| 1. |
- Nilsson, Kerstin
(författare)
-
To work or not to work in an extended working life? Factors in working and retirement decisions
- 2013
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In most of the industrialised world, the proportion of older and retired people in the population is continuously increasing. This will have budgetary implications for maintaining the welfare state, because the active working section of the population must fund the non-active and old population. Aim: The overall aim of this thesis was to obtain knowledge about older workers’ work and life situation in association with their planning and decision to retire from working life. Method: The thesis includes one qualitative and three quantitative studies conducted in Sweden. Result: Self-rated health was found to be a better measure than diagnosed disease of whether older workers believed they could work until 65 years or beyond. Health seems not to be a general impediment to working in old age if older workers are satisfied with their work situation and have enough time and opportunities to recover from fatigue. In one of Sweden’s most hazardous work environments, older workers were not injured significantly more often than younger workers. Good mental and physical work environment, moderate working pace and working time, and the right competence and possibility for skills development were factors determining whether older workers believed they can extend their working life. Attitude to older workers in the organisation, motivation and work satisfaction were factors determining whether older workers want to extend working life. Health, personal economic incentives, family/leisure pursuits and attitude to pension in society affected both whether people believed they can and wanted to extend their working life. In their final retirement decision, older workers considered: i) their possibility to balance and adapt functional ageing and health to a sustainable work situation; ii) their economic situation; iii) possibilities for social inclusion and coherence; and iv) possibilities for meaningful activities. Whether these requirements were best fulfilled in or outside working life determined the decision to continue working or to retire. Conclusion: If it is desirable for society that people will to extend their working life, both the “can work” and the “want to work” factors need to be met. It is important to provide a good fit inside working life. This requires a focus not only on older workers, but also on organisations and managers in order to provide incentives that keep older workers in the work force.
|
|
| 2. |
- Eliasson, Kristina, 1979-
(författare)
-
Ergonomists’ risk assessments : From guesstimates to strategic approaches
- 2020
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Musculoskeletal disorders are among the most prevalent causes of work-related ill-health, consequently risk assessments of hazardous factors related to these disorders are important for prevention. Occupational Health Services (OHS) providers are independent experts, supporting employers regarding work environment issues and rehabilitation. Ergonomists represents one of the professions within OHS, and risk assessment regarding musculoskeletal disorders is within the scope of their work tasks. The overall objective was to explore Swedish ergonomists’ practices and approaches with risk assessments, in order to contribute new knowledge about how ergonomists’ work methods can be further developed to improve prevention of work-related musculoskeletal disorders. Paper I explored the process of risk assessment assignments and the ergonomists’ use of observation-based risk-assessment tools. The result showed a lack of systematic approaches regarding risk assessment assignments and limited use and knowledge of observation-based risk-assessment tools. In Paper II inter-observer and intra-observer reliability of risk assessments, without the use of an explicit observational method were assessed. The results showed a non-acceptable reliability. Paper III explored ergonomists experiences of an e-learning concept for knowledge translation in the OHS context. The e-learning concept was considered as feasible. The knowledge translation inspired increased use of risk-assessment tools, changes in the risk assessment procedures, e.g. selection of tools, and employing a participatory approach. Paper IV described the development of a process model for occupational health surveillance for workers exposed to hand-intensive work (HIW-model), and the studies that will explore the model. Paper V explored company representatives’ experiences of the HIW-model, and factors which facilitated the execution of the model. The model contributed to increased risk awareness and understanding of how individual workers’ musculoskeletal ill-health relates to exposures in work. Facilitating factors were: a joint start-up meeting in which the process was planned, clear communication, and clarity regarding the ownership of the process. In conclusion, the findings showed that ergonomists’ expertise is needed in the entire risk management process and not only in the risk assessment phase. In this process, the ergonomists need to be active and take the expert role (which includes a stocked toolbox) and support the employer through the whole risk management process from initiation to evaluation of risk controlling measures.
