| 1. |
- Catucci, Ester, 1973-
(författare)
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Undervisningsuppdraget i förskolan ur ett didaktiskt perspektiv
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis is to increase knowledge of how the teaching mission can be understood and realised in preschool as an educational practice. The main research questions are: 1. How can teaching be realised in preschool daily practice? 2. How is preschool teachers’ specific responsibility for teaching expressed during collegial meetings? 3. In what way does preschool teachers’ didactical leadership emerge during collegial meetings? The thesis is based on four articles. Each one of the articles answers specific research questions. The data for study 1 and 2 were gathered through observations, video filming and field notes. Three preschool teachers and 12 children participated in substudies 1 and 2. The observations focused on preschool teachers’ actions and how these influenced children’s meaning making. Substudy 1 focused on preschool teachers’ teaching in relation to three different activities. It shows different didactical consequences that teaching leads to in relation to children’s meaning making. Substudy 2 explored how preschool teachers’ habits influenced and limited teaching in relation to preschool curriculum goals. The analysed activities were outdoor activities, with a specific focus on sand play. The theoretical perspective used for the data analysis in substudies 1 and 2 was John Dewey’s pragmatism. The data in substudies 3 and 4 were gathered through non-participant observation and audio recording of seventeen collegial meetings. Five qualified preschool teachers, one unqualified preschool teacher and one preservice preschool teacher participated in substudies 3 and 4. Some of the collegial meetings were led by the principal and a pedagogical mentor. The focus for substudy 3 was on the challenges expressed by the preschool teachers in relation to their own teaching responsibility. Substudy 4 explored what didactical questions the preschool teachers discussed during the collegial meetings and how these could be related to preschool teachers’ didactical leadership. Basil Bernstein’s theory of pedagogic practice was used to analyse the results of substudies 3 and 4. The results of the four substudies show how preschool teachers’ actions create both possibilities and constraints for children’s meaning making. The opportunities for meaning making were limited when children’s actions were only confirmed or when the purpose of an activity was unclear for the participating children. On the other hand, when preschool teachers’ actions expanded ongoing activities by introducing new elements, children’s opportunities for meaning making increased. Furthermore, the results show how preschool teachers’ specific responsibility for teaching is toned down by the preschool teachers themselves. Instead, a shared pedagogical responsibility in the team is considered most important. Nevertheless, preschool teachers express challenges in relation to a shared pedagogical responsibility, especially when a common understanding for the pedagogical practice is missing in the team as a whole. Furthermore, they express a lack of full legitimacy to lead other colleagues. A conclusion that can be drawn from the study’s result is that preschool is embedded in what Bernstein describes as an invisible pedagogy. As a result of this, it may be challenging for preschool teachers to establish didactical leadership and subsequently take on their own specific responsibility for teaching.
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| 2. |
- Del Gaiso, Tove
(författare)
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Förskollärare i en digital praktik : Rhizomatiska sammanflätningar, dilemman och händelser
- 2023
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Denna studie undersöker vad som händer när förskollärare använder digitala teknologier i förskolan. Praktiknära forskningsmetoder har använts för att undersöka digitala teknologiers rhizomatiska sammanflätningar i två svenska förskolor. Studien pågick under åtta månader med deltagande förskollärare. Forskning om digital teknologi i förskolan har till stor del fokuserat på vad digital teknologi kan användas till för att främja barns lärande inom specifika ämnesområden. Denna studie undersöker hur förskolepraktiken påverkas av användningen av digitala teknologier. Studien belyser de dilemman, konflikter och frågor som uppkommer när digital teknologi används i förskolans praktik. Studien utgår från ett teoretiskt antagande om att materialiteter medskapar de händelser som uppstår i undervisning med digitala teknologier och undersöker även hur detta sker i den aktuella studien.Studien använder ett sociomateriellt perspektiv för att utforska materialitet i aktiviteter med digital teknologi. Studiens data har konstruerats tillsammans med förskollärare i dialogiska samtal som utgår från deras observationer och filmade aktiviteter med barn mellan två och fem år. I de dialogiska samtalen har gemensamma analyser gjorts och förskollärarna har sedan planerat för nya aktiviteter som de genomfört och observerat på förskolorna. Data har analyserats med metoden att gå med data vilket innebar att analysen skedde med en rörelse genom datan utan en bestämd riktning. Analysen av dialogiska samtal riktades mot de olika materialiteter som kunde ses som medskapande i förskolans digitala praktik. Särskilt fokus låg på att studera förändringar, brytpunkter, svårigheter, oväntade och oplanerade händelser som uppstod. Gilles Deleuze och Félix Guattaris begrepp rhizom och kartografi används för att analysera data. I resultaten synliggjordes fyra dilemman som uppstod i den digitala förskolepraktiken. I) Digitala teknologier som möjlighet och risk. II) Relationen mellan vårdnadshavare och förskollärarnas uppdrag. III) Barns tidigare relationer till digitala teknologier. IV) Inre konflikt hos förskollärarna gällande deras professionella och privata åsikter. Resultaten visar även att de sammanflätningar som sker av materialiteter som förskollärare, digital teknologi, barn och förståelser av digitala teknologier skapar oväntade händelser i barns undersökande och lek med digital teknologi. Resultaten tyder på att ett sociomateriellt perspektiv och kartografering kan vara användbart för forskare och förskollärare för att utforska hur flertal materialiteter blir sammanflätade med förskolans praktik och digital teknologi.
