidence and outcome of CHD in diabetic patients does not show the same favourable trend as in the general population. Thus, the overall aim of the thesis was to investigate how the treatment goals for CVD risk factors contained in the national guidelines for diabetes care were reflected in clinical practice, and to explore factors that might influence the remaining high incidence of CHD in the type 2 diabetes population. Research designs and results I. The effectiveness of the introduction of treatment goals for dyslipidaemia was evaluated in a retrospective observational population-based cross-sectional study of 971 diabetic patients participating in the Västerbotten Intervention Programme (VIP) 1995–2004. There was a stronger trend of decrease in cholesterol levels among patients with diabetes compared to the non-diabetic population in 2000–2004. Increased use of lipid-lowering agents influenced the trend in diabetic patients, even though only 25.3% received lipid-lowering treatment after the introduction of the new guidelines. II. The experiences of general practitioners relating to treatment practice for type 2 diabetes with specific focus on the prevention of cardiovascular disease were explored in a focus group study. The overall theme was ‘dilemmas’ in GPs’ treatment practice for patients with type 2 diabetes. Five main dilemma categories were identified. First, GPs were hesitant about labelling a person who feels healthy as ill. Second, as regards communicating a diabetes diagnosis and its consequences, GPs were unsure as to whether patients should be frightened or comforted. Third, GPs experienced uncertainty in their role: should they take responsibility for the care or not? Fourth, GPs expressed concern over a conflict between lifestyle changes and drug treatment. Fifth, the GPs described difficulties when attempting to translate science into reality. III. Screening for microvascular and coronary heart disease according to national guidelines was evaluated in a cross-sectional study of 201 screening-detected patients with type 2 diabetes 1.5±0.7 years after diagnosis. A larger proportion of diabetic patients was screened for nephropathy and retinopathy than for CHD. Twenty-three percent of the patients had minor or major ECG abnormalities, but ECG findings seemed to have little or no impact on CHD prevention using lipid-lowering medication and ASA. A clinical history of CHD correlated with a larger proportion of patients receiving secondary prevention. IV. Time trends relating to the achievement of treatment goals and 10-year CHD risk at three years of diabetes duration were studied in 19,382 patients with type 2 diabetes without CHD, who were reported by primary health care sources in the National Diabetes Register in 2003–2008. National treatment goals for glycaemia, blood pressure, total cholesterol, and LDL cholesterol were achieved in 78.4%, 65.5%, 55.6%, and 61.0%, respectively, of the diabetic patients in 2008 following a trend of improved results in 2003–2008. Absolute 10-year risk of CHD increased between year of diagnosis and follow up in a studied subgroup while modifiable risk decreased. Conclusions The introduction of treatment goals for dyslipidemia in Swedish national guidelines in 1999 were reflected in lowered cholesterol levels in people with type 2 diabetes. Since the introduction of the guidelines, an increasing number of diabetic patients are treated in accordance with guidelines. A remaining microvascular focus on the patients together with the revealed dilemmas within the GP’s consultation with diabetic patients might negatively influence the remaining high incidence of CHD in the type 2 diabetes population. Lipid levels, blood pressure and smoking are targets for further improvements.
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| 3. |
- Andersson, Gunnel, 1958-
(författare)
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Urinary incontinence : prevalence, treatment seeking behaviour, experiences, and perceptions among persons with and without urinary leakage
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis is to describe urinary incontinence (UI) from a population perspective and to describe experiences and perceptions of UI from an individual perspective. This includes assessing the prevalence of urinary incontinence as well as describing treatment seeking and experiences of living with UI. A secondary aim was to describe the perception of UI among cultures other than the Swedish mainstream, exemplified in this case by Syrian women living in Sweden. Both quantitative and qualitative methods were used, including questionnaires and interviews. Studies I and II were quantitative studies based on a population-based study. Together with a postal survey on general health and living conditions “Life & Health”, a questionnaire on urinary incontinence was sent out to 15 360 randomly-selected residents aged 18-79 in Orebro County, Sweden. In Study I, UI was found to affect 19%. The majority of the respondents experienced minor problems, and only 18% of those reporting UI wanted treatment. However, there was also a group who reported severe problems, but despite this 42% of them did not want treatment. Study II investigated why people with UI refrain from seeking care and treatment. It was found that the desire for treatment was regulated by the frequency of UI, being restricted from participating in various activities, the degree of inconvenience, and the type of UI. Studies III and IV were both qualitative interview studies, describing older women’s experiences of living with UI (Study III) and Syrian women’s perceptions of UI (Study IV). There were similarities between the results of these two studies; the women described UI as a normal and expected problem, and they knew that the district nurse could prescribe incontinence protections and that treatments existed. In both studies, the women expressed difficulties in making contact with the health care service, while the women who did not speak Swedish (Study IV) also had difficulties due to different communication problems. In conclusion, it is important that health care resources are optimized to identify and meet the needs of those who experience major problems with UI, and that there is awareness of the communication difficulties that can be present in meeting with people who speak other languages. However it is also important not to medicalize those who experience minor problems and who have the desire to manage on their own.
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| 4. |
- Alvinius, Aida, Docent, 1979-, et al.
(författare)
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Do military leaders resist organizational challenges?
- 2019
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Ingår i: Journal of Resistance Studies. - Ed : Irene Publishing. - 2001-9947. ; 5:1
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Tidskriftsartikel (refereegranskat)abstract
- Armed forces in many Western countries have been facing societal change processes for more than twenty years; including value changes, government savings and, more recently, by the unstable security environment. The starting point here is that there is a relationship between processes of societal change and organizational challenges. The purpose of this study is to examine how military leaders manage and respond to different kinds of organizational challenges, focusing on resistance. The empirical material was collected using a grounded theory approach. Informants possessing wide experience of leadership participated in this study. The qualitative analysis describes the coping strategies, acceptance and resistance found among military leaders when dealing with organizational demands. Challenges caused by societal changes are experienced as negative aspects of organizational structure. This may be an explanation for why military leaders cope with them applying both resistance and acceptance. However, our main conclusion is that resistance to change stays within a culture of obedience.
