1.
Erichsén, Eva, 1959-
(författare)
Constipation in palliative care : Prevalence, definitions, symptom distress and risk-factors
2015
Licentiatavhandling (övrigt vetenskapligt/konstnärligt) abstract
Background and aims: Constipation for patients in palliative care is common and described with variations in prevalence. Side -effects from opioid- treatment, is considered to be one of the main factors leading to constipation. The overall aim of the thesis was to study constipation among patients admitted to specialized palliative care- settings in Sweden. The specific aims of the thesis were 1) To describe and explore the prevalence, definition and symptom distress of constipation by applying different definitions of constipation, in patients admitted to specialized palliative care settings in Sweden. 2) To identify factors related to constipation in patients in specialized palliative care and comparing these factors for patients with different types of constipation to patients without constipation.Methods: A literature- search were conducted where prevalence of- and factors related to constipation was explored and included in a questionnaire, developed for this thesis. Data was collected in a cross- sectional design with a response rate of 50% and analysed with logistic regression.Results: A total of 485 patients from 38 specialized palliative care- units in Sweden participated. Prevalence of constipation for patients in specialized palliative care varied between 7- 43 % depending on definition used. Two different constipation- groups were identified: Medical constipation- group 23% (MCG) and Perceived constipation- group 35% (PCG). Three sub- groups was also identified: patients with i) only ≤ 3 defecations/week, 7%, ii) only perception of being constipated, 19%, and iii) patients with both ≤ 3 defecations/ week and perception of being constipated,16%. Several factors were found to be related to constipation as hospitalisation, absence of laxative- treatment, haemorrhoids, poor appetite, hard stool form and opioids.Conclusions: Prevalence of constipation may differ depending on definitions used. Distress from constipation and other factors related to constipation, than opioids, needs to be incorporated into the clinical constipation- assessment. Validated constipation assessment tool needs to be developed.
2.
Olsson, Ulf
(författare)
OM FRISKVÅRDSPEDAGOGIK I ARBETSLIVET. : EN O/RÄTTVIS BETRAKTELSE.
1993
Licentiatavhandling (övrigt vetenskapligt/konstnärligt) abstract
I fokus för detta arbete står friskvård inom arbetslivet som pedagogisk praktik med hälsoprofilsbedömning, en metod för undersökning och påverkan av människors hälsostatus och hälsovanor, som konkret exempel. En bakgrund till detta är framväxten av insatser för folkhälsa och den ökade betoning av friskvård inom arbetslivet som skett inom såväl privat som offentlig sektor. Friskvård handlar om människors levnadsvanor när det gäller kost, motion, stress, alkohol, tobak m.m.Hälsoprofilsbedömning och friskvårdspedagogik inom arbetslivet ses här ur två olika perspektiv. Ur det ena perspektivet behandlas verksamheten på dess egna villkor - som en metod att inom ramen för arbetslivet få till stånd ner hälsosamma livsstilar genom kontrakt mellan självständiga parter. Det andra perspektivet kan ses som kritiskt granskande. Här ifrågasätts premissema för hälsoprofilsbedömningen utifrån begrepp som makt och disciplinering. En inspirationskälla har därvid bland annat Michel Foucaults arbeten varit. Som empiriskt material för analysen används två avhandlingar som presenterar hälsoprofilbedömningen som metod.Ur dessa båda perspektiv erhålles två olika betraktelser om hälsoprofilsbedömning och friskvårdspedagogik inom arbetslivet - en rättvis och en orättvis. På basis av en kritisk pragmatisk ansats diskuteras möjligheten till ett samtal baserad på relationen mellan de båda betrakelserna.
3.
4.
Tinnfält, Agneta
(författare)
Adolescents' perspective on mental health and health-promoting dialogues
2007
Licentiatavhandling (övrigt vetenskapligt/konstnärligt) abstract
Young people in Sweden are satisfied with most things in their lives. But they are not satisfied with school and not with their opportunities for personal influence. The Convention on the Rights of the Child emphasizes the right for children to express their views freely and that their views should be given due weight. In the present academic essay adolescents, 13, 15 and 16 years old, have been interviewed about matters concerning mental health. The overall aim of the study is to increase our knowledge of adolescents´ perceptions, of mental health and of school nurses´ mental health-promoting dialogue. Focus groups were used in the data collection in study I, as well as in study II. In study II these were combined with individual interviews. Altogether 26 adolescents in study I and 48 in study II were interviewed. Content analysis was used in the analysis in study I, and in study II a phenomenographical approach was used in the analysis. The findings in study I include what issues to discuss and where the school nurse’s mental health-promoting dialogue should take place. The findings show that adolescents emphasize as most important what the school nurse is like as a person in the health-promoting dialogue, and that trust, attentiveness, respectfulness, authenticity, accessibility during school hours and continuity are established. In study II, the findings show that adolescents find mental health to be an emotional experience where positive and negative health is part of the concept. Family is perceived as the most important determinant for young people’s health, closely followed by friends and thereafter school. The girls and the boys in study II did not feel that there were large differences in mental health between girls and boys, but they saw differences in the way they act; girls are talkative and emotional, and boys are silent and tough. Age differences seem to be more important than gender in the adolescents’ perception of mental health. The findings are discussed in relation to gender and previous research. Furthermore, the voice of young people and ethical issues in interviewing young people are discussed. The findings are thereafter placed in an ecological model.