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| 3. |
- Delblanc, Åsa
(författare)
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Pedagogiska möjligheter i mångfaldens förskola
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- I denna sammanläggningsavhandling diskuteras tre olika delstudier som alla utgåttf rån förskolepraktik i förskolor som kännetecknas av en mångfald av språk och erfarenheter. Delstudie 1 fokuserar på barns kommunikation i en flerspråkig förskolemiljö och vad som kan hindra eller möjliggöra den. Delstudie 2 undersöker ett aktionsforskningsprojekt i form av en forskningscirkel med målet att i en förskola skapa en flerspråkig miljö i samarbete med föräldrar. Delstudie 3 undersöker ett aktionsforskningsprojekt i form av en forskningscirkel med målet att utveckla förskolans mottagande av nyanlända familjer. Avhandlingen utgår från ett sociokulturellt perspektiv i vilket människor ses som lärande varelser som skapar kunskap gemensamt med tillgängliga kulturella artefakter. Affordanceteorin (Gibson, 1986; Reed, 1993; Barab & Roth; 2006 och Clakin-Philips & Carr, 2012) har använts för att göra analyser av barns och lärares handlingar. Affordance tolkas genomgående som erbjudanden, och tre olika typer av erbjudanden undersöks, kommunikationserbjudanden, flerspråkiga erbjudanden samt nätverk av erbjudanden. Utifrån Barab och Roth (2006) och Clakin- Philips och Carr ( 2012) undersöks sedan hur erbjudanden ger olika typer av möjligheter, tillgängliga, inbjudande och personliga, här rubricerade som pedagogiska möjligheter.Resultatet visar att olika typer av möjligheter uppstår i olika sammanhang. I de sammanhang i vilka det inte finns en planerad eller strukturerad idé om hur ett erbjudande kan användas blir möjligheterna mindre inbjudande. Möjligheter blir personliga då barns, lärares och föräldrars erfarenheter används som en utgångspunkt i den pedagogiska praktiken. Om möjligheter blir personliga finns samtidigt en risk att det blir ett ökat fokus på skillnader och att tankar om att skapa trygghet ses som viktigare än att skapa förutsättningar för lärande.
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| 4. |
- Ehrström, Monica, 1970-
(författare)
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Uppmärksamhet för bedömning : att följa varje barns lärprocesser för en likvärdig utbildning i förskolan
- 2023
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The purpose of this study was to contribute with knowledge about the tension between preschool teachers' mission to teach and support children's learning on the one hand and the mission to assess children's learning processes on the other hand, in relation to equality in education. In Swedish preschools, children with different experiences meet, all of whom should have the opportunity to develop and learn based on their varied circumstances and needs. According to the Education Act (SFS, 2010:800), preschool education must be equal, and all children must have the opportunity to learn and develop as far as possible based on their potential. However, previous research (Alasuutari, Vallberg Roth & Markström, 2014) indicates that assessment involves risks for children’s identity creation. This study examines how seven preschool teachers tackle the challenge of assessing and paying attention to individual children in their ongoing learning processes. A sociocultural perspective (Vygotskij, 1978) has been used to study preschool teachers' reasoning about assessment in relation to each child's possibilities for being supported in their proximal development zone. The sociocultural perspective stresses the importance of cultural tools for communication. Stimulated-recall interviews were conducted with seven preschool teachers in Sweden. Content analysis was used to reveal the views that emerged in preschool teachers’ descriptions.In the preschool teachers' reasoning, different strategies for assessment and methods for making the child's learning processes visible as well as approaches for following the progression in children's learning processes have emerged, which can create both opportunities and limitations for children to learn based on their potential. Findings indicate three areas significant for assessment in relation to an equivalent education in this study. Firstly, there is clarity regarding the approach to assessment, what is to be given attention and assessed and how the assessment should be carried out. Secondly, the preschool teachers in the study have knowledge about various methods to make children's learning processes visible and thus possible to follow over time. Thirdly, the preschool teachers in the study know how to draw attention to and make visible the child's learning from a holistic perspective. The Licentiate thesis highlights different strategies for assessment, methods for making the child's learning processes visible and approaches for following the progression in children's learning processes that emerged during the preschool teachers' reasoning. The study has shown that attentiveness (Elbaz, 1992) can be used as a concept to bridge the tension surrounding assessment.
