| 1. |
- Bruno, Linnéa, 1975-
(författare)
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Ofridstid : Fäders våld, staten och den separerande familjen
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The present thesis explores intersectional and institutional conditions for counteracting domestic violence in the Swedish welfare state. Empirically, the study focuses on professional discourses and practices concerning fathers’ violence against mothers and children in the context of separation, in three domains of practice: 1) Children’s education; 2) Disputes concerning custody, contact and residence; and 3) Welfare benefits such as financial aid. Theoretically, the study draws on feminist political theory and sociology, childhood studies and critical race studies. The empirical material consists of court orders and interviews with staff and victimised mothers. Two main social processes that undermine implementation of children’s rights are identified and discussed: Familialisation and selective repression. The thesis is based on four articles:Article I, (Skolan, familjerätten och barnen) School, family law and children exposed to violence, explores how staff at school and preschool understands their professional task, when in encounters with children in difficulties due to family law proceedings. The results suggest that two competing perspectives shape staff understandings of risks, solutions and violence. When arguing from the child’s rights’ perspective, the staff prioritises children’s safety and participation, while an upbringing perspective tends to construct violence mainly as a problem of order, with disquieting implications for vulnerable children.Article II, (Pedagoger i det sociala uppdragets gränstrakter: Att hantera familjerättsliga processer, hot och våld)Pedagogues in the borderland of their social task: Dealing with family law proceedings, threats and violence, investigates strategies used by preschool and school staff, when encountering gendered conflicts and violence between parents. How do the staff cope with their own and children’s vulnerability? An analytical model of six types of proactive and reactive strategies, ranging from keeping distance to normalisation of own vulnerability, is utilised in the analysis and discussed in relation to organisational and professional circumstances and intersecting social relations of inequality.Article III, Contact and evaluations of violence: An intersectional analysis of Swedish court orders, examines obstacles to implementation of children’s rights in contested parental contact cases in which there are indications of violence. The analysis shows that the contact presumption is strong, and generally overrides protection. This norm applies even where there are convictions or explicit reports of child abuse or domestic violence. In cases with ‘non-Nordic’ fathers however, the contact presumption is less likely to override protection than in cases with ‘Nordic’ fathers.Article IV, Financial oppression and post-separation child positions in Sweden, deals with post-separation child positions in two domains of practice in the Swedish welfare state: Welfare benefits such as financial aid, and child contact. The area of concern is financial oppression in the context of parental separation. Findings suggest that financial abuse in the context of parental separation is a non-question in the domain of welfare benefits, and in the domain of child contact framed as a conflict between equal parties. The age order as a form of domination may be reinforced by the practice of both domains.
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| 2. |
- Dahlberg, Karuna, 1979-
(författare)
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e-Assessed follow-up of postoperative recovery : developement, evaluation and patient experiences
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The majority of all surgeries are performed as day surgery. After discharge, patients are expected to take responsibility for their postoperative recovery themselves. Recovery Assessment by Phone Points (RAPP) is an e-assessment developed for assessing and providing follow-up on postoperative recovery, which includes the Swedish web-version of the Quality of Recovery questionnaire (SwQoR). It also enables the patient to get in contact with the day surgery unit. The overall aim of this thesis was to further develop and evaluate a systematic follow-up of postoperative recovery using a mobile app in adult persons undergoing day surgery, as well as to describe their experiences of postoperative recovery when using the mobile app. Study I: This study included three steps. Equivalence testing between the paper and app versions of the SwQoR showed agreement (n=69). The feasibility and acceptability evaluation showed that participants (n=63) were positive towards using a mobile phone application during postoperative recovery. Content validity of the SwQoR reduced the original 31 items to 24. Studies II and III: A multicentre, two-group, parallel, single-blind randomized controlled trial including 997 participants was conducted to investigate the effect of e-assessment on postoperative recovery (II) and cost-effectiveness (III) in a RAPP group compared with a control group. The RAPP group reported significantly better quality of postoperative recovery on postoperative days 7 and 14 compared with the control group. Moreover, RAPP may be cost-effective as it provides low-cost care. Study IV: Explored experience of postoperative recovery in participants using a mobile phone app during their postoperative recovery. Qualitative inductive semi-structured interviews (n=18) were performed. Findings showed that feeling safe is important during postoperative recovery. This feeling can be created by patients themselves, but sufficient support and information from health care and next of kin is needed. Overall, this thesis showed positive results for RAPP, suggesting that RAPP is a solution that may benefit patients after day surgery.