|
|
| 3. |
- Noor Baloch, Adnan
(författare)
-
Epidemiological aspects of health and work ability in the Swedish workforce
- 2024
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Many working-age individuals suffer from health issues, impacting their work ability and potentially leading to early workforce exit. More understanding of individual and occupational factors influencing work ability and the use of machine learning techniques in occupational health research is needed. Aim: This thesis aims to describe and investigate the effect of health and work environment factors on work ability. In addition, it seeks to compare different statistical and machine learning methods for predicting work ability among workers by using demographic and work environment data. Methods: Study I and II used data from 247 working-age gynecological cancer survivors to study if and how gastrointestinal syndromes influence the likelihood of disability pension. Study I utilized log-binomial regression, and Study II used counterfactual-based mediation analysis methods. Study III used multiple mediation analysis to investigate stress's long-term impact on work ability among 1432 young adults. Study IV compared the predictive performance of logistic regression with machine learning techniques among 6302 workers with musculoskeletal symptoms. Results: In Study I, an increased risk of disability pension was found for survivors with radiation-induced gastrointestinal syndrome. However, Study II showed that this increased risk is mediated via different aspects of self-assessed quality of life, including global physical health, physical strength, psychological well-being, and satisfaction with sleep. Study III indicated that the association between perceived stress (at baseline) and work ability among young adults was mediated by stress five years later, feelings of control over one’s personal life, work demands affecting personal life, and feeling well-rested upon waking. In Study IV, all machine learning techniques exhibited strong performance, with Extreme Gradient Boosting, AdaBoost, and Gradient Boosting Machines performing best. The calibration varied across techniques. Conclusion: There exists a complex relationship between health and work ability. Radiation-induced gastrointestinal syndrome influences the self-reported quality of life and disability pension, where quality of life mediates part of the gastrointestinal syndrome’s effect on disability pension. Occupational factors mediate the impact of perceived stress on work ability in young adults. Also, feelings of control over personal life are important for maintaining work ability in young adults with stress complaints. The performance of multivariable logistic regression, which utilizes clinically relevant predictors, is comparable to that of sophisticated machine learning algorithms when it comes to predicting disability pensions.
|
|
| 4. |
- Asplund, Sofia, 1982-
(författare)
-
Work-related stress among municipal employees in rural northern Sweden
- 2022
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Many rural municipalities in Sweden are facing challenges like depopulation, decreased economy, and difficulties in recruiting staff. Living and working in rural areas may involve adverse working conditions and higher risks of ill-health. Work is generally good for employee health, but various physical and psychosocial aspects of work can also be hazards and cause work-related stress, health problems, reduced productivity, and long-term sick leave. Leadership by managers in the organisation is important for the work environment, work performance, and occupational health of employees. The Swedish municipal sector employs almost 20% of employees in the labour market, where school, preschool and care of older people are the dominating areas. Previous research has shown that there are adverse psychosocial working conditions in Swedish municipal organisations. The municipal sector has the highest rate of long-term sick leave compared to other sectors in the labour market, mainly due to stress-related disorders, such as exhaustion disorder (ED). Therefore, it is important to focus on organisational and psychosocial work environments, work-related stress, and health in the municipal sector of rural northern Sweden.Aim: The overall aim was to explore organisational and psychosocial work environments, work-related stress, and health among municipal employees in rural northern Sweden.Methods: Both quantitative and qualitative methods were used to collect data. Study I and II had a quantitative approach, a cross-sectional design, and used a questionnaire for collecting data. Participants were employees (n =1093) in the municipal sector in two municipalities in rural northern Sweden. The questionnaire was constructed to contain instruments measuring the organisational and psychosocial work environments, perceived stress, self-rated exhaustion disorder (s-ED), and physical activity. Quantitative data were analysed using logistic regression in Study I, and partial least squares regression in Study II. Studies III and IV had a qualitative approach. In Study III, semi-structured individual interviews were conducted with 15 municipal employees with high self-reported stress. In Study IV, semi-structured individual interviews were conducted with 15 managers at different levels in the municipal sector. All qualitative data were analysed using inductive qualitative content analysis.Results: In Study I, results showed that 21.5 % of the municipal employees reported s-ED.Cognitive problems, sleep problems,depressiveivsymptoms, high stress, poor self-rated health, and stomach problems were the health-related factors most strongly associated with s-ED. In Study II, results showed that there were significant differences between the s-ED and the non–s-ED group in all but one of the 32 organisational and psychosocial environmental