| 1. |
- Adalberth, Gunnar
(författare)
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Total knee arthroplasty : Alternative aspects on fixation, design and postoperative treatment
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Total knee arthroplasty as a treatment of severe gonarthrosis has become a great success, but tibial component loosening is still a major reason for failure. When total knee arthroplasty was introduced, only all-polyethylene (AP) tibial components were available. Based on mostly theoretical data, AP components were more or less abandoned during the 1980:ies in favor of metal-backed (MB) tibial components. The aim of the present study was to evaluate whether insufficient fixation would result, using an all-polyethylene tibial component instead of a more costly metal-backed prosthesis. Further, to compare different antibiotic loaded bone cements, and to investigate whether post- operative drainage is beneficial in total knee arthroplasty. Radiostereometric analysis (RSA) was used to obtain accurate and standardized evaluations facilitating comparison between prosthetic designs.Magnitude and pattern of migration of a moderately conforming AP tibial component was analyzed in 22 patients. Migration was on par with a more conforming previously used frequently, AP component, indicating a favorable prognosis regarding future aseptic loosening. Another 34 arthroplasties with a flat on flat (non-conforming) articulating geometry were randomized to an AP or MB cemented tibial component. There were no differences in migration between the groups. None of the AP implants displayed any continuous migration between 1 and 2 years postoperative. In a similar randomized series of 38 arthroplasties with a semiconstrained articulation, fixation measured with RSA was not inferior for AP implants compared with MB. Both studies indicate a good long-term prognosis using an AP component. A new antibiotic loaded bone cement was prospectively randomized against a more commonly used bone cement in a series of 51 arthroplasties. Neither fixation of the tibial component nor the radiographic and clinical results differed between the cements, indicating a good prognosis for the new cement. Postoperative drainage of knee arthroplasty is widely used. 90 patients were prospectively randomized into three groups: no drain, ordinary drain system and a retransfusable drain system. Postoperative drainage in knee arthroplasty has no adverse clinical consequences but seems not to be necessary.
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| 2. |
- Ahlgren, Inger
(författare)
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Utbildningsplaner och reformimplementering : Sjuksköterskeutbildningen i fokus
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This study describes the course of events within the area of health care with regard to two educational reforms in Sweden: the 1982 reform of certain middle length health care education called the Health Care 77 reform and the 1993 University and College reform. As a result of the first of these reforms, the nursing education was transformed from an education on the secondary school level to a university college level.The present study which has its underpinnings within the implementation process has twoaims: first to clarify the governmental intentions and to illustrate how these intentions wereinterpreted and formulated by those in charge of executing the reforms and secondly toinvestigate to what degree other factors than those directly connected to the actual reformshave influenced the content and form of the operative activities.The frame of reference describes the problems of political governing of education as twofold: the process of making political decisions and the process of executing those decisions.The reality where the goals are formulated and reality where goals are realized are governedby different contingencies, which may be difficult to bridge between. In the present study, thepolitical governing of a reform is seen in a curriculum theoretical perspective and theexecution of the reform is seen in an organization theoretical perspective.The empirical material in this study entails primarily government and local documentssupplemented by interview studies along with studies of correspondence studies with thoseinvolved in the units of interest.There are two main results of this study. The first result was that the formal politicalgoverning of an education has a certain impact but that the informal execution of a reformwill be dependent upon the values and culture of those in the local organization. The secondresult showed that the implementation process entails two phases: a transformation phasewhere government directives are reformulated into local documents and an implementationphase where the local documents are executed in an activity. Commonly, researchers includethe transformation phase within the implementation process but the results of this studysuggest that it may be of greater value to view the transformation phase as phenomena, whichcan be both defined and studied on its own.
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| 3. |
- Ahlsén, Göran
(författare)
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Structure-activity and resistance studies of HIV-1 protease inhibitors
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The present investigation was undertaken in order to identify inhibitors of HIV-1 protease that would be efficient in vivo and against HIV-1 protease carrying mutations known to confer resistance to inhibitors in clinical use. A second interest was to understand details of inhibitory mechanisms and to gain understanding of the molecular details of resistance.Linear inhibitors of transition-state type showed to have a resistance pattern similar to protease inhibitors in clinical use, whereas cyclic inhibitors of sulfonamide were somewhat different in their inhibitory profiles. It was found that mutation L90M in some situations could lessen the decrease in overall efficiency suffered by the enzyme when aquiring other mutations. Also presented are results from the characterization of double mutation I84V/L90M, formerly not investigated. Testing of triple and quadruple mutant confirmed the additive features of some mutations. In an attempt to find new leads for inhibitor development, extracts from bee propolis, a natural product, was investigated, and it was found that one extract inhibited wild-type enzyme with an I50-value of 0.2 μg/mL. Even more interesting is the result that propolis extract also inhibited all the investigated mutant enzymes.
