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- Becker, Per
(författare)
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On the governmentalization of sustainability : the case of flood risk mitigation in Sweden
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Contemporary society is confronted with numerous sustainability challenges. Some are new, others have been around since time immemorial, but none have been governed on the societal level since their emergence. Despite an abundant literature that addresses the governing of a range of such sustainability challenges, the processes through which they become something governable in the first place have not received much attention. This thesis, therefore, seeks to increase our understanding of how complex sustainability challenges become governmentalized in advanced liberal democracies. It presents an empirical investigation of the recent problematization of flood risk mitigation in a specific area. The goal is to answer two questions: (1) how flood risk mitigation is governed; and (2) how the process of governmentalization is conditioning this governing in Sweden. It combines theoretical perspectives of governmentality and new institutionalism. The case study focuses on the governing of flood risk mitigation in Lomma municipality and the Höje Å catchment area in Southern Sweden, and mixes structural and interpretative methods.Data were collected through 217 interviews with all actors who actively contribute to flood risk mitigation in the area, together with numerous documentary sources. The findings reveal remarkable spatial, temporal, and functional fragmentation in the regime of practices mitigating flood risk, a concentration of responsibility for flood risk mitigation in municipal administrations, and an escalating penetration and diffusion of the market in its governing. Four constituent processes of governmentalization were identified. Reductivization refers to the process of conceptualizing the complex problem in smaller, disconnected parts. Projectification captures how the problem is addressed through piecemeal projects. Responsibilization is the process by which responsibility is transferred to an actor with less power and who lacks appropriate resources, and commodification refers to seeing the solution to the problem as the aggregation of standardized modules that can be sourced on the market. While these processes are intrinsically linked, and combine to seriously undermine the purpose of flood risk mitigation, they are also fundamental for it to become governable in the first place. This nexus may be a general feature of the governmentalization of complex sustainability challenges in advanced liberal democracies, albeit to various degrees and in different ways depending on the penetration and diffusion of neoliberalism.
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| 2. |
- Klintö, Kristina, et al.
(författare)
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Inter-centre comparison of data on surgery and speech outcomes at 5 years of age based on the Swedish quality registry for patients born with cleft palate with or without cleft lip
- 2022
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Ingår i: BMC Pediatrics. - : Springer Science and Business Media LLC. - 1471-2431. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The objective of the Swedish cleft lip and palate registry (CLP registry) is to promote quality control, research and improvement of treatment, by the comparison of long-term results. The aim was to compare data from the CLP registry among the six treatment centres, regarding data on surgery and speech outcomes at 5 years of age.METHODS: The participants were 430 children born in Sweden from 2009 to 2014, with cleft palate with or without cleft lip and without known syndromes and/or additional malformations. The number of primary and secondary palatal surgeries up to 5 years of age, timing of the last primary palatal surgery, percentage consonants correct, percentage non-oral speech errors and perceived velopharyngeal competence at 5 years were assessed. Multivariable binary logistic regression adjusted for sex and cleft type was used to compare results between the six centres.RESULTS: At one centre (centre 4), the palate was closed in one to three stages, and at the remaining centres in one or two stages. At centre 4, more children underwent a higher number of palatal surgeries, and the last primary palatal surgery was performed at a higher age. Children in centre 4 were also less likely to achieve ≥86% correct consonants (OR = 0.169, P = < 0.001), have no non-oral speech errors (OR = 0.347, P = < 0.001), or have competent or marginally incompetent velopharyngeal competence (OR = 0.244, P = < 0.001), compared to the average results of the other centres. No clear association between patient volume and speech outcome was observed.CONCLUSIONS: The results indicated the risk of a negative speech result if the last primary palatal surgery was performed after 25 months of age. Whether the cleft in the palate was closed in one or two stages did not affect speech outcome. The Swedish CLP registry can be used for open comparisons of treatment results to provide the basis for improvements of treatment methods. If deviating negative results are seen consistently at one centre, this information should be acted upon by further investigation and analysis, making changes to the treatment protocol as needed.
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| 3. |
- Melin, Karin, 1964, et al.
(författare)
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Treatment Gains Are Sustainable in Pediatric Obsessive-Compulsive Disorder: Three-Year Follow-Up From the NordLOTS
- 2020
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Ingår i: Journal of the American Academy of Child and Adolescent Psychiatry. - Amsterdam : Elsevier BV. - 0890-8567 .- 1527-5418. ; 59:2, s. 244-253
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Tidskriftsartikel (refereegranskat)abstract
- © 2019 American Academy of Child and Adolescent Psychiatry Objective: This study evaluated the long-term outcomes of a stepped care treatment for pediatric obsessive-compulsive disorder (OCD) and investigated whether response to first-step cognitive-behavioral therapy (CBT) is an important indicator of 3-year outcomes. Method: This study is a part of the Nordic Long-term OCD Treatment Study (NordLOTS), in which 269 children and adolescents were treated with CBT. Nonresponders to CBT were randomized to extended treatment with continued CBT or pharmacotherapy with sertraline. Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) scores no higher than 15 and no higher than 10 were defined as treatment response and remission, respectively. Participants were assessed 2 and 3 years after first-step CBT. Linear mixed-effects models were used to analyze the outcomes. Results: Intent-to-treat analyses showed a significant decrease in CY-BOCS total score from baseline (24.6) to 3-year follow-up (5.0; p = .001), with a mean decrease of 5.9 from after treatment to 3-year follow-up. Three years after treatment, 90% (n = 242) of participants were rated as responders and 73% were in clinical remission. The duration of treatment did not influence the symptom level at 3-year follow-up (p = .998) and no significant difference was found (p = .169) between the extended treatment conditions. Conclusion: The results suggest that evidence-based treatment for pediatric OCD has long-term positive effects, whether a first step of manual-based CBT or extended treatment with CBT or sertraline. The improvements were maintained, and the symptoms decreased further during follow-up and were, after 3 years, similarly independent of treatment duration and form of extended treatment. Clinical trial registration information: Nordic Long-term Obsessive-Compulsive Disorder (OCD) Treatment Study; www.controlled-trials.com; ISRCTN66385119.
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