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| 5. |
- Andersson, Helene
(författare)
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MRSA and other resistant bacteria : prevalence, patient and staff experiences, wounds and infection control
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Antibiotic resistance has become a major and serious global problem in healthcare. Limited treatment options for infections caused by these organisms can lead to increased morbidity and mortality. Sweden has a low prevalence of antibiotic resistance compared to most other countries but this presents an increasing problem for society and healthcare even in Sweden. The overall aim of this thesis was to illuminate potential problems related to antibiotic resistance from different perspectives: assessing the prevalence of resistant bacteria methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) or other resistant bacteria, and associated wound types, patient and health staff experiences when confronted with resistant bacteria infection, and the occurrence of such infections in the nursing home environment. In the first study a total of 2172 patients admitted to hospital or as out-patient visit at a University hospital during one day were examined with the purpose to identify all wounds, wound types and wound characteristics, and to identify bacteria in all wounds, particularly MRSA, VRE and multi-resistant Gramnegative rods. Four hundred and eight (19%) patients had a total of 668 wounds. Of these, 248 wounds, from 216 patients were cultured. Two unknown MRSA-patients were identified. No patient with VRE was found and there was a low prevalence of other multi-resistant bacteria. In the second study fifteen patients with MRSA infected wounds were interviewed. The aim was to ascertain and describe patients’ knowledge, perceptions and experiences of being MRSA-positive. The interviews were analyzed according to qualitative content analysis. From the analysis three categories and one overall theme were identified. Results showed that information about the MRSA diagnosis often caused a shock-like reaction. The patients’ perception of being MRSA-positive was that it was stigmatizing like the plague or leprosy; they felt dirty and a severe threat to their environment. Fears of infecting someone else and being rejected were commonly expressed. Knowledge and empathy from staff involved in their care was crucial to optimise patients’ experiences. Staff’s needs of education to meet patients’ demands for information, and to prevent spread of antibiotic contamination was essential. In the third study eight nurses and seven assistant nurses from different hospital wards and nursing homes were interviewed regarding their experiences of caring for MRSA-positive patients. Qualitative content analysis was carried out when analysing the data and three themes were identified during the process. Stress and too high workload were factors which were described to cause concerns in the caring situation. A major concern was that nurses felt at risk of becoming infected themselves and then transmitting the infection to other patients and to family members. Knowledge and ignorance about MRSA affected the nurses’ caring; ignorance made them afraid and insecure while knowledge and understanding shaped confidence in their role as caregivers. In the fourth study 560 residents in a total of 67 wards, in nine nursing homes were investigated for prevalence of MRSA, VRE and extended-spectrum β-lactamase (ESBL) - producing Enterobacteriaceae and if carriage of resistant bacteria was related to antibiotic treatment, other risk factors and/or staff´s adherence to guidelines for infection control. In all 296 staff members were interviewed and observed. No resident was positive for MRSA or VRE. Fifteen residents were found to be ESBL-positive. Usage of antibiotics was higher in wards where ESBL-positive residents were detected and there was an indication that there was transmission of ESBL between residents. Staff´s adherence to infection control guidelines sometimes revealed shortcomings but no significant difference regarding adherence to the guidelines could be found. In conclusion: Prevalence of MRSA appears low in both hospitalized patients, out-patients and nursing home residents. Adherence to infection control guidelines among healthcare staff, however, needs further improvement. MRSA colonized patients experienced psychological pressure and stigmatization. Knowledge and empathy from staff involved in their care is crucial to optimise patients’ experiences. Staff education to meet patients' demands for information and the prevention of contamination is essential
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| 6. |
- Gonzalez Lindh, Margareta, 1965-, et al.
(författare)
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Subjective swallowing symptoms and related risk factors in COPD
- 2019
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Ingår i: ERJ Open Research. - : European Respiratory Society. - 2312-0541. ; 5:3
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: This study aimed to investigate the prevalence of subjective (i.e. self-reported) swallowing symptoms in a large cohort of patients with stable chronic obstructive pulmonary disease (COPD) and to identify potential related risk factors.Methods: A total of 571 patients with COPD, investigated in a stable phase, participated in this multicentre study (335 females, 236 males; mean age: 68.6 years (sd 7.7)). Data were derived from spirometry, a questionnaire and a 30-metre walking test.Results: In total, 33% (n=186) patients reported at least some degree of swallowing problem. The most frequently reported symptom was food lodging in the throat (23%). A significant relationship was found between swallowing symptoms and dyspnoea, assessed as modified Medical Research Council (mMRC) ≥2 compared with <2 (46% versus 22%; p<0.001) and health-related quality of life, assessed as the COPD Assessment Test (CAT) ≥10 (40% versus 19%; p<0.001). Swallowing problems were also related to lower physical capacity (p=0.02) but not to lung function (p>0.28).Conclusion: Subjective swallowing symptoms seem to be a common problem in patients with stable COPD. This problem is seen in all stages of the disease, but is more common in symptomatic patients and in patients with lower physical capacity.