5.
Cakici, Baki, 1984-
(författare)
Disease surveillance systems
2011
Licentiatavhandling (övrigt vetenskapligt/konstnärligt) abstract
Recent advances in information and communication technologies have made the development and operation of complex disease surveillance systems technically feasible, and many systems have been proposed to interpret diverse data sources for health-related signals. Implementing these systems for daily use and efficiently interpreting their output, however, remains a technical challenge. This thesis presents a method for understanding disease surveillance systems structurally, examines four existing systems, and discusses the implications of developing such systems. The discussion is followed by two papers. The first paper describes the design of a national outbreak detection system for daily disease surveillance. It is currently in use at the Swedish Institute for Communicable Disease Control. The source code has been licenced under GNU v3 and is freely available. The second paper discusses methodological issues in computational epidemiology, and presents the lessons learned from a software development project in which a spatially explicit micro-meso-macro model for the entire Swedish population was built based on registry data.
6.
Miedema, Elke, 1985
(författare)
HEALTH PROMOTION AND HEALTHCARE ARCHITECTURE - Conceptualizations of Health Promotion in relation to Healthcare Building Design
2017
Licentiatavhandling (övrigt vetenskapligt/konstnärligt) abstract
Background: Today's healthcare system is under development and reorienting and adapting to embrace a person centred and holistic perspective on health, including a focus on health promotion. This reorientation results in changes in the healthcare models, processes as well as it sets new requirements for healthcare building design. A vast majority of research has been devoted to the relation between inpatient healthcare building design and individual health, e.g. how our hospitals affects treatments and patient outcomes. Less attention has been paid to the relation between outpatient healthcare building design and public or population health and wellbeing, e.g. healthcare in the community to lessen the load on large hospitals. At the same time as the aforementioned development is happening there is a growing body of research emphasizing the importance of the built environment for public health. Objective: This licentiate thesis aim to explore conceptualizations of health promotion in the context of outpatient healthcare building design, the aim is to enable a broader platform to enable incorporation of several health promotion perspectives into future healthcare building design. The main research question is: How is health promotion conceptualized in the context of outpatient healthcare building design? In addition, several other questions emerged in the research process: What aspects of building design result in health-promoting building design? How is health-promoting building design conceptualized in the literature and in practice? What tools and outcomes are referred to when evaluating health-promoting building design? Methods: The research included two studies with an explorative approach: a scoping review and a content analysis of interviews. Results: The results present different conceptualizations of health promotion in the context of healthcare building design. In addition, the results provide an interpretation of health-promoting building design. The results also relate to health promotion strategies, perspectives on health-promoting building design and some aspects of building design that can contribute to, or prevent, health promotion. Discussion: The discussion emphasizes challenges related to developing health-promoting building design, such as vague and contradicting definitions and interpretations of core concepts as health promotion and itís interpretation in the built environment. In addition, the discussion highlights the challenges associated with evaluating health-promoting building design. Conclusions: Health promotion perspectives, have been shown to influence healthcare building design through altered implications for the built environment. As shown, healthcare building design thus seems to have the opportunity to promote the health and wellbeing of patients, staff, visitors and the community. However, the vocabulary used to address health promotion, the different perspectives and health-promotion is weak and inconsistent. The thesis therefore proposed definitions for health promotion and health-promoting building design, that might guide future research and discussions on health promotion vocabulary. Future research should focus on developing the health-promoting building design vocabulary, collecting examples of health-promoting building design, relating health promotion theory to existing architecture theory, and methods and outcomes to evaluate health-promotion building design.
7.
Sandberg, Johanna, 1981-
(författare)
Institutionally Shaped Response to the Introduction of National Guidelines : Case Studies in the Swedish Regional Health Policy Arena
2018
Licentiatavhandling (övrigt vetenskapligt/konstnärligt) abstract
The purpose of this thesis is to explore the institutionally shaped response to the introduction of the national guidelines on the Swedish regional health policy arena. The thesis consists of two case studies. Adapting a qualitative approach, the data is based on individual interviews and these were analysed thematically. The first paper explores the response by four Swedish regional health authorities to the introduction of the National Guidelines for Cardiac Care, while the second paper aims to broaden the understanding of how the national guidelines are used for strategic purposes among politicians.As illustrated in this thesis, organizations will respond, adjust and react to external pressure according to conditions shaped by the institutional context. Key findings here are that the national guidelines are a complex policy instrument that, beyond being able to be used in an instrumental fashion by the medical managment, can also serve a legitimizing function for political decision-makers.The goals of the national guidelines, i.e. equal and efficient care, and the uncertainty about who, among multiple stakeholders, is responsible for the guidelines in the regional health authority, is a source of ambiguity and potential conflict. Those who are potentially responsible represent different rationales – a political rationale and a scientific rationale. The dominating scientific rationale of the national guidelines can create instability, when pushing towards the use of explicit priority-setting.Priority-setting in the institutional setting of a regional health authority has strong elements of becoming “wicked problems” since the dilemma of prioritization remains regardless of ambitions to apply a “technocratic fix”. A wicked problem is characterized by high complexity and being persistently hard to solve (Williams et al. 2012). A recurring dilemma is that priority-setting still contains many wicked problems, as social values and political considerations remain important parts of the policy process. One weakness of the national guidelines, identified in this thesis, is that the guidelines discuss each service area separately, and thereby reinforce a silo mentality in the Swedish health policy arena.To sum up, the national guidelines create a multifaceted and complex response in the Swedish health policy arena where different rationalities collide, and where conflicts appear and are dealt with within the regional health authorities.