work factors. Various demands—i.e., quantitative, emotional, intellectual—and work conflicts were important factors associated with s-ED. Social support, resources, and time for work and reflection were important factors associated with non–s-ED. Findings from Study III showed that the employees with high self-reported stress experienced feelings of suffering through endless chaos when they worked in an organisation with high demands and low resources, control, and support. They also experienced feelings of insufficiency, and negative effects on health and family life. Findings from Study IV showed that managers in the municipal sector experienced feelings of striving for stability on shaky ground. They struggled inside slimmed-down organisations with a substitute shortage and reduced means, were burdened by conflicting demands, and experienced health and family life impairments. Managers expressed the importance of motivation, social support, and coping strategies.Conclusion: This thesis illuminates adverse psychosocial working conditions among municipal employees in two municipalities in the rural context of northern Sweden, where a stressful work environment, s-ED and health impairments are relatively common.It also provides important insights of municipal employee’s experiences of work-related stress, the importance of acknowledging suffering, and managers’ experiences of working in municipal organisations with shrinking resources, as in addition to a work–family imbalance. It seems important that organisations in the municipal sector have supportive and effective leadership, and allow employees control over their work. Furthermore, it seems important that various demands are balanced by sufficient resources; such as staff, social support, and economic resources in order to prevent work-related stress. Findings from this thesis can contribute to future interventions, aiming to prevent work-related stress and improve occupational well-being and work performance. They also have value for development work in municipal organisations.
|
|
| 5. |
- Borgestig, Maria
(författare)
-
The impact of gaze-based assistive technology on daily activities in children with severe physical impairments
- 2016
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The aim of the thesis was to investigate the impact of gaze-based assistive technology on daily activities in children with severe physical impairments and without speech. The objectives were to develop and pilot a gaze-based assistive technology intervention (GAT intervention) at home and in school for these children and to understand its impact on daily activities as experienced by their parents.Methods: Study I was a pilot study in which the basic components that were developed for the intervention were evaluated for students with physical impairments. The study aimed at improving the use of computers as assistive technology (AT) in school. Based on the findings in Study I, the GAT intervention was developed. The GAT intervention aimed at implementing gaze-based AT in daily activities. It consisted of two parts; having access to gaze-based AT and having access to services from a multi professional communication team during nine to ten months. Studies II-IV concerned gazebased AT for children with severe physical impairments without speech who participated in the GAT intervention. The participants were ten children (ages 1-15) (Studies II, III), and their parents (Study IV). Studies II and III had longitudinal designs and children were followed during 15-20 months with repeated measurements before, after and at follow-up. In Study II children’s repertoire of computer activities, extent of use, and goal attainment with gaze-based AT was evaluated, as well as parents’ satisfaction with the AT and with services. In Study III children’s eye gaze performance when using gaze-based AT was examined. In Study IV, parents were interviewed twice with the aim of exploring their experiences of children’s gaze-based AT use in daily life. In Study IV a hermeneutical approach was used.Results: The findings of Study I showed that the basic components of intervention improved the use of computers in school. Study II showed an increased repertoire of computer activities with the gazebased AT, maintained use in daily activities for all at follow up, and that all children attained goals for gaze-based AT use in daily activities. Parents were satisfied with the gaze-based AT, and with the services in the GAT intervention. In study III, nine children improved in eye gaze performance over time when using the gaze-based AT in daily activities. Study IV revealed that children’s gaze-based AT usage in daily activities made a difference to parents since the children demonstrated agency, and showed their personality and competencies by using gaze-based AT, and for the parents this opened up infinite possibilities for the child to do and learn things. Overall, children’s gaze-based AT usage provided parents with hope of a future in which their children could develop and have influence in life.Conclusions: This thesis shows that these children with severe physical impairments and without speech acquired sufficient gaze control skills to use gaze-based AT for daily activities in the home and at school. The gaze-based AT had a positive impact on performing activities, for example, play activities and communication- and interaction-related activities. For the parents, children’s gaze-based AT usage made a difference since it shaped a hope of a better future for their children, where they can develop and gain influence in their future life. Furthermore, the children continued to perform daily activities with gaze-based AT over time. This finding suggests that key persons were provided with sufficient knowledge and skills to support children in maintained use of gaze-based AT after withdrawal of the services provided in the GAT intervention.