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| 7. |
- Oscarsson, Marie, 1956-
(författare)
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Healthy women or risk patients? : Non-attendance in a cervical cancer screening program
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Women afflicted with cervical cancer who have the highest morbidity and mortality rates have been the least likely to be screened. The overall aim of this research project was to investigate non-attendance in a cervical cancer screening (CCS) program among women with no registered cervical smear during the previous five years. Both quantitative (I,III) and qualitative methods (II) as well as costeffectiveness analysis (IV) were used in this research project. In Kalmar County women (aged 23-65 years) are invited to CCS every third year. All cervical smears taken both in opportunistic and organised CCS are coordinated in a register called Sympathy. The coverage is 88.4 %. From Sympathy, a random sample of 400 women served as a study group and another 400 women as a control group (III,IV). From the study group, 133 women participated in study I and 14 women in study II. Data was collected by telephone interviews based on a questionnaire (I), qualitative face-to-face interviews (II), questionnaire, promotive efforts and outcome (III), costs and effectiveness (IV). Quantitative data was analysed by descriptive and analytic statistics (I,III), qualitative data was analysed by content analysis. In study IV, cost-effectiveness analysis was used.The women believed that CCS was a good idea for all other women, but tended to refer to various circumstances resulting in their own non-attendance. One of the most common reasons for non-attendance was the feeling of being healthy. The women prioritized family and work commitments, and the invitation to attend CCS was sometimes experienced as a stressful disturbance. The feeling of discomfort was related to the gynaecologic examination, or to health care visits in general (I,II). Of 133 women, 120 could consider having a cervical smear taken and their two most common requirements for doing so were to be assured they would be treated in a friendly way (19%) and to find a suitable time (18%) for having the cervical smear. Fifty women wanted to be helped to have a cervical smear taken. Promotive efforts ranged from making a simple telephone call to arranging an appointment time to a combination of promotive efforts including repeated encounters in order to create a trusting relationship with respect to taking the smear. In the study group, 29.5% (n=118) had a registered cervical smear at follow-up compared to 18.5% (n=74) in the control group, (p<0.001) (III). In the study group, the cost per cervical smear taken was 66.87 €, and in the control group it was 16.62 €. The incremental cost per additional cervical smear taken was 151.36 € (IV). In conclusion, women’s reasons for not attending CCS are complex and are influenced by both present and earlier circumstances. In settings with high coverage, further contact in order to promote women’s attendance at CCS seems to be associated with high costs in relation to the number of additional cervical smears taken.
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| 8. |
- Ackesjö, Helena, 1973-
(författare)
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Barns övergångar till och från förskoleklass : Gränser, identiteter och (dis-)kontinuiteter
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this study is to gain knowledge of how the transitions to and from preschool class are described and understood by children. Previous research has indicated that transitions between different school forms can be seen as both problematic and threatening. Transitions should be facilitated and "smooth", something that indicates that continuity is important. Of interest for this study is to gain knowledge of children's perspective of continuities: which continuities and discontinuities children express intransitions.Transitions are theoretically considered as social processes that are constructed, shared and reconstructed together with others. In these processes, children mark and construct borders through speech and action. Their border markings (for example, expression of differences and/or similarities between different communities and between different school forms) also become part of a child's identity constructions.The thesis is based upon the research described in three articles. The empirical data underlying these studies was constructed in a longitudinal ethnographic inspired field work where children have been observed in two transitions between three different school forms: preschool, preschool class and compulsory school.Results suggest that from children’s perspectives the transitions between different school forms contain challenges, opportunities, limitations, changes and preservation. However, the transitions also involve expressions concerning security, risk-taking and include visual markings between the different school forms.One of the conclusions that can be drawn from this work is that it isn’t enough to turn to policy level, such as curricula or even teachers’ aims or aspirations to facilitate these transitions. The child’s perspectives need to be taken into account. Through children's narratives, we have gained knowledge about the opportunities transitions can offer, but also how transitions can be considered as threats or be difficult to interpret for children. This study has also increased our understanding of the importance of continuity as well as discontinuity to mark borders between different school forms.
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| 9. |
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| 10. |
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| 11. |
- Choi, Sun-Kyoung, 1967-
(författare)
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Kraften att älska, makten att tjäna : religion, emancipation och den kvinnliga skapande kraften i Jeanna Oterdahls sagor 1908–1927
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation studies the Swedish author Jeanna Oterdahl (1879–1965), and the fairy tales and stories she wrote in the period 1908–1927. Oterdahl was a well-known Christian public intellectual in her day. Besides being an author, she worked as a teacher and a lecturer, and was importantly involved in a number of organizations for societal development, such as the Association of the Christian Social Life [Förbundet för kristet samhällsliv] and the Settlement Movement [Hemgårdsrörelsen].The purpose of this study is to investigate the religious elements in her fairy tales and stories, and to study how these elements relate to the ideology of the early Swedish women’s emancipation movement. This movement rejected the conservative Christian faith of the Lutheran State Church, and aligned itself with the liberal form of Christianity that, to a greater extent, recognized the equality of men and women before God.Part I deals with the Christian message of love and its relation to emancipatory elements in Otherdahl’s stories. The point of departure for the analysis is Bremer’s interpretation of the Virgin Mary’s response to God’s calling, "Behold, the Lord’s servant" [Se, Herrens tjänarinna] and its emancipatory meaning. The women of Oterdahl’s stories take the role of servants of the Lord – not Lords [Herrens tjänarinna, inte herrarnas]Part II studies the female characters’ quest for their true (female) selves and their true home where alienation between the sexes will cease to exist and a spiritual kinship can take its place. This true home need not necessarily be a physical place; it can be in the form of an idea or a faith in something higher – such as God – where the self can live and reach its full personal potential. Part II analyzes Oterdahl’s understanding of the female characters’ quest against the background of Emilia Fogelklou’s interpretation of the role of Eve in the Genesis creation narrative (presented in her work “Two fairy tales” [Två sagor]), and against the background of one of Oterdahl’s own lectures, “How We Create a Home” [Hur vi skapa ett hem].The study ends with a discussion of how the concepts of freedom and power figure in Oterdahl’s stories. “Freedom” in Oterdahl’s stories is not a pursuit of power, but has to do with the use of one’s special gifts and with service to others. Freedom, in other words, means to take on responsibilities not only in the private home, but also in the community. Fogelklou describes this as a “human cause” [människosak] – something for women and men to strive for together.By examining how the Christian message of love is expressed through the emancipatory efforts of the female protagonists in Oterdahl’s stories, the dissertation highlights a new dimension in her work, and puts in question the common description of her stories as reactionary. Reinterpreted against the background of the Christian concept of calling/vocation and the ideology of the early emancipationist movement, the seemingly reactionary stories can be understood as emphasizing the importance of women in a changing society.