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| 3. |
- Eriksson, Heléne, 1964-
(författare)
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End of Life Stroke Care : perspectives of health-care professionals and family members
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- IntroductionEven though medical improvements have reduced the mortality rates for patients afflicted by stroke, mortality during the first few days at hospital is significant. Today, there is an increasing recognition that the principles of palliative and supportive care are important components of meeting the needs of patients severely afflicted by stroke even in acute settings. However, there is limited knowledge about which factors have an impact on the end-of-life care (EoLC) for these patients or about how these last days of life are experienced from the family members’ perspective.AimThe overall aim of this thesis was to describe the EoLC of patients severely afflicted by stroke and to identify factors impacting upon EoLC for the patients and their family members in Sweden out of various contexts and methods.Design and MethodsThis thesis is based upon four papers employing qualitative, quantitative and mixed-method designs.Paper I is a qualitative study based on focus-group interviews with 41 health-care professionals (HCPs) in different professions related to stroke care at three stroke units. The aim was to study ethical dilemmas, different approaches and what consequences they had among health HCPs; the data was analysed using content analysis. The result inspired the design and conduct of the following studies.Paper II is a quantitative comparative study based on a retrospectively registered questionnaire from the Swedish Registry of Palliative Care (SRPC). Patients dying of stroke (n =1626) were compared with patients dying from cancer (n=1626), according to symptoms, symptom management and communication with the patient and family members during the last week of life. Data was statistically calculated using OR.Paper III is a mixed-method study employing a sequential explanatory design. In the first, quantitative, part, 995 stroke patients who died in hospital were compared with 631 stroke patients who died at nursing homes, according to symptoms, symptom management and communication with the patient and family members during the last week of life. The quantitative data was statistically calculated using OR and the qualitative data was analysed using content analysis. Nine significant differences drawn from the quantitative results regarding care were chosen to be discussed by twelve nurses working in stroke units.Paper IV is a qualitative interview study with the aim to study the family member descriptions of the trajectory from admission to the hospital until their loved one died. A semi-structured interview guide was used, and data was analysed using thematic analyses.ResultsFactors that had an impact on EoLC were consequences related to the difficulties around decision-making about withholding or withdrawing life-sustaining treatment. Non-decisions or not holding to the decision generated communication barriers causing obstacles in inter-professional collaboration and ethical dilemmas within the team (Study I). The absence of a mutual approach to care resulted in underprovided palliation, undignified medical treatment and ambiguity in care, generating feelings of distrust among the family members. The results described in Study I of underprovided palliation were further investigated in Study II. The differences in knowledge about whether symptoms were present or not in patients afflicted by stroke compared to patients with cancer were significant. For example, the HCPs in the stroke group did not know if pain was present nine times more frequently than in the cancer group. These differences in knowledge about whether symptoms were present of not were also identified in Study III. Here, HCPs at the nursing home more often had knowledge about whether a symptom was present in patients dying of stroke or not, compared to HCPs at hospitals. This study also identifies differences in the presence of the symptoms being compared and whether the patient’s suffering was fully relieved. The nurses working at stroke units explained that these differences were a consequence of the stroke unit’s aim (saving lives), no previous relationship to the patient and