| 1. |
- Kambugyiro, Doris Kwesiga, 1981-
(author)
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Exploring the Under Reporting of Pregnancy and Adverse Pregnancy Outcomes in Population and Health Surveys : A Multi-Country Qualitative Study
- 2023
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Doctoral thesis (other academic/artistic)abstract
- Introduction: Globally in 2021, an estimated 2.3 million newborn deaths and 1.9 million stillbirths occurred, with highest mortality in sub-Saharan Africa and southern Asia. True mortality is likely higher due to under reporting of pregnancies and Adverse Pregnancy Outcomes (APOs). Accurate data are critical for monitoring and preventing these events but many countries rely on Demographic and Health Surveys (DHS), despite measurement challenges. Few studies have explored reasons for under reporting pregnancy and APOs in low income countries, within surveys and surveillance settings.Objective: To explore enablers and barriers to reporting pregnancy and APOs during population and health surveys in multi-country contexts, informing measurement improvements.Methods: The study was conducted in Uganda, Guinea-Bissau, Ghana, Ethiopia and Bangladesh between 2018 and 2021. Focus group discussions (Study I and II), narratives (Study III) and cognitive interviews (Study IV) were undertaken. Thematic analysis was done for the first three studies and qualitative description for Study IV.Results: Methodological challenges included question framing, where double barrelled questions resulted in wrong answers. There were incorrect definitions for miscarriages and stillbirths. Enablers were mostly around interviewers’ skills like building rapport, probing and empathy. Community barriers comprised socio-cultural factors that encouraged silence, including fear of witchcraft. Stigma towards APOs was common, with some foetal deaths viewed as not human, thus less reported. Informal reporting of APOs within social networks sometimes resulted in social support. Individually, APOs left women and men with negative psychosocial effects like depression, thus their reluctance to report. Nevertheless, some respondents said interviews left them feeling better, especially if the interviewer comforted them. Respondents accepted interviews hoping to receive health education about pregnancy loss.Conclusions: Many adverse pregnancy outcomes are avoidable, but they must be accurately measured before designing appropriate interventions. Surveys like the DHS are globally trusted but this study demonstrates that they have weaknesses and sometimes inaccurate data. Improving measurement requires precise questions, strengthened interviewer training, embedded counseling and health education. Supportive policies encouraging reporting are critical, alongside sensitizing citizens on its importance. Otherwise, APOs shall remain invisible and a continued burden to the mental health of those who experience them.
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| 2. |
- Alogheli, Hiba
(author)
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Computational Studies of Macrocycles and Molecular Modeling of Hepatitis C Virus NS3 Protease Inhibitors
- 2018
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Doctoral thesis (other academic/artistic)abstract
- Computational tools are utilized in the drug discovery process to discover, design, and optimize new therapeutics. One important approach is structure-based drug design which relies on knowledge about the 3D structure of the biological target. The first part of this work focuses on applying structure-based drug design for binding mode prediction of HCV NS3 protease inhibitors. The NS3 protease is a challenging target from a computational perspective as it contains an extended binding site. Binding mode predictions were performed for various classes of new acyclic and macrocyclic HCV NS3 protease inhibitors and was used in the design of new inhibitors. None of the synthetized inhibitors have been co-crystallized yet, which has made the evaluation of the suggested binding mode predictions challenging.Macrocycles are an interesting compound class in drug discovery due to their unique structural architecture, which can enable access to new chemical space. Macrocycles can successfully modulate difficult therapeutic targets, as exemplified in the development of protease inhibitors. Furthermore they can improve drug-like properties, such as cell permeability and bioavailability. The second part of this thesis focuses on macrocycles from a computational point of view. A data set of 47 clinically relevant macrocycles was compiled and used in these studies. First, two different docking protocols rigid docking of pre-generated conformers and flexible docking in Glide were evaluated and compared. The results showed that flexible docking in Glide was sufficient for docking of macrocycles with respect to accuracy and speed.The aim of the second study was to evaluate and compare the performance of the more general conformational analysis tools, MCMM and MTLMOD, with the recently developed macrocycle-specialized conformational sampling tools, Prime-MCS and MMBS. In most cases, the general conformational analysis tools (with enhanced parameter settings) performed equally well as compared to the macrocycle-specialized conformational sampling techniques. However, MMBS was superior at locating the global energy minimum conformation.Finally, calculation of the conformational energy penalty of protein-bound macrocycles was performed. The macrocycle data set was complemented with linear analogues that are similar either with respect to physicochemical properties or 2D fingerprints. The conformational energy penalties of these linear analogues were calculated and compared to the conformational energy penalties of the macrocycles. The complete data set of macrocycles and non-macrocycles in this study differ from previously published work addressing conformational energy penalties, since it covers a more extended area of chemical space. Furthermore, there was a weak correlation between the calculated conformational energy penalties and the flexibility of the structures.