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| 12. |
- Christianson, Monica
(författare)
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What's behind sexual risk taking? : exploring the experiences of chlamydia-positive, HIV-positive, and HIV-tested young women and men in Sweden
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim was to explore the experiences of sexual risk taking among Chlamydia Trachomatis positive (CT+), HIV positive (HIV+), and HIV tested young women and men. The specific aims were to explore, from a gender perspective, the course of events, the norms, considerations and emotions involved in sexual risk taking in CT+, explore the perception of sexual risk taking in HIV+ youth, and their understanding of why they caught HIV and look at how the Law of Communicable Diseases Act impacts their sexuality. Moreover, to investigate why young adults test for HIV, how they construct the HIV risk, and what implications testing has for them.42 informants between 17-24 years of age were recruited from a youth clinic in Umeå and from three infection clinics for HIV patients in Sweden.In depth interviews and focus group interviews were tape-recorded, transcribed verbatim and analyzed according to a Grounded Theory approach.The finding revealed that behind sexual risk taking, there was a drive to go steady, where lust and trust guided if sex would take place. In one-night stands women were expected to be less forward compared with men. We found an uneven responsibility concerning condom use where men expected women to be "condom promoters". By catching CT, women experienced guilt, while men felt content through knowing "the source of contamination".Among the HIV+ youth, socio-cultural factors such as; lack of adult supervision, naivité, love, alcohol, drugs, the macho ideal and cultures of silence blinded the informants to the risks and made them vulnerable. By grouping narratives according to degree of consensus in sexual encounters, this demonstrated that sexual risks happened in a context of gendered power relations where the informants had varied agency. The Law of Communicable Diseases Act implied both support and burden for these HIV+ youth. A lot of responsibility was put on them and to be able to handle the infromation duty they tried to switch off lust, switch off the disease, or balance lust and obedience.Among the HIV tested youth, HIV was seen a distant threat. Many had event-driven reasons for testing for HIV; multiple partners being one. Risk zones, like bars were perceived to be a milieu that often was expected to include one-night stands. Responsibility for testing was a gendered issue; "natural" for women, while men rather escaped from responsibility and had a testing resistance. Receiving a "green card" confirmed healthiness and provided relief, and made the informants felt "clean". They could restart with new ambitious, including reconsidering risk.The findings can be used in public health and in health care sectors that work with young people. We present suggestions on how to decrease the spread of STIs:To implement how men could play an equal part in sexual and reproductive health.Promote general CT screening for men.Liberal HIV testing among both young women and men.Promote safer sex behaviour from the uninfected youth, especially focusing on men??.Consider the role of gender and social background in the context of risky behaviours.Give lots of positive rewards concerning HIV disclosure to diminish the risk for HIV transmission.
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| 13. |
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| 14. |
- Dögg Eddudottir, Sigrun, et al.
(författare)
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The history of settlement and agrarian land use in a boreal forestin Värmland, Sweden, new evidence from pollen analysis
- 2021
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Ingår i: Vegetation History and Archaeobotany. - : Springer. - 0939-6314 .- 1617-6278. ; , s. 1-13
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Tidskriftsartikel (refereegranskat)abstract
- Shielings are the historically known form of transhumance in Scandinavia, where livestock were moved from the farmsteadto sites in the outlands for summer grazing. Pollen analysis has provided a valuable insight into the history of shielings. Thispaper presents a vegetation reconstruction and archaeological survey from the shieling Kårebolssätern in northern Värmland,western Sweden, a renovated shieling that is still operating today. The first evidence of human activities in the area nearKårebolssätern are Hordeum- and Cannabis-type pollen grains occurring from ca. 100 bc. Further signs of human impactare charcoal and sporadic occurrences of apophyte pollen from ca. ad 250 and pollen indicating opening of the canopy ca.ad 570, probably a result of modification of the forest for grazing. A decrease in land use is seen between ad 1000 and 1250,possibly in response to a shift in emphasis towards large scale commodity production in the outlands. Emphasis on bloomeryiron production and pitfall hunting may have caused a shift from agrarian shieling activity. The clearest changes in the pollenassemblage indicating grazing and cultivation occur from the mid-thirteenth century, coinciding with wetter climate at thebeginning of the Little Ice Age. The earliest occurrences of anthropochores in the record predate those of other shieling sitesin Sweden. The pollen analysis reveals evidence of land use that predates the results of the archaeological survey. The studyhighlights how pollen analysis can reveal vegetation changes where early archaeological remains are obscure.
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| 15. |
- Ekblom Bak, Elin, 1981-, et al.
(författare)
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Accelerometer derived physical activity patterns in 27.890 middle‐aged adults : The SCAPIS cohort study
- 2022
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Ingår i: Scandinavian Journal of Medicine and Science in Sports. - : John Wiley & Sons. - 0905-7188 .- 1600-0838. ; 32:5, s. 866-880
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Tidskriftsartikel (refereegranskat)abstract
- The present study aims to describe accelerometer-assessed physical activity (PA) patterns and fulfillment of PA recommendations in a large sample of middle-aged men and women, and to study differences between subgroups of socio-demographic, socio-economic, and lifestyle-related variables. A total of 27 890 (92.5% of total participants, 52% women, aged 50–64 years) middle-aged men and women with at least four days of valid hip-worn accelerometer data (Actigraph GT3X+, wGT3X+ and wGT3X-BT) from the Swedish CArdioPulmonary bioImage Study, SCAPIS, were included. In total, 54.5% of daily wear time was spent sedentary, 39.1% in low, 5.4% in moderate, and only 0.1% in vigorous PA. Male sex, higher education, low financial strain, born in Sweden, and sedentary/light working situation were related to higher sedentary time, but also higher levels of vigorous PA. High BMI and having multiple chronic diseases associated strongly with higher sedentary time and less time in all three PA intensities. All-year physically active commuters had an overall more active PA pattern. The proportion fulfilling current PA recommendations varied substantially (1.4% to 92.2%) depending on data handling procedures and definition used. Twenty-eight percent was defined as having an “at-risk” behavior, which included both high sedentary time and low vigorous PA. In this large population-based sample, a majority of time was spent sedentary and only a fraction in vigorous PA, with clinically important variations between subgroups. This study provides important reference material and emphasizes the importance of a comprehensive assessment of all aspects of the individual PA pattern in future research and clinical practice.