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| 5. |
- Glasdam, Stinne, et al.
(författare)
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Nurses’ use of social media during the COVID-19 pandemic—A scoping review
- 2022
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Ingår i: PLoS ONE. - San Francisco, CA : Public Library of Science (PLoS). - 1932-6203. ; 17:2
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundDuring the COVID-19 pandemic, nurses stand in an unknown situation while facing continuous news feeds. Social media is a ubiquitous tool to gain and share reliable knowledge and experiences regarding COVID-19. The article aims to explore how nurses use social media in relation to the COVID-19 pandemic.MethodA scoping review inspired by Arksey and O’Mally was conducted by searches in Medline, CINAHL, Academic Search Complete and Web of Sciences. Empirical research studies investigating nurses’ use of social media in relation to COVID-19 were included. Exclusion criteria were: Literature reviews, articles in languages other than English, articles about E-health, and articles investigating healthcare professionals without specification of nurses included. Articles, published in January-November 2020, were included and analysed through a thematic analysis. The PRISMA-ScR checklist was used.ResultsMost of the eleven included studies were cross-sectional surveys, conducted in developing countries, and had neither social media nor nurses as their main focus of interest. Three themes were identified: ‘Social media as a knowledge node’, ‘Social media functioned as profession-promoting channels’ and ‘Social media as a disciplinary tool’. Nurses used social media as channels to gain and share information about COVID-19, and to support each other by highlighting the need for training and changes in delivery of care and redeployment. Further, social media functioned as profession-promoting channels partly sharing heroic self-representations and acknowledgment of frontline persons in the pandemic, partly by displaying critical working conditions. Finally, nurses used social media to educate people to perform the ‘right ‘COVID-19’ behaviours in society.ConclusionThis review provided snapshots of nurses’ uses of social media from various regions in the world, but revealed a need for studies from further countries and continents. The study calls for further multi-methodological and in depth qualitative research, including theoretically framed studies, with a specific focus on the uses of social media among nurses during the pandemic.
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| 6. |
- Grønning, Anette, et al.
(författare)
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The entanglements of media and health in everyday life
- 2023
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Ingår i: Mediekultur. Journal of Media and Communication Research. - 1901-9726. ; 39:74, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- Just as the title above suggests, it is difficult to address health issues without considering the role of the media and everyday life; the time and space when health is produced and cared for or put at risk and exposed. In the introduction to this special issue, ‘Media and health in everyday life’, we will discuss the three components of the theme. We will offer some definitions, but also problematise the conceptual underpinnings and highlight the intertwinement of the three. We set off by reflecting on health. Then we will engage with ideas around the notion of everyday life. In the final section, we add the component of the media before we present and summarise the nine contributions to the special issue and clarify to what extent they add to our understanding of the theme.
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| 7. |
- Jonsson, Kristina, 1970-, et al.
(författare)
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Samtal om värdegrunden för att främja barns sociala lärande i fritidshemmet
- 2020
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Ingår i: Förskollärares egen forskning. - Lund : Studentlitteratur AB. - 9789144140599 ; , s. 150-166
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Bokkapitel (populärvet., debatt m.m.)abstract
- För fritidshemmet betonar policydokument att elever ska stöttas särskilt utifrån det sociala lärandet. Elevers sociala lärande kan tolkas utifrån det som i läroplanen beskrivs som arbetet med skolans värdegrund. Värdegrundsarbetet är en central del av uppdraget och i läroplanen betonas även vikten av att personal är aktiva och medvetna i sitt uppdrag. Detta kapitel baseras på en studie, vars syfte är att belysa fritidshemspersonals perspektiv på arbetet med socialt lärande i fritidshemmet. Sammanlagt gjordes fyra gruppintervjuer med totalt 21 fritidspersonal, på deras respektive arbetsplatser. Resultatet visar skilda perspektiv på hur personalen förhåller sig till att samtala om värdegrundsarbetet och hur de beskriver sin verksamhet utifrån det. Dels visar sig en uppfattning om värdegrunden som underförstådd och att den inte är nödvändig att samtala om. Dels framträder bilden av en verksamhet med en uttalad medvetenhet om betydelsen av de kollegiala samtalen som grund för arbetet med att kontinuerligt främja elevers sociala lärande. Utifrån dessa perspektiv diskuterar vi kollegiala samtal som en del av ett didaktiskt reflekterat värdegrundsarbete i fritidshemmet.