ambiguity in the evaluation of symptoms. The patient’s altered levels of consciousness increased the difficulties in evaluation. In addition, the hospital setting’s aim increased the risk of prolonged treatment, for example nutrition supplied during the last day of life, and underprovided palliation of for example, pain compared to nursing homes. In Study IV, family members were seeking trust through mutual collaboration and creating relationships with the HCPs. If the family did not feel that their search for trust was taken care of, it generated feelings of distrust allied with anxiety and memories of failing to do the best for their loved one at in the end of life. During the trajectory at the hospital, family members were “seeking trust in chaos”, “seeking clarity when deciding about living or dying” and finally they were “seeking trust in care as a final act of love”.Conclusions:The results of this thesis suggest that the absence of a coherent approach contributes to developing ethical dilemmas within the HCPs. The ambiguity in care had an impact on the quality on EoLC, with an increased risk of unnecessary suffering and questionable symptom management. The prevailing culture at acute-care hospitals affected the HCPs’ attitudes towards EoLC, with attention being predominantly on life-sustaining treatments. There is an increasing recognition of the need for improvement in the PC approach at acute-care hospitals in order to create equal quality of care during end of life, irrespective of the place of death for patients dying of stroke. Furthermore, family members need to feel trust, which is achieved through relationships and collaboration with HCPs. In the striving to accomplish a wholly compensatory care of quality during the trajectory, this thesis can be a source of knowledge and guidance for nurses and for teams at the stroke unit.
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| 4. |
- Flinkfeldt, Marie, 1982-
(författare)
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Legitimacy Work : Managing Sick Leave Legitimacy in Interaction
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis studies how sick leave legitimacy is managed in interaction and develops an empirically driven conceptualization of ‘legitimacy work’. The thesis applies an ethnomethodological framework that draws on conversation analysis, discursive psychology, and membership categorization analysis. Naturally occurring interaction is examined in two settings: (1) multi-party meetings at the Swedish Social Insurance Agency, in which participants assess and discuss the ‘status’ of the sick leave and plan for work rehabilitation; (2) peer-based online text-in-interaction in a Swedish forum thread that gathers people on sick leave.The thesis shows how mental states, activities and alternative categories function as resources for legitimacy work. However, such invocations are no straight-forward matter, but impose additional contingencies. It is thus crucial how they are invoked. By detailed analyses of the interaction, with attention to aspects such as lexicality and delivery, the thesis identifies a range of discursive features that manage sick leave legitimacy. Deployed resources are also subtle enough to be deniable as legitimacy work, that is, they also manage the risk of an utterance being seen as invested or biased.While legitimate sick leave is a core concern for Swedish policy-making, administration, and public debate on sick leave, previous research has for the most part been explanatory in orientation, minding legitimacy rather than studying it in its own right. By providing detailed knowledge about the legitimacy work that people on long-term sick leave do as part of both institutional and mundane encounters, the thesis contributes not only new empirical knowledge, but a new kind of empirical knowledge, shedding light on how the complexities of sick leave play out in real-life situations.Traditional sociological approaches have to a significant extent treated legitimacy as an entity with beginnings and ends that in more or less direct ways relate to external norms and cognitive states, or that focus on institutions, authority or government. By contrast, the herein emerging concept ‘legitimacy work’ understands legitimacy as a locally contingent practicality – a collaborative categorially oriented accomplishment that is integral to the interactional situation.