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| 16. |
- Feldman, Inna, Docent, 1951-, et al.
(författare)
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Cost-effectiveness of a high-intensity versus a low-intensity smoking cessation intervention in a dental setting : long-term follow-up
- 2019
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Ingår i: BMJ Open. - : BMJ PUBLISHING GROUP. - 2044-6055. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim of this study was to conduct a cost-effectiveness analysis (CEA) of a high-intensity and a low-intensity smoking cessation treatment programme (HIT and LIT) using long-term follow-up effectiveness data and to validate the cost-effectiveness results based on short-term follow-up.Design and outcome measures: Intervention effectiveness was estimated in a randomised controlled trial as numbers of abstinent participants after 1 and 5-8 years of follow-up. The economic evaluation was performed from a societal perspective using a Markov model by estimating future disease-related costs (in Euro (Euro) 2018) and health effects (in quality-adjusted life-years (QALYs)). Programmes were explicitly compared in an incremental analysis, and the results were presented as an incremental cost-effectiveness ratio.Setting: The study was conducted in dental clinics in Sweden.Participants: 294 smokers aged 19-71 years were included in the study.Interventions: Behaviour therapy, coaching and pharmacological advice (HIT) was compared with one counselling session introducing a conventional self-help programme (LIT).Results: The more costly HIT led to higher number of 6-month continuous abstinent participants after 1 year and higher number of sustained abstinent participants after 5-8 years, which translates into larger societal costs avoided and health gains than LIT. The incremental cost/QALY of HIT compared with LIT amounted to Euro918 and Euro3786 using short-term and long-term effectiveness, respectively, which is considered very cost-effective in Sweden.Conclusion: CEA favours the more costly HIT if decision makers are willing to spend at least Euro4000/QALY for tobacco cessation treatment.
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| 17. |
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| 18. |
- Hjort-Telhede, Eva, 1968-
(författare)
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Health intervention with weighted blankets for frail older people with insomnia in nursing homes
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Insomnia is a common health problem among frail older people in nursing homes. An alternative method of dealing with insomnia has been developed through weighted blankets. The overall aim was to explore and describe how older people with insomnia living in nursing homes are affected in terms of sleep, quality of life, ADL ability, nutritional status and medication after an intervention using a weighted blanket. The study uses a qualitative and quantitative approach to explore the experiences and outcomes of using the weighted blankets. It increases the opportunity to integrate different perspectives and methods to understand the weighted blanket sufficiently. Study I aimed to explore how frail older people insomnia living in nursing homes experience the use of a weighted blanket. Study II aimed to explore nursing staff’s experiences of how a weighted blanket-based intervention influenced nursing home residents’ self-rated health. Study III investigated the effects of weighted blankets on the health of older people nursing home residents in terms of QoL, sleep, nutrition, cognition, ADL, and medication needs. Study IV examined how weighted blankets affect the sleep patterns of frail older people living in nursing homes. The studies suggest that weighted blankets improve the sleep of frail older people living in nursing homes by reducing the number of times they wake during the night. They can also improve overall well-being, emotional state, cognitive function, nutritional status, and daytime activity levels. However, it is essential to consider individual differences, as some users may find the blankets uncomfortable. Study IV revealed that weighted blankets can improve the sleep and quality of life of older people nursing home residents. Their use constitutes a safe and non-pharmacological intervention, but more research is needed to explore the long-term effects.
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| 19. |
- Johansson, Petter, 1981-
(författare)
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On the topology of the coamoeba
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In this thesis we study the topology and geometry of the coamoeba of an algebraic variety V. The strategy that we use is to relate the coamoebas corresponding to the initial varieties of V to the coamoeba of V. We also define an analogue of the Ronkin function for the coamoeba and give an explicit formula for it.
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| 20. |
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| 21. |
- Lindberg, Eva-Rut, 1958-
(författare)
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Byggprojektering för personer med funktionsnedsättningen elöverkänslighet : ett arbete i spänningsfältet mellan tro och vetande
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Elöverkänslighet är ett officiellt funktionshinder. Enligt Socialstyrelsens Miljöhälsorapport 2009 uppger 3,2 procent av befolkningen i åldrarna mellan 18 och 80 år att de är känsliga/överkänsliga eller allergiska mot elektriska och magnetiska fält, vilket motsvarar drygt 200 000 personer. 0,4 procent uppger att de har svåra besvär. Detta motsvarar knappt 30 000 personer som får svåra sjukdomsliknande symptom som exempelvis yrsel, illamående, huvudvärk, sömnproblem och hudbesvär när de vistas i elintensiva miljöer som större delen av befolkningen inte besväras av. Avhandlingen består dels av teoretiska studier över radiofrekvent strålning och hur denna kan avskärmas, dels av en enkätundersökning för att undersöka hur landets kommuner, försäkringskassekontor och tre landsting bemöter dessa personer. Genom den arkitektorienterade forskningsmetoden ”research by design” har ett förslag på ett elfritt typhus, som även kan avskärma de högre frekvenserna från den radiofrekventa strålningen, utformats men ännu inte byggts. Utifrån enkätundersökningen framgår att personer med funktionsnedsättningen elöverkänslighet ytterst sällan får hjälp med den tillgänglighetsanpassning i bostaden de enligt svensk lag har rätt till. Avhandlingen visar på vad som byggtekniskt kan utföras för att förbättra boendemiljön för personer med funktionsnedsättningen elöverkänslighet.
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| 22. |
- Liu, Sirui, et al.