|
|
| 6. |
- Jacobsson, Ann, 1964-
(författare)
-
Exploring firefighters' health and wellbeing
- 2018
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: This thesis supports the assumption that firefighters’ health and mental well-being is important, in order to cope with the stress that the profession implies. As health is an essential part of everyday life, it seems substantially to understand how an almost exclusively male workforce of firefighters construct their discourse in relation to health and well-being. The overall purpose of this thesis is to explore health and ill-health among firefighters in relation to their work environment, including coping strategies, critical incidents and ‘ordinary’ day-to-day work at the fire and rescue service station.Methods: In Study I, 180 firefighters (16 women, 164 men) answered an open-ended question. Qualitative content analysis was used based on free text answers and focused on critical incidents. Study II, was based on a cross-sectional survey measuring burnout, psychosocial work environment and coping strategies. Participants were randomly selected and the final sample consisted of 476 firefighters (58 women, 418 men) and analyzed with multiple linear regression. In Study III and Study IV, a total of 28 fire-fighters (4 women and 24 men) participated in the study. Regarding Study IV a strategic sample of policy documents was also included. For Study III and IV, the research questions was dealt with applying critical discourse analysis on the focus group discussions (FGD) and individual interviews. In Study IV the analysed material also included policy documents.Results: Findings from Study I were presented in four categories; ‘overwhelming critical situations’, ‘risks of delay, ‘risk of failure’ and ‘risks to oneself’. Women in Study I described their experiences in a more distanced account, while men described their experiences more vividly. Results from Study II showed overall low mean values in the burnout scales of emotional exhaustion (EE) and depersonalization (DP) among both women and men. Only 2 % of women and 1% of men scored high levels of EE, and only 2% of women and 3% of men scored high level of DP. A multiple linear regression showed that high demand and lack of social support contributed significantly to predicting EE among men. The coping strategies among firefighters influence the level of EE and DP, and these strategies were different between women and men. In Study III six dominant themes were identified. A strong sense of the firefighter community was articulated as health promoting. The physical exercise at work and the balance between emergency and station work were also two recurrent theme supporting firefighters’ health. Another health-promoting theme concerns clarity of roles among firefighters. Peer support and tolerance in the work group was another common theme, alongside with expressions of the firefighter as hero or helper. Themes described as hindrances to health and well-being in firefighters’ discourse were; diversity, preventive work and education. All hindrance themes were articulated as important struggles in the firefighter discourse against changes in work. In Study IV, we have identified two sides in the struggles, on the one hand we have the ‘insiders’, a majority of male firefighters working in the fire and rescue services representing a collective defending its autonomy and traditions. On the other hand we have the ‘outsiders’, represented by the government, the Swedish Civil Contingencies Agency, (MSB), municipalities, politicians at different levels and academic researchers.Conclusion: Firefighters described critical incidents at work as overwhelming situations, along with negative experiences of organizational and practical tasks. Despite these experiences firefighters were reported as healthy according to EE and DP (Study I and II). Results of Study II also showed a relationship between psychosocial work environment and burnout among men, but not among women. The coping strategies among firefighters influence the level of burnout, and these strategies differ between women and men. The well-being in firefighters’ discourse, at least partly, is gained from a strong sense of belonging to a homosocial group characterized by closeness to each other and peers who take care of each other. The firefighters in our studies articulate this community-sense, and describe the importance of the similarity, rather than diversity (Studies III and IV). Findings from our studies regarding health and well-being, add knowledge to the current explanations relating to firefighters’ resistance to change.