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| 4. |
- Ahn, Sang-Hoon
(författare)
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Pro-welfare politics : A model for changes in European welfare states
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation explores the changing conditions of European welfare states and the underlying driving forces behind these changes. It is broadly based on the recently emphasized notions of dynamic structuring and internal structure of welfare programs, taking into account the new environment of the welfare state. More specifically, it seeks to uncover the political mechanisms behind the changes in public welfare program structure by examining important driving forces at a macro level, then by relating this to political processes at the micro level. Thus, this dissertation is composed of two parts, i.e., a macro- and a microanalysis of pro-welfare politics.In the macro analysis, the relative explanatory power of core driving forcesbehind welfare efforts is examined using a pooled time series analysis of 12 European countries for the period between 1960 and 1989. In addition to drawing on traditional approaches that emphasize the importance of political driving forces, differences in the roles played by Left party power and Christian party power are examined. The meaning of intergenerational conflict is also examined in the context of welfare program changes.The microanalysis is devoted to uncovering mechanisms of pro-welfare politics by analyzing the complex internal relationships of those pro-welfare politics.This is approached using a theoretical framework of "welfare statuses of rights and duties" as an alternative to the class-based cleavage framework. Also in this second part, Swedish survey data collected in 1995 is analyzed using the LISREL method to check the empirical validity of the suggested framework.The dissertation concludes by suggesting the new notion of welfare rights alliance as a conceptual tool for linking the macro-micro-macro relationships of pro-welfare politics. Building on this, a multi-dimensional model of public welfare change is presented, along with examples of how the preceding discussions and analyses can be understood in the context of the model.
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| 5. |
- Al-Windi, Ahmad
(författare)
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Determinants of health care and drug utilisation : The causes of health care utilisation study
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The costs of health care and medicines are a considerable and rapidly increasing part of the gross national product in Sweden. like in many other countries.The purpose of this study was to identify factors that influenced the we of health care and drugs in subjects aged 16 years and above in Håbo, a Swedish municipality. The study population consisted of 827 men and women from a random age-stratified population sample of 1,312 subjects. A postal questionnaire was used to collect information on sociodemographic characteristics. well-being variables. symptoms and chronic disease, and on the use of health care (including alternative medicine), drugs (including herbal medicines) and self-care products.Several sociodemographic characteristics, such as as sex, marital status, household size, educational level and occupational status, were related to many of the well-being variables and symptoms. These sociodemographic characteristic were also independently related to the use of health care. drugs and self-care products.Well-being variables (particularly bad perceived health), a high number of symptom (six or more) and chronic disease were also independently related to the use of health care, drugs and self-care products. Combinations of certain independent variables could explain, or "predict", special patterns of health care and drug use. For example, the likelihood of consulting a physician frequently (three times or more per year] was very high in subjects with a certain profile, viz. high age. female sex, sick leave or disability pension bad perceived health. high number of symptoms and chronic disease. Indeed, 31-92% of appointments to a physician could be attributed to these factors, depending on the model used. The same combination of factors, except high age, explained 21 to 91% of the number of patients using prescribed pharmaceuticals. Between 6% and 85% of the number of days in hospital were attributable to the combination of sick-leave or disability pension and bad perceived health, chronic disease.Using information on the most important variables, i.e. those with the strongest independent relationships to the use of health care and drugs. in the population of a specific district may be of value in estimating the demand for health care resources in that district. and in the allocation of resources. It may also provide a basis for preventive efforts aiming at reducing the needs.