(författare)
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Design of Hygroscopic Bioplastic Products Stable in Varying Humidities
- 2023
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Ingår i: Macromolecular materials and engineering. - : Wiley. - 1438-7492 .- 1439-2054. ; 308:2
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Tidskriftsartikel (refereegranskat)abstract
- Hygroscopic biopolymers like proteins and polysaccharides suffer from humidity-dependent mechanical properties. Because humidity can vary significantly over the year, or even within a day, these polymers will not generally have stable properties during their lifetimes. On wheat gluten, a model highly hygroscopic biopolymer material, it is observed that larger/thicker samples can be significantly more mechanically stable than thinner samples. It is shown here that this is due to slow water diffusion, which, in turn, is due to the rigid polymer structure caused by the double-bond character of the peptide bond, the many bulky peptide side groups, and the hydrogen bond network. More than a year is required to reach complete moisture saturation (≈10 wt.%) in a 1 cm thick plate of glycerol-plasticized wheat gluten, whereas this process takes only one day for a 0.5 mm thick plate. The overall moisture uptake is also retarded by swelling-induced mechanical effects. Hence, hygroscopic biopolymers are better suited for larger/thicker products, where the moisture-induced changes in mechanical properties are smeared out over time, to the extent that the product remains sufficiently tough over climate changes, for example, throughout the course of a year.
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| 23. |
- Montagnese, Sara, et al.
(författare)
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A pilot study of golexanolone, a new GABA-A receptor-modulating steroid antagonist, in patients with covert hepatic encephalopathy
- 2021
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Ingår i: Journal of Hepatology. - : Elsevier. - 0168-8278 .- 1600-0641. ; 75:1, s. 98-107
-
Tidskriftsartikel (refereegranskat)abstract
- Background & Aims: Golexanolone is a novel small molecule GABA-A receptor-modulating steroid antagonist under development for the treatment of cognitive and vigilance disorders caused by allosteric over-activation of GABA-A receptors by neurosteroids. It restored spatial learning and motor coordination in animal models of hepatic encephalopathy (HE) and mitigated the effects of intravenous allopregnanolone in healthy adults in a dose-dependent fashion. Herein, we report data on the safety, pharmacokinetics (PK) and efficacy of golexanolone in adult patients with cirrhosis.Methods: Following single/multiple ascending dose studies, adults with Child-Pugh A/B cirrhosis and abnormal continuous reaction time (CRT) on screening were randomized to 3 weeks’ dosing with golexanolone (10, 40 or 80 mg BID) or placebo. CRT, psychometric hepatic encephalopathy score (PHES), animal naming test (ANT), Epworth sleepiness scale (ESS) and electroencephalogram (mean dominant frequency [MDF]; delta+theta/alpha+beta ratio [DT/AB]) were obtained at baseline, 10, and 21 days.Results: Golexanolone exhibited satisfactory safety and PK. Baseline characteristics were similar between the 12 and 33 patients randomized to placebo or golexanolone, respectively. By prespecified analyses, golexanolone was associated with directionally favourable changes vs. placebo in ESS (p = 0.047), MDF (p = 0.142) and DT/AB (p = 0.021). All patients also showed directionally favourable changes in CRT, PHES and ANT, but with no statistical difference between golexanolone and placebo. Post hoc analyses taking into account the variability and improvement in CRT, PHES and ANT observed between screening and baseline suggested an efficacy signal by cognitive measures as well.Conclusion: Golexanolone was well tolerated and associated with improvement in cognitive performance. These results implicate GABA-A receptor-modulating neurosteroids in the pathogenesis of HE and support the therapeutic potential of golexanolone.Lay summary: Many patients with cirrhosis experience subtle but disabling cognitive problems, including sleepiness and poor attention span, that impair their ability to be gainfully employed or carry out activities of daily living. This pilot study tested the hypothesis that these problems with cognition, for which there is no approved treatment, might be improved by an experimental drug, golexanolone, designed to normalize the function of receptors which inhibit brain function. The results of this study suggest that golexanolone is well tolerated and may improve cognition, as reflected by measures of sleepiness, attention span and brain wave activity, paving the way for future larger studies of this promising experimental drug.Clinical trial registration number: EudraCT 2016-003651-30.
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| 24. |
- Obrenovic Johansson, Sanja
(författare)
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Från kombifeminism till rörelse : Kvinnlig serbisk organisering i förändring
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This study is about seven women’s organizations in Belgrade, Serbia and their relations to domestic and international donors during the period 2003-2006. My main research questions focus on their choices of either domestic or international cooperation partners. How and why did the women organize themselves? What factors were essential when selecting donors? In what ways were the organizations influenced by donors?Through interviews, with organization representatives’ concepts such as gift and reciprocity, power and dependency, trust and mistrust and collective identity emerged. These concepts were used as points of departure for developing deeper understanding of women organizations’ choice of cooperation partners.The women organizations’ basically had two alternatives for cooperation: cooperation with foreign donors which offered funds, organizational development and social networks. Alternately, cooperation with local donors, which offered the equivalent except for the organizational development. Cooperation with the foreign donor has resulted in more professional attitudes to the work that have been desired by other international donors. A result is that they can compete with other women’s organizations’ for international funding. Cooperation with local donors has led to fewer resources but more independent working practices. For these women organizations’ independence was important so they choose partners who, they felt more respected this allowing them to write articles or discuss gender in the media with little external influence. Regardless of the chosen donor the reciprocity is embedded in the relation between the donor and the receiver of aid, which in various ways is beneficial for both parties.
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| 25. |
- Olsson, Eva-Karin, 1973-
(författare)
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Media Crisis Decision Making : A Case Study of SR (Swedish Radio), SVT (Swedish Television) and TV4
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The study takes as its starting point that news organizations’ actions during crises vary more than one can expect based on previous research on news work. Accordingly, the dissertation aims to move beyond the notion of news organizations as homogenous and attempts to open the ‘black box’ of news organizations’ decision making. The study is based on interviews with members of three Swedish broadcasting organizations: the Swedish Public Television (SVT), the Swedish Public Radio (SR), and TV4. The interviews focused on how the three organizations dealt with the news coverage of the September 11th 2001 terrorist attacks in the USA. The four articles included in this dissertation challenge from different perspectives the previous assumptions presented in the field of media and journalism. First, as a response to the variety of definitions of non-routine news events applied in previous research, Article I sets out to propose a definition of crisis news events from a news organizational perspective. Accordingly, the article proposes to understand crisis news as surprise events that challenge key organizational values and that demand a swift response. Second, in questioning the notion of news organizations as homogenous, Article II examines the actions taken by the three Swedish broadcasting organizations in response to 9/11. This article argues, based on a neo-institutional perspective, that news organizations’ decision making can be explained by differences in organizational ‘rule-regimes’. Third, Article III challenges the assumption that newsroom actions are homogeneous by examining two newsroom responses to 9/11, in particular their everyday organizational structures and previous experiences. The last Article (IV) applies a slightly different perspective in arguing that during crises media managers’ decisions are not only influenced by the audiences’ informational needs but also by the ritual role news organizations play in times of crises.