|
|
| 7. |
- Karimpour, Masoumeh, 1986-
(författare)
-
Multi-platform metabolomics assays to study the responsiveness of the human plasma and lung lavage metabolome
- 2016
-
Konstnärligt arbete (övrigt vetenskapligt/konstnärligt)abstract
- Metabolomics as a field has been used to track changes and perturbations in the human body by investigating metabolite profiles indicating the change of metabolite levels over time and in response to different challenges. In this thesis work, the main focus was on applying multiplatform-metabolomics to study the human metabolome following exposure to perturbations, such as diet (in the form of a challenge meal) and exhaust emissions (air pollution exposure in a controlled setting). The cutting-edge analytical platforms used for this purpose were nuclear magnetic resonance (NMR), as well as gas chromatography (GC) and liquid chromatography (LC) coupled to mass spectrometry (MS). Each platform offered unique characterization features, allowing detection and identification of a specific range of metabolites. The use of multiplatform-metabolomics was found to enhance the metabolome coverage and to provide complementary findings that enabled a better understanding of the biochemical processes reflected by the metabolite profiles. Using non-targeted analysis, a wide range of unknown metabolites in plasma were identified during the postprandial stage after a well-defined challenge meal (in Paper I). In addition, a considerable number of metabolites were detected and identified in lung lavage fluid after biodiesel exhaust exposure compared to filtered air exposure (in Paper II). In parallel, using targeted analysis, both lung lavage and plasma fatty acid metabolites were detected and quantified in response to filtered air and biodiesel exhaust exposure (in Paper III and IV).Data processing of raw data followed by data analysis, using both univariate and multivariate methods, enabled changes occurring in metabolites levels to be screened and investigated. For the initial pilot postprandial study, the aim was to investigate the plasma metabolome response after a well-defined meal during the postprandial stage for two types of diet. It was found that independent of the background diet type, levels of metabolites returned to their baseline levels after three hours. This finding was taken into consideration for the biodiesel exhaust exposures studies, designed to limit the impact of dietary effects. Both targeted and non-targeted approaches resulted in important findings. For instance, different metabolite profiles were detected in bronchial wash (BW) compared to bronchoalveolar lavage (BAL) fluid with mainly NMR and LC-MS. Furthermore, biodiesel exhaust exposure resulted in different metabolite profiles as observed by GC-MS, especially in BAL. In addition, fatty acid metabolites in BW, BAL, and plasma were shown to be responsive to biodiesel exhaust exposure, as measured by a targeted LC-MS/MS protocol. In summary, the new analytical methods developed to investigate the responsiveness of the human plasma and lung lavage metabolome proved to be useful in an analytical perspective, and provided important biological findings. However, further studies are needed to validate these results.