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| 8. |
- Jonsson, Kristina, 1970-
(författare)
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Socialt lärande i fritidshemmet : En intervjustudie med fritidshemspersonal och fritidshemsrektorer
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis is to investigate social learning in the Swedish school-age educare (SAEC), based on the descriptions of the SAEC staff and SAEC principals. The results are based on two sub-studies. Sub-study 1 was conducted with SAEC staff, with a total of 21 persons divided into four groups. This sub-study sought answers to what knowledge and abilities the SAEC staff consider to be important for pupils in their work with social learning in the SAEC, and what appears to be significant in the work to promote pupils’ social learning. In the second sub-study, the focus is on the principals’ descriptions. Initially, seven principals in the SAEC for the early years were interviewed individually. Thereafter, six of them participated in a series of group interviews. This sub-study aimed to answer the questions of what characterises social learning in the SAEC in the principals’ descriptions, and what vision for social learning in the SAEC, is expressed by the principals.The data were analysed abductively, using Bronfenbrenner’s bioecological system theory. The analysis highlights the factors that impact the work in the SAEC and how they interact. The theory thereby contributes to an understanding of what affects the work of social learning in the SAEC. This enables a didactic understanding of the SAEC’s activities, and how social learning for pupils is enabled in the SAEC, based on what is expressed by the SAEC staff and the principals. The results show that both the SAEC staff and the SAEC principals have a pupil-centred view of social learning. However, their views differ somewhat, since the SAEC staff mainly describe social learning from the point of view of daily SAEC activities, while the principals have a wider perspective. They describe the work of social learning as a part of a societal assignment. The SAEC activities are influenced by both close and distant factors concerning leading, planning for, and conducting the activities. Some of them have didactic consequences, which can affect how social learning is facilitated for the pupils. Furthermore, visions for social learning are shown in terms of the SAEC and the compulsory school as being one unit, with a teaching culture as the basis of the work. This shows that social learning should be considered as an area for education, which points out the importance of consciously reflected activities in the SAEC. Collegial discussions can be important for this, not just for the SAEC staff, but also for the principals leading the SAEC.
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| 9. |
- Norinder, Maria
(författare)
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A person-centred approach to support family caregivers in specialised home care : The Carer Support Needs Assessment Tool Intervention
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Family caregivers are crucial providers of support and care for patients with lifethreatening illness and many report unmet support needs. With the use of quantitative and qualitative methods this thesis aimed to evaluate the Carer Support Needs Assessment Tool (CSNAT) and explore experiences and potential effects of utilising the Carer Support Needs Assessment Tool Intervention (CSNAT-I) among family caregivers and registered nurses in the context of specialised home care. The results showed that the CSNAT tool was valid and reliable for use among family caregivers in specialised home care (I). Family caregivers reported most the need for additional support concerning “Knowing what to expect in the future” (I, II). They reported and described how higher levels of need for more support were associated with poorer quality of life (II). The intervention was effective in significantly increasing family caregivers’ preparedness for caregiving (p = 0.002) (IV). Participating nurses expressed that their everyday clinical practice changed while learning to use the CSNAT-I and they experienced professional and personal growth (III). Their assessments and supportive inputs shifted from reactive towards proactive and more in collaboration with family caregivers. When utilizing the CSNAT-I, family caregivers experienced their conversations with nurses as co-created, providing new perspectives and insights which increased their involvement and helped in finding solutions (V).In conclusion, this thesis gives further weight to the importance of addressing family caregivers' support needs as a part of nursing.
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| 10. |
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| 11. |
- Sandström, Anette, et al.