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| 26. |
- Penno, Eva, 1971-
(författare)
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Studies of Acute Rejection Using Contrast Agents and Magnetic Resonance Imaging
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Solid organ transplantation is today an established form of treatment for end-stage organ disease. Monitoring of graft function and pharmacological therapy constitutes a maze of clinical observations and histological evaluations of biopsy specimens; with the biopsy results playing a decisive role. The aims of this doctoral research were to investigate the feasibility of detecting acute rejection of transplanted organs and monitoring the effect of anti-rejection treatment, with the use of ultrasmall superparamagnetic iron oxide particles (USPIO) and magnetic resonance (MR) imaging with a clinical MR scanner.Allogeneic and syngeneic heterotopic heart transplantations were performed in rats. Three different-sized USPIO were given to one allogeneic and one syngeneic group. The change in MR signal intensity (SI) over time was measured. An increase in SI was interpreted as damage to micro vessels due to the pronounced inflammatory reaction caused by acute rejection, which led to leakage of USPIO into the tissue. A decrease in SI was interpreted as normal vascular structure, since USPIO normally remains in the intravascular space. The same method, using one of the previously tested USPIO, was used in a treatment study in which acute rejection in transplanted rats was induced and subsequently treated. An attempt was also made to detect presence of macrophages in an acutely rejecting graft, since this cell type plays an important role in the acute rejection process; this was done by testing the ability of macrophages to phagocytose the UPSIO compound.In permeability studies with MR imaging all three USPIO tested discriminated between rejecting and non-rejecting grafts without any overlap of the groups. Factors that contributed to the ability to distinguish between grafts were the size and half-life of the particle. We were also able to monitor effects of anti-rejection treatment by studying the vascular permeability of USPIO and MR imaging. We did not succeed in detecting macrophages in the rejecting grafts with USPIO and MR imaging.This thesis presents a novel approach to detection of acute rejection of transplanted organs and to monitoring the effects of anti-rejection treatment using different USPIO contrast agents and MR imaging in a clinical MR scanner.
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| 27. |
- Ställberg, Björn, 1951-
(författare)
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Asthma in Primary Care : Severity, Treatment and Level of Control
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims. The overall aim was to examine the severity, treatment and level of control in patients with asthma in primary care in Sweden. The specific aims were to assess what matters to asthma patients, evaluate symptoms, medication and identify factors related to asthma severity, compare the extent of asthma control in 2001 and 2005, and investigate the development of asthma and degree of asthma control in adolescents and young adults who had reported asthma six years earlier. Methods. The first study was a telephone interview of a representative sample of Swedish asthmatics. In the second study a random sample of 1,136 patients answered two questionnaires. A classification of the asthma severity similar to that in the GINA guidelines was made. In the third study two surveys were performed, in 2001 and in 2005, with a random sample of 1,012 and 224 asthma patients, respectively, and a classification of asthma control similar to the recent GINA guidelines was made. In the fourth study 71 individuals who reported physician-diagnosed asthma in a population-based survey in 1997 and were defined as current asthmatics, were reinvestigated in 2003 with a skin prick test, methacholine challenge test, eucapnic voluntary hyperventilation test and measurement of exhaled nitric oxide. Results. Common situations causing symptoms of asthma were physical exertion and contact with pets. Nocturnal symptoms were frequent. In primary care 35% of the women and 24% of the men were classified as having severe asthma. Female sex, increasing age, not filling the asthma prescription owing to cost, daily smoking, and pollen allergy increased the odds of having severe asthma. In 2001, 37% had achieved asthma control, as compared with 40% in 2005. Uncontrolled asthma was more common in women and smokers. In the 2003 study of adolescents and young adults with asthma six years earlier, the definition of current asthma was fulfilled by 50 of the 71 subjects and one third had achieved asthma control. Conclusions. The majority of the asthmatics reported a large number of symptoms and limitations in their daily living. Many asthma patients in primary care have insufficient asthma control. One reason for lack of control might be undertreatment with inhaled corticosteroids.
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| 28. |
- Sylwan, Ida, 1984-
(författare)
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Sludge-derived char : utilisation as a metal sorbent in dilute wastewaters
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Metal concentrations in soil and water have increased since the Industrial Revolution, which may have negative health and environmental effects. Metal pollution occurs, for instance, in municipal wastewater, industrial wastewater, and stormwater. Concentrations are often low, due to dilution. A common technology for metal removal is sorption. Char produced from pyrolysis of municipal sludge (SDC), has been pointed out as a potential low-cost sorbent. However, the scientific literature mainly focuses on experiments using artificial solutions at concentrations much higher than those found in said wastewaters (in a Swedish context). The goal of this study was to investigate SDC use for the removal of metals, focusing on reuse of SDC in primary treatment (PT) of municipal wastewater and with some attention to other applications. The investigation was performed through experimental laboratory studies, modelling, and literature review/assessment. The data obtained from the literature review indicated that sorption is suitable for enhancing removal of nickel (Ni), copper (Cu), cadmium (Cd), lead (Pb), and zinc (Zn) during PT. With respect to Ni and Cu; from ~7–50% and ~10–70%, respectively (no SDC), to ~65–98% and ~45–85%, respectively (with SDC). Experimental results showed that SDC could remove >95% of Pb, Cd, Cu, Cr, Ni, Hg, and Ag from artificial solution, at concentrations similar to those in raw municipal wastewater. However, sorption of Cu and Ni was inhibited in real wastewater (a decrease from >99 and 99%, respectively, to 68 and 40% respectively). The inhibition was linked to the presence of dissolved organic matter. Modelling, based on raw wastewater composition indicated that SDC addition in PT may enhance the removal of Cd and Cu (from 39% to 79% and 30 % to 43%, respectively). Experiments showed that the investigated SDC had a larger Pb sorption capacity, compared to activated carbon and wood-derived char. Experimental investigations and modelling (sorption isotherms) indicated that literature data did not give satisfactory estimations of the Pb sorption capacity onto SDC at concentrations considered; the available data was generally valid for much higher concentrations. The experimentally determined Cd sorption capacity of SDC produced from primary sludge exceeded that of SDC produced from digested sludge. However, given the loss of biogas production the theoretical energy balance of primary sludge pyrolysis was negative. Finally, the local demand for Cd-sorbent in the Västerås region could potentially be covered by the SDC generated locally.