|
|
| 8. |
- Albrecht, Sophie Charlotte, 1988-
(författare)
-
The Highs and Lows of Work-Time Control : Exploring the role of control over working hours for health
- 2021
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Flexible work-time arrangements are thought to create ways of aligning work and private life and facilitate recovery. While temporal flexibility is found to generally bolster work–life balance, its effects on health outcomes are less well known. The present thesis seeks to examine if and how perceived control over working hours benefits workers’ health. Utilising a large Swedish cohort study, four empirical studies explored the association of work-time control (WTC) with subsequent mental and physical health as well as the underlying mechanisms and moderating influences.Study I assessed the factorial structure of an instrument to measure WTC and found two sub-dimensions: control over daily hours (the length, starting and ending times of a workday) and control over time off (the taking of breaks/time/days off, paid and unpaid). Levels of control per sub-dimension were described by demographic and work-related factors for a large sample of Swedish workers. In particular, shift, public sector and female workers reported low levels of WTC.Study II examined effects of control over daily hours and time off on depressive symptoms. Increasing control over time off was related to decreasing depressive symptoms over time, whereas only initial level of control over daily hours was associated with lower levels of depressive symptoms. For both sub-dimensions of WTC, the direction of this effect was predominantly from perceived control to subsequent depressive symptoms; reversed processes were of less importance.Study III focused on work–life interference as one step on the causal chain between WTC and depressive symptoms and musculoskeletal complaints, respectively. For both sub-dimensions of WTC, part of the effect on depressive symptoms went through work–life interference. Reversed processes played a role between depressive symptoms and work–life interference only. Control over time off was found to mitigate work–life interference and subsequent depressive symptoms more than control over daily hours, albeit with generally small effects. Regarding musculoskeletal complaints, effects were even smaller and work–life interference appeared to be less important.Study IV assessed gender differences in the impact of WTC on work–life interference and exhaustion regarding the mediating role of overtime hours. In a sample of knowledge workers, higher control over time off was associated with lower subsequent work–life interference and exhaustion, while control over daily hours was unrelated to both outcomes. Although men worked more overtime hours than women on average, no evidence was found for men with high control over time off/daily hours to perceive more work–life interference/exhaustion due to increased overtime compared to women.This thesis found that higher levels of WTC were beneficial for a range of health outcomes, which was partly explained by fewer work–life conflicts. While these effects were generally small, control over time off in particular was consistently associated with favourable outcomes in health, work-life balance and working hours. Given that the level of workers’ discretion over working hours varies starkly by work and demographic factors, enhancing the availability of flexible work-time arrangements is in the interest of public health. WTC, with a particular focus on employees’ ability to take time off from work, may improve the daily work–life interface and support a sustainable working life.
|
|
| 9. |
- Backman, Helena, 1979-
(författare)
-
Lung function and prevalence trends in asthma and COPD
- 2016
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Asthma and chronic obstructive pulmonary disease (COPD) are common obstructive airway diseases with a substantial burden in terms of morbidity, mortality and costs. Smoking is the single most important risk factor for COPD, and is associated with incident asthma. It is important to know if the prevalence of asthma and COPD is increasing or decreasing in the population in order to effectively allocate health care resources. The definitions of these diseases have varied over time which makes it difficult to measure changes in prevalence. The preferred method is to estimate the prevalence with the same procedures and definitions based on cross-sectional population samples with identical age distributions in the same geographical area at different time points. Measurements of lung function (spirometry) are required to diagnose COPD, and spirometry is used to evaluate disease severity and progress of both asthma and COPD, where observed values are compared to reference values. The most commonly used reference values in Sweden are published during the mid 1980s, and there are few evaluations of how appropriate they are today based on Swedish population samples. The aim of the thesis was to estimate trends in the prevalence of asthma and COPD in relation to smoking habits, and to evaluate and estimate reference values for spirometry.Methods: The project was based on population-based samples of adults from the Obstructive Lung Disease in Northern Sweden (OLIN) studies. Postal questionnaires were sent to large cohorts, recruited