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| 5. |
- Fängström, Karin, 1980-
(författare)
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‘I don’t even remember anything’ : Optimising the choice of method when interviewing preschoolers
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- There is increasing need and demand in various contexts to take children’s perspectives into account, including the views and opinions of the youngest children. However, listening to the voices of children is a challenging and complex task, and the field is normatively loaded. There is thus a growing need for valid and reliable methods and techniques that aid children to verbalise their experiences. The overall aim of this thesis was to examine the ability of the In My Shoes computer assisted interview and a Standard verbal interview to elicit accurate information and evaluative content, when used with preschool-aged children and determine their suitability in relation to situationally shy children.Our studies show that the two interview methods, in general, provided equally accurate and complete statements. In addition, the IMS interview can be a more useful and suitable tool during the rapport phase with situationally shy children compared to the Standard verbal method. For non-shy children, the interview methods were equally adequate. In relation to evaluative information, the recommended open-ended questions in the Standard verbal interview were insufficient. Children appeared to need evaluative questions in order to provide evaluative content. Examining the ability of IMS to elicit subjective experiences showed that using IMS aided children to provide detailed and varied descriptions of emotions, somatic experiences, and objects such as toys. Thus, when choosing the optimal child interview method, there are several aspects that need to be considered, including the degree to which children’s statements need to be accurate and complete and/or contain evaluative information and the child’s level of shyness. These studies have increased the number of evaluated methods for interviewing children and contributed to new knowledge about the challenging task of optimising the choice of method for interviewing preschoolers.
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| 6. |
- Lagerström, Maria, 1986-
(författare)
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Occurrence and environmental risk assessment of antifouling paint biocides from leisure boats
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The use of biocidal antifouling (AF) paints is the most common way to prevent fouling on leisure boat hulls. The main aim of this thesis was to investigate the pathways through which AF biocides, past and present, may reach the environment through their use on leisure boats and to improve the risk assessment of biocidal AF paints intended for amateur use. The work presented focuses mainly on the Baltic Sea, with emphasis on regulation and risk assessment procedures in Sweden. A new method was developed for the quantification of nowadays banned organotin compounds (OTCs) such as tributyltin (TBT) in paint flakes (paper I). OTCs were detected in hull paint scrapings from three countries around the Baltic Sea. Thus, historic layers of organotin paint on leisure boats may constitute as sources of TBT to the marine environment. Total tin was identified as an indicator for the presence of OTCs on boat hulls, allowing for quicker identification of vessels in need of remediation. Nowadays, most AF paints tend to contain high amounts of copper (Cu) and zinc (Zn). The use of AF paints was shown to cause exceedance of guideline values for these two metals in soil, sediment and water in various investigated marinas (papers II and IV). The pollution of boatyard soil was linked to hull maintenance activities carried out over unprotected ground (paper II). AF paints were also found to impact both the concentration and speciation of dissolved Cu and Zn in two Baltic Sea marinas, with increased concentrations as well as an increased proportion of bioavailable species as a function of an increased number of moored boats (paper IV). A new method utilizing X-Ray Fluorescence (XRF) was used to derive the release rates of Cu and Zn in the field for five commercially available AF paints for amateur use (paper III). Salinity and paint properties were found to be important parameters affecting the release. The in situ release rates were also found to exceed those derived with current standardized release rate methods. Given the high release rates, none of the studied paints should have been approved for the Swedish market. This finding likely explains the exceedance of guideline values for dissolved Cu and Zn in investigated Baltic Sea marinas (paper IV). In conclusion, there is a need for caution when authorizing new biocides as the phasing out of banned substances can be a lengthy process due to their continued presence in historic paint layers. Additionally, paint-specific release rates determined under conditions reflecting the intended use of the product should be used for a more realistic environmental risk assessment of AF paints.