(författare)
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Exercise capacity in adult patients with tetralogy of Fallot
- 2021
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Ingår i: International Journal of Cardiology Congenital Heart Disease. - : Elsevier. - 2666-6685. ; 5
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Tidskriftsartikel (refereegranskat)abstract
- Background: On a group level, patients with repaired tetralogy of Fallot have impaired exercise capacity. Since exercise capacity is related to prognosis, and more patients survive into higher age, it is important to know the expected exercise capacity at different ages. Furthermore, factors associated with exercise capacity and the relation between exercise capacity and mortality need further evaluation.Methods: The national register of congenital heart disease was searched for exercise tests in adults with repaired tetralogy of Fallot. The results from exercise tests were compared with national reference data.Results: 314 patients were identified (median age 33.2 [IQR 24.8-44.7], 40.8% women). The mean percent of predicted workload was 74.8 (±19.6) % without change across ages. In multivariable analysis, NYHA class I (odds ratio [OR]4.2, 95% confidence interval [CI]1.7-10.0) and higher physical activity level (>3 h/week) (OR 3.6, 95%CI 1.8-7.3) were positively associated with higher exercise capacity, while ongoing cardiovascular therapy (OR 0.4, 95%CI 0.2-0.7) and male sex (OR 0.3, 95%CI 0.2-0.6) were negatively associated with higher exercise capacity. Both exercise capacity (HR 0.96, 95%CI 0.93-0.98) and heart rate reserve (HR 0.96, 95%CI 0.94-0.98) were associated with mortality.Conclusions: In patients with repaired tetralogy of Fallot the exercise capacity was approximately 75% of expected, regardless of age. Patients with better NYHA class and high physical activity level had a higher exercise capacity. Low exercise capacity and low heart rate reserve were associated with higher mortality. Therefore, evaluating exercise capacity as part of follow up is of importance.
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| 12. |
- Sandström, Anette, 1966-
(författare)
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Long-term outcome and exercise capacity in adults with congenital heart disease with focus on tetralogy of Fallot
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Congenital heart disease (CHD) includes a wide range of malformations, from simple lesions, e.g. ventricular septal defect, that resolve spontaneously, to severe lesions, e.g. univentricular heart, not compatible with life without intervention. Tetralogy of Fallot (ToF) is the most common cyanotic congenital heart disease.In Sweden, approximately 1% of the children are born with CHD each year of which about 30 have ToF. The prognosis has improved remarkably due to advances in surgical techniques as well as peri- and postoperative care. Nowadays, 97% of babies with CHD born in Sweden can be expected to survive into adulthood. Despite huge improvements in prognosis, the relative mortality is still 7 to 97 times higher in patients with CHD, depending on lesion severity, compared with matched controls. Therefore, it is important to improve long-term follow-up and to identify robust and easily available tools to predict poor outcome and optimize timing of possible reinterventions. Addressing quality of life (QoL) has also become more important when survival increases.The main focus of this thesis was on QoL and long-term outcome in patients with repaired tetralogy of Fallot (rToF). In studies I, II and III, we analysed health related quality of life (HRQoL), prevalence of cardiac devices (i.e. pacemakers and implantable cardioverter defibrillators), and exercise capacity, respectively, in patients with rToF. In study IV, the aim was to broaden the perspective and include patients with a wide range of CHD, and to investigate whether exercise capacity, measured as workload could be of help in predicting mortality.Methods: The studies were performed as nationwide register studies. Data from the Swedish registry of congenital heart disease (SWEDCON) were used in studies I-IV. Study II also included data from the Swedish ICD and Pacemaker registry. In studies I-III, only patients with rToF were included, whilst study IV included patient with a broad spectrum of CHD diagnoses.Results: More than half (57%) of the patients with rToF reported best possible HRQoL. New York Heart Association (NYHA) class I and being physically active were associated with best possible HRQoL. Fourteen percent of patients with rToF had a cardiac device, either a pacemaker or an implantable cardioverter defibrillator (ICD). The prevalence of having a cardiac device was lower compared with reports from previous studies, especially for ICDs. Exercise capacity was 75% of predicted in patients with rToF and there was no decline in percent of predicted exercise capacity with age. Low heart rate reserve and low percent of predicted exercise capacity were associated with higher mortality.In study IV, including a wide range of lesions, percent of predicted exercise capacity was associated with mortality. Patients with percent of predicted exercise capacity between 50 and 69.9% had 1.7 times, and patients with exercise capacity <50% of predicted had 2.2 times higher risk of being deceased, over a median follow-up time of 9 years. NYHA class III-IV and ongoing cardiovascular medication were also associated with increased risk of death when adjusted for sex, physical activity and impaired left ventricular function.Conclusions: HRQoL in our patients with rToF was good, despite a fairly high prevalence of cardiac devices. Impaired exercise capacity was associated with an increased mortality. Our results reinforce the need for regular evaluation of exercise capacity in patients with CHD to identify patients at risk of worse outcome. Furthermore, the results in this thesis emphasize the importance of assessing NYHA class and physical activity as part of the follow-up since these parameters are easily attainable and strongly associated with HRQoL and exercise capacity.