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| 29. |
- Westborg, Inger, 1960-
(författare)
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Safety and efficacy in the cataract surgery process
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundCataract and age-related macular degeneration (AMD) are two major causes for visual impairment in the elderly. Cataract surgery is one of the most common surgical interventions performed in the western world. As a consequence of the increasing number of operations performed, postoperative visits are a large workload for surgical units. It is important that all parts of the cataract surgery procedure are appropriate and cost-effective. During the last 20 years the trend is towards fewer visits both pre- as well as postoperatively. The number and timing of postoperative visits are also a subject of an ongoing debate. Few studies have previously evaluated safety perspectives concerning the number and timing of post-operative visits.The last decade, new treatments for wet AMD have evolved and the number of patients receiving treatment has increased. It has been debated if blue-blocking intraocular lenses (IOL) have a protective effect on the development of wet AMD and decreasing the need for AMD-treatment after cataract surgery.AimsTo analyse parts of the modern cataract surgery process including peri- and post-operative routines from a safety and efficacy perspective. To analyse pre- and perioperative risk factors as well as protective factors associated with the need for wet AMD-treatment after cataract surgery.MethodsI, II. These prospective, observational cohort studies included all cataract surgery cases (n=1249) during a 1-year period, at one institution. The cohort was analysed regarding the use of a standardized anaesthetic regimen and the safety perspectives, when the standard routine is no planned postoperative visit in uncomplicated cases without ocular comorbidity.III. The above-mentioned cohort (study group), was compared with a cohort from another clinic (control group) with a different follow-up routine, i.e. each case with first eye cataract surgery had a planned postoperative visit. In the control group all patients (n= 1162 cases) had surgery during the same 1-year period. The number of planned and unplanned visits was recorded, and the surgical outcome from the two institutions was compared.IV. A register-based cohort study included all patients registered in the Swedish National Cataract Register and the Swedish Macula Register in 2010 - 2017, to find all eyes with past cataract surgery that were subsequently treated for wet AMD. Complete registry data was used for comparisons and analyses of pre- and peri-operative risk- and protective factors for wet AMD treatment after cataract surgery.ResultsI. A standardized anaesthetic method with topical and intracameral anaesthetics without sedation was used in most cases (90%). Median pain score after surgery was 0.7 (VAS 0-10) and most patients (97%) would choose the same anaesthetic method again.II, III. Evaluation of all medical records 2 years after the cataract surgery procedure, found no report of missed adverse events. Significantly less patients in the study group (9% vs 16%; p=0.000036) initiated a postoperative unplanned contact compared with the control group. Patients with 70 km or longer to the hospital were less inclined to seek unplanned care (p=0.016).IV. Female gender and high age are associated with an increased risk of needing treatment for wet AMD ≥1 year after cataract surgery. Eyes with a diagnosis of AMD preoperatively, and subsequently treated for wet AMD, had a significantly (p=0.023) lower degree of blue-blocking IOLs implanted at their previous cataract surgery.ConclusionI. A standardized anaesthetic method with topical and intracameral anaesthetics without sedation seems well tolerated by the patients, and is effective at cataract surgery, also in cases when complications/adverse events occur.II, III. Without compromising patient safety, it is possible to refrain from standard postoperative visits after cataract surgery in patients with uncomplicated surgery and no ocular comorbidity. A significant reduction in postoperative visits is only obtained if the standard routine applies to both first and second eye surgery.IV. Patients without preoperative AMD have no benefit from the use of blue-blocking IOLs. In patients with preoperatively diagnosed AMD, blue-blocking IOLs may offer some protection from the subsequent development of AMD.
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| 30. |
- Wickman, Kim, 1970-
(författare)
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Bending mainstream definitions of sport, gender and ability : Representations of wheelchair racers
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Inspired by feminist post-structural thinking and with a discourse analytic approach, this study’s main theme is gendered identity, disability and sport. It consists of four separate, but interrelated, empirical studies and focuses on two research questions. Firstly, how do female and male wheelchair racers construct and perform their identities? Secondly, how are female and male wheelchair racers represented in Swedish sports media? To answer the research questions, semi-structured interviews with wheelchair racers, and a critical analysis of sports media texts from the Paralympics in Sydney, 2000 have been conducted. In this dissertation the composition of unwritten regulations produced by the media texts, that shaped the practice of wheelchair athletes was conceptualized as the discourse of able-ism. Findings indicate that the sports media texts constructed the subject of ‘disabled sportsman/sportswoman’, which indirectly reproduced the conception of a copy and not an original. The exclusion was, however, concealed and neutralized through the regulation and differentiation that the discourse of able-ism legitimated. Although sports media still seems to reinforce negative stereotypes of disabled athletes, the wheelchair racers themselves are challenging the gender, sport and disability discourses and establishing new ways of being physically powerful and excellent in and outside the sports arena. In fact, when the athletes got the opportunity to make their voices heard in media, they re-dressed the twisted picture of wheelchair racing as passive rehabilitation training into elite sport. Consequently, it seems that wheelchair racing and its high status in disability sports empowers both male and female racers which increases their possibility to be represented as ‘real’ sportsmen and sportwomen. Finally, although, the athletes have shown that wheelchair racing has a given place in modern sport, ‘being able’ as an athlete and being a gendered individual are still strongly connected to the appearance and performance of the un-impaired body.
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