8.
Björkqvist, Susan, 1967
(författare)
Source-specific volatile organic compounds in human breath, wood smoke and biogas
1997
Licentiatavhandling (övrigt vetenskapligt/konstnärligt) abstract
Volatile biogenic compounds are often overlooked in air quality studies. This work deals with the analysis of specific organic compounds of biogenic origin and with their sources. General aspects of indoor air chemistry and measurements of volatile organic compounds in indoor air are also discussed. The determinations were based mainly on adsorbent sampling followed by gas chromatographic separations on different types of suitable columns. Identifications were made by mass spectrometry.
9.
Bonander, Carl, 1988-
(författare)
Searching for causal effects of road traffic safety interventions : applications of the interrupted time series design
2015
Licentiatavhandling (övrigt vetenskapligt/konstnärligt) abstract
Traffic-related injuries represent a global public health problem, and contribute largely to mortality and years lived with disability worldwide. Over the course of the last decades, improvements to road traffic safety and injury surveillance systems have resulted in a shift in focus from the prevention of motor vehicle accidents to the control of injury events involving vulnerable road users (VRUs), such as cyclists and moped riders. There have been calls for improvements to the evaluation of safety interventions due to methodological problems associated with the most commonly used study designs. The purpose of this licentiate thesis was to assess the strengths and limitations of the interrupted time series (ITS) design, which has gained some attention for its ability to provide valid effect estimates. Two national road safety interventions involving VRUs were selected as cases: the Swedish bicycle helmet law for children under the age 15, and the tightening of licensing rules for Class 1 mopeds. The empirical results suggest that both interventions were effective in improving the safety of VRUs. Unless other concurrent events affect the treatment population at the exact time of intervention, the effect estimates should be internally valid. One of the main limitations of the study design is the inability to identify why the interventions were successful, especially if they are complex and multifaceted. A lack of reliable exposure data can also pose a further threat to studies of interventions involving VRUs if the intervention can affect the exposure itself. It may also be difficult to generalize the exact effect estimates to other regions and populations. Future studies should consider the use of the ITS design to enhance the internal validity of before-after measurements.
10.
Flyborg, Johan
(författare)
The use of the intelligent powered toothbrush in health technology
2022
Licentiatavhandling (övrigt vetenskapligt/konstnärligt) abstract
BackgroundApplied health technology is a research field that ties together several disciplines to improve and preserve the health and quality of life of individuals and society. Helping especially elderly to meet the above goals is an important and necessary task and assistive technology and collection of health data are part of this work.AimsPaper I aims to investigate whether the use of a powered toothbrush could maintain oral health in a group of individuals with MCI and if changes in oral health affect various aspects of quality of life. Paper II and III aims to examine the capacity of a powered toothbrush as a carrier and mediator of health-related data.MethodsFor papers I and II, the participants were recruited from the Swedish site of the multicenter project Support Monitoring And Reminder Technology for Mild Dementia and for paper III from the Department of Health at Blekinge Institute of Technology. In all three papers, a powered toothbrush has been used as a tool, sensor carrier and transmitter of data. For Quality-of-life assessment two instruments are used, The QoL-AD and OHIP 14.ResultsBy introducing an intelligent powered toothbrush in the group of older individuals with mild cognitive impairment we have showed that they, regardless of cognitive level,improved their scores for plaque index, bleeding index and deepened periodontal pockets ≥ 4mm, over 12 months. The quality-of-life instrument related to oral health improved in parallel with the improvement in oral health. Furthermore, it is possible to use the intelligent powered toothbrush both as a carrier for healt related sensors and to transfer user data via Bluetooth technology to a single-core processor that stores or forwards the data via Wifi to an external computer for processing, analysis and storage. A fesibility study regarding temperature sensor for measuring body temperature during toothbrushing have been evaluated and found to be comparable to traditional oral temperature measurement. ConclusionsAn intelligent powered toothbrush is a well-functioning tool for maintaining oral health in older people with mild cognitive impairment as well as for collecting and transferring brush and health data to external units for storage and analysis.