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| 7. |
- Rosestedt, Maria
(författare)
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Affibody Molecules for HER3-targeted Theranostics of Malignant Tumours
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The HER3 receptor plays a strong role in disease progression and resistance to therapies in several cancer types. Due to its endogenous expression and low overexpression in malignant tumours, it is a particularly challenging target. The primary aim of this thesis project was to develop, evaluate and characterize affibody molecules for theranostic applications in HER3-expressing malignant tumours.Paper I investigated the in vivo targeting properties and therapeutic efficacy of a bivalent affibody construct fused with an albumin binding domain, ZHER3-ABD-ZHER3. This construct could slow down the growth of HER3-expressing tumour xenografts without causing health problems or side effects in mice.Paper II compared the in vitro and in vivo properties of two HER3-targeting affibody molecules (Z08698 and Z08699) to select an imaging probe for HER3 diagnostics. While the two constructs had similar properties, Z08698 demonstrated better blood clearance and better radioactivity retention in tumours.Paper III and IV present the development of a HER3 imaging probe for PET using gallium and cobalt isotopes. We demonstrated that imaging of HER3 expression could be obtained as soon as 3 h pi using gallium-68. Additionally, we demonstrated that affibody molecules labelled with a neutral cobalt-NOTA complex had a lower radioactivity uptake in the liver than molecules radiolabelled with a positive gallium-NOTA complex. Imaging contrast increased over time. As the dose of the injected protein increased, the activity uptake in normal organs decreased, whereas the tumour uptake remained the same, which improved the imaging contrast and allowed discrimination between xenografts with high and low HER3 expression. This modification did not influence tumour activity uptake.Paper V presents the HER3-targeting affibody molecule trimer as a tool to block hepatic uptake in order to increase the imaging contrast in the liver. The trimer demonstrated its ability to bind to endogenous receptors in the liver, which decreased the hepatic uptake of the radiolabelled monomer. This phenomenon enabled the monomer to pass the liver barrier, which increased tumour radioactivity uptake and improved imaging contrast.
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| 8. |
- Ullsten, Alexandra, 1967-
(författare)
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Singing, sharing, soothing : Family-centred music therapy during painful procedures in neonatal care
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- To sing is to communicate. The soothing, comforting and emotional regulating properties of a lullaby are well-known cross-culturally and historically. This doctoral thesis addresses neonatal pain management from a novel and groundbreaking perspective, studying the efficacy of live music therapy on infants’ pain responses during venepuncture. New research is needed to advance the non-pharmacological interventions in neonatal pain care, and neonatal music therapy (NICU MT) offers active methods to involve the parents in pain management. The doctoral thesis includes two empirical and two theoretical articles. In paper I, preterm and term infants (n=38) were subjected to venepuncture with and without live lullaby singing, in a randomised order with a crossover design. Parent-preferred lullabies were performed live by a music therapy student and standard care was provided for all infants. The results did not show any significant pain-alleviating effects, however, the live singing was not stressful for the infants.In paper II, the microanalysis disclosed that live lullaby singing is a communicative reciprocal intervention that also applies to premature infants during painful procedures. Live lullaby singing is a tool suitable as a means to optimise the homeostatic mechanisms. The results from the theoretical papers III and IV are further developed and synthesised in the thesis into a theoretical strategy; The Nordic NICU MT pain management strategy, featuring the parents and their singing voices as mediators for pain relief. The role of the music therapist in neonatal pain management is as a facilitator and an educator for the parents. Coaching parents to better meet their infant’s attachment needs during a painful procedure may lead to more efficacious interventions. The biopsychosocial parental infant-directed singing is presumably an applicable parent-driven non-pharmacological intervention, which promotes pain relief and attachment formation during painful procedures. Neonatal music therapy is still in its infancy in the Nordic countries, but the societal and healthcare contexts afford important prerequisites to further develop NICU MT as a truly family-centred approach. This doctoral thesis will hopefully contribute to the important interdisciplinary endeavour worldwide of involving and integrating parents in neonatal pain management.