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| 13. |
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| 14. |
- Vuorinen, Tuula, 1965-
(författare)
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Mötet mellan föräldraansvar och förskollärarkompetens - föräldrasamverkan i förskolan
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis is to explore the experience of parental collaboration in preschool, by addressing preschool teachers’ competence and parental responsibility as described by preschool teachers and parents. The results are based on in-depth interviews with 30 preschool teachers and 10 parents. Data were gathered and analysed by means of conventional content analysis and constructivist grounded theory (CGT). The empirical material is presented in four articles. The first article focuses on preschool teachers’ approaches when professionally supporting parents, in relation to various views of children, parents and childrearing. The second article describes and analyses preschool teachers’ views on teachers’ professional competence, in the context of home and preschool collaboration. The third article explores parents’ perspectives on, and experiences of, home and preschool collaboration. The fourth article focuses on how parents perceive the process of building good relationships with preschool practitioners. Finally, all four articles are analysed as a whole to provide a synthesis of the findings and the knowledge acquired about home and preschool collaboration in a Swedish context.The findings demonstrate that both preschool teachers and parents value parental collaboration in the preschool. They also emphasize the importance of developing and strengthening the relationship between home and preschool. However, preschool teachers and parents approach collaboration from different starting points and perspectives. Preschool teachers endeavour to support parents in their parental role and consciously work to familiarize parents with their professional skills as regards children's learning and the content of the preschool curriculum. Parents, on the other hand, strive to shoulder their parental responsibilities by `remote parenting´, when persuading preschool practitioners to both `indivisualize´ and `individualize´ preschool practice. Time, continuity, and recognition are seen as central to building secure and authentic relationships. The results demonstrate the importance of preschool teachers critically examining the content expressed in the meeting between them and parents, as well as endeavouring to create preconditions for practical relationship building and collaboration in the preschool. Weak or non-existent relationships not only contribute to weakening parental participation and parental familiarity with the preschool, but also make it more difficult for guardians to exercise their legal parental responsibilities and support their child.
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| 15. |
- Wikner, Anna, et al.
(författare)
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Impaired exercise capacity and mortality risk in adults with congenital heart disease
- 2023
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Ingår i: JACC: Advances. - : Elsevier. - 2772-963X. ; 2:5, s. 100422-100422
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Tidskriftsartikel (refereegranskat)abstract
- Background: An association between impaired exercise capacity and risk of mortality has been reported among adults with congenital heart disease (CHD). Over the years, treatment methods have improved and may influence outcome. Hence, we report data from a national cohort reflecting a contemporary population.Objectives: The purpose of this study was to investigate the association between exercise capacity (workload) and mortality in a large registry-based cohort.Methods: Data on exercise capacity using cycle ergometer were retrieved from the national registry of CHD. The association between predicted exercise capacity (%ECpred) and mortality was analyzed using Cox regression.Results: In total, 3,721 adults (>18 years, 44.6% women) with CHD were included. The median age was 27.0 years (IQR: 20.8-41.0 years) and mean %ECpred was 77% ± 20%. Over a mean follow-up of 9.4 ± 6.0 years, there were 214 (5.8%) deaths. The Multivariable Cox regression model showed that moderately and severely impaired exercise capacity (50-<70 %ECpred: HR: 2.1, 95% CI: 1.4-3.2, P < 0.001, and <50 %ECpred: HR: 3.5, 95% CI: 2.1-6.0, P < 0.001) and CHD complexity were associated with higher mortality (moderate complexity: HR: 1.9 95% CI: 1.2-3.0, P = 0.003, great complexity: HR: 2.3 95% CI: 1.3-4.2, P = 0.008) when adjusted for New York Heart Association class, physical activity, cardiovascular medication, sex, impaired systemic ventricular function, and age.Conclusions: Impaired exercise capacity and CHD complexity are independently associated with all-cause mortality in patients with CHD. Exercise capacity is an easily accessible variable that may be a useful tool for risk assessment in adult patients with CHD, but this needs confirmation in prospective studies.
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