in 1992 (n=4851, 20-69 years), 1996 (n=7420, 20-74 years) and 2006 (n=6165, 20-69 years), respectively. The questionnaire included questions on respiratory symptoms and diseases, their comorbidities and several possible risk factors including smoking habits. Structured interviews and spirometry were performed in random samples of the responders to the 1992 and 2006 surveys, of which n=660 (in 1994) and n=623 (in 2009) were within identical age-spans (23-72 years). The trend in asthma prevalence was estimated by comparing the postal questionnaire surveys in 1996 and 2006, and the trend in COPD prevalence was estimated by comparing the samples participating in dynamic spirometry in 1994 and 2009, respectively. The prevalence of COPD was estimated based on two different definitions of COPD. Commonly used reference values for spirometry were evaluated based on randomly sampled healthy non-smokers defined in clinical examinations of participants in the 2006 postal questionnaire (n=501). The main focus of the evaluation was the global lung function initiative (GLI) reference values published in 2012, for which Z-scores and percent of predicted values were analysed. New sex-specific reference values for spirometry were estimated by linear regression, with age and height as predictors. These new OLIN reference values were also evaluated on a sample of healthy non-smokers identified in the population-based West Sweden Asthma Study.Results: Although the prevalence of smoking decreased from 27.4% to 19.1%, p<0.001, between 1996 and 2006, the prevalence of physician-diagnosed asthma increased from 9.4% to 11.6%, p<0.001. The prevalence of symptoms common in asthma such as recurrent wheeze did not change significantly between the surveys or tended to decrease, while bronchitis symptoms such as cough and sputum production decreased significantly. The evaluation of the GLI reference values showed that the predicted values were significantly lower compared to the observed values in Norrbotten, which makes the percent of predicted too high. This was especially true for FVC percent predicted with a mean of 106%. In general, the deviations were more pronounced among women. New OLIN reference values valid for the Norrbotten sample were modelled and showed a high external validity when applied on the sample from western Sweden. The prevalence of moderate to severe COPD decreased substantially over the 15-year period between 1994 and 2009, regardless of definition.Conclusions: In parallel with substantially decreased smoking habits in the population between 1996 and 2006, the prevalence of several airway symptoms decreased while the prevalence of physician-diagnosed asthma increased. These results suggest increased diagnostic activity for asthma, but may also suggest that the asthma prevalence has continued to increase. In contrast to asthma, the prevalence of COPD tended to decrease and moderate to severe COPD decreased substantially. The continuous decrease in smoking in Sweden during several decades prior to the study period is most likely contributing to these results. The evaluation of reference values showed that the GLI reference values were lower than the observed spirometric values in the population, especially for women, why the new up-to date reference values may be of importance for disease evaluation in epidemiology and in the health care as well.
|
|
| 10. |
- Bank, Sakarias Einar Sefik
(författare)
-
Promoting Air Quality Policy Adoption and Change
- 2021
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Air pollution is a localised issue but negatively influences health and finance globally. Conurbations and regional governments struggle to find the best policy solutions to meet air quality limit levels while competing over resources and attempting to secure growth. As such, methods to increase the adoption of effective pollution-focused policies are warranted. This thesis has set out to create a framework for understanding the relationship between behaviour change of policy makers and the adoption of new air quality policies at regional levels of government. Chapter four of this thesis looked into the quality and results of previous literature through a systematic review (study 1), investigating how previous interventions have attempted to promote policy adoption. Within chapter five, a vignette study with policy practitioners (study 2; n = 15) was conducted to evaluate the use of intervention functions. Alongside the vignette study, an online questionnaire looked at perceived barriers to policy adoption. Data from both were amalgamated using thematic analysis. Finally, in chapter six, the use of interventions to promote air quality policy and the state of current UK air quality policy was reviewed (study 3). Collectively these studies have contributed to the understanding of how intervention functions influence policy intention formation and policy adoption. The combined outcomes of these studies suggest a) a need for increased education of policymakers and b) for councils to share learning and take inspiration from each other. Throughout the studies, key barriers to policy intentions and policy adoption were investigated, the most prominent being economic and administrative barriers. Within chapter seven, results are summarised and directions for future research and practice are suggested.
|
|