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| 9. |
- Axelsson, Karin, 1969-
(författare)
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Entrepreneurship in a School Setting : Introducing a Business Concept in a Public Context
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Entrepreneurship has during the last decades gained an immense interest in academia, politics and practice. It is argued from politics that more entrepreneurs are necessary for the economic development. In addition, nowadays entrepreneurship is also perceived as a solution to social and societal challenges. This drives a need for entrepreneurial people everywhere in society who can cope with the inconstant and uncertain world of today. As a consequence, there are around the world numerous educational initiatives trying to inspire and fuel an entrepreneurial mind-set. Here, educations of all kind become relevant contexts since they provide an opportunity to affect children, youth’s and adult’s interest and attitudes towards entrepreneurship, and as such give a possibility to reach a vast number of people.Sweden is no exception, and in 2009 the Swedish Government launched a ‘Strategy for entrepreneurship in the field of education’ in which entrepreneurship is said to run like a common thread throughout education. The main focus is that self-employment is to become as natural as being an employee. As such the Government took an active stand for implementing entrepreneurship in the school setting on a broad front, from preschool to adult education.This development can be seen as part of New Public Management; a development where concepts from the private sector are lent and transferred to the public sector. Thus, when introducing entrepreneurship in the Swedish educational system, this at the same time means introducing a traditional business concept in a public setting. Therefore, the overall aim of this thesis is to increase knowledge of and insights on how a business concept – entrepreneurship – is operationalised and constructed in a public setting.When placing entrepreneurship in new societal contexts other questions arise and complexity intensifies. In this qualitative research, the empirical context in focus are schools. It investigates how entrepreneurship is constructed among teachers in their work. But also how this business concept is included in a non-business setting by studying how the entrepreneurship strategy is operationalised in educational practice.As such the thesis and its findings contribute to the scientific discussions on societal entrepreneurship and entrepreneurship education, as well as on strategy and strategising in a public context. The research also aspire to serve inspiration, insights and food for thoughts on discussions and reflections on entrepreneurship within the school practice. This compilation thesis include five papers. To be able to fulfil the aim this research use a broad theoretical base and multiple qualitative research methods. The combination of methods include semi-structured interviews, in-depth interview using the stimulated recall method, focus group interviews, participative meetings, observations, document studies, digital questionnaires, written inquiries, analysing texts and critical incidents questionnaires.
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| 10. |
- Bighiu, Maria Alexandra, 1989-
(författare)
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Use and environmental impact of antifouling paints in the Baltic Sea
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Biocide-based antifouling (AF) paints are the most common method for preventing biofouling, i.e. the growth of algae, barnacles and other organisms on boat hulls. AF paints for leisure boats are predominantly based on copper (Cu) as the main biocide, with zinc (Zn) present as a pigment and stabilizer. Both metals are released from the paint matrix into the water column, leading to contamination of marinas which typically have only limited water exchange. Thus, the aim of this PhD thesis was to describe the use of AF paints in different regions in Sweden, as well as the associated environmental consequences with regard to contamination of the environment and toxicity to non-target aquatic snails. Using a recently developed X-ray fluorescence application, high levels of Cu were detected on boats moored in freshwaters, despite a more than 20-year-old ban, as well as high levels of tin (Sn) on 10 % of the boats, indicating the presence of (old) tributyltin paints (TBT), which might pose an environmental risk and a health hazard for people performing the paint scraping (paper 1). In addition, very high levels of Cu and Zn were measured in the biofouling material collected from the boat hulls, and this is problematic because the biofouling is commonly disposed of on the soil in boatyards at the end of each season. No difference was found in the amount of biofouling on boats coated with Cu or biocide-free paints, which implies that Cu might be currently overused in areas of low salinity and low barnacle density (paper 2). This work also introduces the use of a new species for ecotoxicological field experiments, the snail Theodoxus fluviatilis. Chronic field experiments (paper 3) revealed 6-fold increases in snail mortality, negative growth and up to 67-fold decreased reproduction in marinas, compared to areas not impacted by boating (‘reference areas’). Moreover, a higher prevalence of snails with histopathological alterations (e.g. necrosis of gills, gonads, midgut gland and parasite infestation, among others) was observed in the marinas, compared to the reference areas (paper 4). Statistical modelling indicated that the majority of the toxic effects were best predicted by the metals, most likely originating from AF paints. The results presented in this thesis depict some important aspects of AF paint use in brackish water and highlight the necessity of implementing a suitable management practice for the heavily contaminated biofouling waste in order to minimize the risk to soils. In addition, the evidence of toxicity to snails in marinas can be used as a basis to increase the public understanding of the impact of recreational boating and encourage people to choose less toxic alternatives to AF paints.
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