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| 6. |
- Alemi, Mansour
(författare)
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Molecular biological techniques as a tool in diagnostic pathology : Applications in B-cell lymphoproliferative disease, medullary thyroid carcinoma and cervical carcinoma
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Identification of malignancy associated with mutations in gene sequences requires detection ofas little as a single base difference. A powerful technique in mutation detection is polymerasechain reaction (PCR) followed by single-strand conformational polymorphism (SSCP) andsequencing.The present investigation is focused on improving tests for the following diagnostic questions:(i) clonality in malignancy of lymphoid origin by developing simple laboratory methodsbased on PCR in which the monoclonal B-cell lineage can be distinguished from thepolyclonal, (ii) presence of mutations in RET proto-oncogene involved in sporadic medullarythyroid carcinoma (MTC), and (iii) development of a simple test which can distinguishbetween prototype human papillomavirus 16 (HPV16) and variant HPV16 containing a pointmutation at codon 83 of the E6 gene.The rearrangement of the immunoglobulin heavy chain gene can be used as a marker of B-celllineage and clonality. By using PCR with specific primers corresponding to the variable and joining regions, it is possible to detect the rearrangement of a small amount of clonal B-cells ina polyclonal background. This study has shown that the SSCP analysis of PCR fragmentsincreases the sensitivity and the specificity of the test.Oncogenic activation of the RET related to somatic missense mutations has been shown insporadic MTC. These mutations are believed to play an important role in the tumorigenesis ofMTC. By combining microdissection of tumor cells followed by PCR-SSCP, fragment sizeanalysis and sequencing, a small proportion of cells with mutation in a subpopulation of cellswithin a tumor can be detected. A variant of HPV 16 has previously been shown to be moreprevalent in invasive cervical carcinoma than in preinvasive lesions. In the present study asimple, rapid PCR-SSCP assay has been developed to identify women who are at increasedrisk of progression to invasive cervical carcinoma.
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| 7. |
- Amcoff, Jan
(författare)
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Samtida bosättning på svensk landsbygd
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This study has two main aims. First, to describe population change and the growth of housingstock in the Swedish countryside. Secondly, to find possible explanations for these changes. The countryside is understood as the livingmilieu outside the builtup cities and localities (urban places). In line with the first aim, data on the population within and outside Swedish localities 1970-1 995, and individual data on the dwellings outside localities in East Central Sweden, are analysed. In line with the second aim the data on dwellings are supplemented by socioeconomic and demographic data on their residents. The study shows that the population outside built-up localities has been growing, particularly in the areas surrounding bigger cities. This is primarily due to an influx of families with children. Although many of them have converted existing second-homes into permanent dwellings, the dwelling-stock is growing even faster than the population. That is primarily due to young people leaving home. A British-inspired possible explanation based on the attractive force of the middle-class image of the rural idyll is rejected on empirical grounds. The same goes for an explanation in terms of low-budget detached housing. Explanations emphasising the reduced geographical restrictions on rural living (e. g. improved commuting possibilities) seem to fit the empirical data better. That does also implies that the attractions of the countryside as a living milieu should be sought for further back in history than in recent time. Sweden is a recently urbanised country where many people still have personal ties to a farmstead or village. It has also been argued that the national culture, for a number of reasons, is oriented towards nature and the rural.
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| 8. |
- Amin, Kawa
(författare)
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The relationship between inflammation and structural changes in the airways of the lower and upper respiratory tract : Studies in patients with asthma, Sjögren's syndrome, rhinitis and children with otitis media with effusion
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The pathophysiology of asthma, Sjögrens syndrome (SS), rhinitis, and otitis media with effusion (OME) in children has been extensively investigated in upper and lower respiratory tract, respectively, and shown to comprise structural changes in the airways and involvement of inflammatory cells. By comparing diseases that have bronchial hyperresponsivenses or mucosal inflammation as a common denominator, it may be possible to learn more about the mechanisms underlying inflammation in the upper and lower respiratory tract.With immunohistochemical techniques and a panel of monoclonal antibodies, inflammatory cells were identified and structural changes of the airway were quantitatively studied in the bronchial, nasal and middle ear mucosa and submucosa.The highest number of eosinophils and mast ceils in bronchial, nasal or middle ear biopsies was found in patients with atopic asthma (AA), perennial non-allergic rhinitis (PNAR) and children with OME. The number of the neutrophils was highest in SS, non-atopic asthma (NAA) and children with OME. The number of T lymphocytes in SS and AA was significantly higher than in NAA and healthy controls (HC). The degree of epithelial damage was higher in the AA group andin patients with perennial allergic rhinitis where the biopsy was taken within the pollen season (PARSEASON) group compared to the other patient groups. The tenascin- and Iaminin-positive layers in AA and SS were thicker than other groups. In AA, and PARSEASON a significant negative correlation was found between epithelial integrity and the count for eosinophils or neutrophils. The most pronounced epithelial damage was observed in patients with allergic rhinitis in areas characterized by an increased number of inflammatory cells. Eosinophils in asthmatic and PARSEASON patients and neutrophils in SS were found in the area of epithelial damage.This work has demonstrated a quantitatively different inflammatory profile in AA, NAA and SS, different profiles in perennial allergic and non-allergic rhinitis and a specific inflammatory profile in the middle ear of children with OME suggesting differences in the pathogenesis of respiratory tract diseases.
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| 9. |
- Andersson, Anna S.
(författare)
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Lithium iron phosphates as cathode materials in lithium batteries
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Iron-based oxides are perhaps the only realistic cathode materials for electric and electric-hybrid vehicle applications. Two types of lithium iron phosphate, LiFePO4 andR-Li3Fe2(PO4)3, have been investigated for use within the lithium/lithium-ion polymer batteryconcept. The main techniques exploited have been: electrochemical cycling; X-ray andneutron diffraction - to study structural changes of the host material during lithiuminsertion/extraction; Mössbauer spectroscopy - to probe changes in the local structure of theFe atoms.Lithium extraction/insertion for LiFePO4, (olivine-type structure) has been followed by acombination of in situ X-ray diffraction and in situ Mössbauer spectroscopy. QuantitativeRietveld analysis of diffraction data has given good agreement with electrochemical andMössbauer spectroscopy data: ca. 20% of the LiFePO4 phase remains after charging. Possiblemechanisms to describe the capacity loss are proposed. High-temperature cycling (at 40oC and60oC) has shown the specific capacity to be markedly enhanced at higher temperatures.In situ Mössbauer spectroscopy has also been used to study the insertion of lithium into R-Li3Fe2(PO4)3. The two non-equivalent Fe3+ ions cannot be distinguished, whereas two typesof Fe2+ site appear on lithium insertion. Lithium appears to enter a site closer to one of theFe atoms. Elevated-temperature cycling shows the temperature dependence of R-Li3Fe2(PO4)3to be less marked than for the LiFePO4 system.The magnetic properties of R-Li3Fe2(PO4)3 have been investigated for the first time: a para- to antiferromagnetic transition is seen at 28 ~ K. Neutron powder diffraction shows that the Fe magnetic dipoles lie close to the ab-plane and are ferromagnetically aligned within an Fesheet perpendicular to the c-axis, but are antiferromagnetically coupled to adjacent sheets.
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| 10. |
- Andersson, Björn
(författare)
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Growth, saving, and demography
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis consists of three self-contained essays.Essay 1 investigates the relationship between economic growth and the age composition of the population. The age distribution is seldom taken into consideration in macro-econometric papers in spite of the fact that established economic theories predict that demographic factors will affect the aggregate economy. This essay investigates empirically the influence of age variables on growth. Unlike recent papers on the subject, the focus here is on investigating the relationship on annual data for individual Scandinavian countries. Estimations of a typical growth specification, augmented with age variables, are run and the results indicate that economic growth is indeed affected by the age distribution, where the demographic structure catches the medium-run trend in the growth rate. The robustness of this finding is first checked by instrumental-variable regressions to control for the potential endogeneity of the economic variables, and then by running ridge regressions to mitigate the collinearity between the age variables.Essay 2 focuses on the causality between saving and growth. The temporal interdependence between saving and output has been in focus in a number of recent empirical studies. Results from these studies have compelled some authors to question the traditional notion of a causal chain where saving leads growth through capital accumulation. This paper contributes to this literature. As opposed to the previous studies, which have mainly utilised panel-estimation methods, the tests of causal chains here are carried out in time-series settings. Saving and GDP are estimated in bivariate vector autoregressive or vector error-correction models for Sweden, the UK, and USA, and tests of Granger non-causality are performed within the estimated systems. The main results show that the causal chains linking saving and output differ across countries, and also that causality associated with adjustments to long-run relations might go in different directions than causality associated with short-term disturbances.Essay 3 investigates life-cycle patterns in the asset allocation of Swedish households. Data on household portfolio allocation are collected from the HINK surveys for the period 1982-1992, and portfolio shares of different asset categories are regressed on age, period, and cohort dummies, as well as socio-economic and demographic variables. There are evident differences in the age profiles for the demand of different assets. The fraction of "risky" financial assets follows a hump-shaped age profile, as does the share of total real assets. While the probability of ownership of "safe" financial assets increases over life, the weight in the portfolio has a U-shaped age pattern. This is also true for the fraction of total financial assets. Furthermore, there are differences in the asset allocation of different birth cohorts; the portfolio weight of real assets is relatively higher for the "baby-boom" generation, while younger generations are more prone to invest in "risky" financial assets. Such differences in cohort behaviour are quite important to recognise in analyses of wealth accumulation and portfolio choice.
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