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| 3. |
- Duc, Duong, 1984-
(author)
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Healthcare context for knowledge translation in Vietnam : Development and application of the Context Assessment for Community Health (COACH) tool
- 2017
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Doctoral thesis (other academic/artistic)abstract
- The failure to translate evidence into clinical practice has been repeatedly highlighted. This failure is partly attributed to disregarding the context within which healthcare is delivered. The aim of this thesis was to develop and psychometrically evaluate the Context Assessment for Community Health (COACH) tool, and, through that process, provide opportunities to measure aspects of context perceived to be important for Knowledge Translation (KT) interventions in low- and middle-income countries (LMIC).All four studies in this thesis were mainly undertaken in Quang Ninh province, Vietnam during 2008–2014. Study II, however, was also conducted in four other LMICs (Bangladesh, Nicaragua, South Africa, and Uganda). Study I employed inductive content analysis of 16 focus group discussions to explore the influence of context in a community-based facilitation intervention in Vietnam. Studies II and III reported on the development of the COACH tool and assessment of its psychometric properties. Study IV used the COACH tool in a survey among health workers in Vietnam.To date, three sources of evidence regarding validity of the COACH tool have been provided, that is, test content, response processes, and internal instrument structure, with promising psychometric characteristics. The COACH tool could be used as means of characterizing aspects of context ahead of KT interventions, for tailoring KT strategies, and for further understanding of the results of KT interventions.
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| 4. |
- Eriksson, Leif
(author)
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Knowledge Translation in Vietnam : Evaluating facilitation as a tool for improved neonatal health and survival
- 2012
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Doctoral thesis (other academic/artistic)abstract
- Neonatal mortality remains a problem worldwide, despite the existence of low-cost and evidence-based interventions. Unfortunately, the translation of these interventions into practice is deficient.The aim of this thesis was to study aspects of knowledge translation (KT) before and during the Neonatal Knowledge Into Practice (NeoKIP) trial in Quang Ninh, Vietnam. Over a period of three years, this trial evaluated the use of facilitators from the Women’s Union who supported maternal and newborn health groups (MNHG) comprised of eight local stakeholders, as an intervention for improved neonatal survival.In the first two studies (before intervention) we assessed primary health care staff’s knowledge and material preparedness regarding evidence-based neonatal care and explored how primary health care staff translated knowledge into practice. The last two studies (during intervention) were process evaluations aimed at describing the implementation, process and mechanism of the NeoKIP intervention.Primary health care workers achieved 60% of the maximum score in the knowledge survey. Two separate geographical areas were identified with differences in staff levels of knowledge and concurrent disparities in neonatal survival, antenatal care and post-natal home visits. Staff perceived formal training to be the best way to acquire knowledge but asked for more interaction between colleagues within the healthcare system. Traditional medicine, lack of resources, low workload and poorly paid staff constituted barriers for the development of staff knowledge and skills.Eleven facilitators were trained to cover eight facilitator positions. Of the 44 MNHGs, 43 completed their activities to the end of the study. In total, 95% of the monthly meetings with a MNHG and a facilitator were conducted with attendance at 86%. MNHGs identified 32 unique problems, mainly families’ knowledge/behavior, and implemented 39 unique actions, mostly regarding communication. MNHGs experienced that the group was strategically composed to influence change in the communes and facilitators were identified as being important to sustaining activities over time. The facilitators’ lack of health knowledge was regarded as a deficit in assisting the MNHGs, but their performance and skills increased over time.This low-cost model, building on local stakeholder involvement, has the capacity to be scaled up within existing healthcare structures.
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| 5. |
- Eriksson, Rickard
(author)
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Structural Changes in Lithium Battery Materials Induced by Aging or Usage
- 2015
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Doctoral thesis (other academic/artistic)abstract
- Li-ion batteries have a huge potential for use in electrification of the transportation sector. The major challenge to be met is the limited energy storage capacity of the battery pack: both the amount of energy which can be stored within the space available in the vehicle (defining its range), and the aging of the individual battery cells (determining how long a whole pack can deliver sufficient energy and power to drive the vehicle). This thesis aims to increase our knowledge and understanding of structural changes induced by aging and usage of the Li-ion battery materials involved.Aging processes have been studied in commercial-size Li-ion cells with two different chemistries. LiFePO4/graphite cells were aged under different conditions, and thereafter examined at different points along the electrodes by post mortem characterisation using SEM, XPS, XRD and electrochemical characterization in half-cells. The results revealed large differences in degradation behaviour under different aging conditions and in different regions of the same cell. The aging of LiMn2O4-LiCoO2/Li4Ti5O12 cells was studied under two different aging conditions. Post mortem analysis revealed a high degree of Mn/Co mixing within individual particles of the LiMn2O4-LiCoO2 composite electrode.Structural changes induced by lithium insertion were studied in two negative electrode materials: in Li0.5Ni0.25TiOPO4 using in situ XRD, and in Ni0.5TiOPO4 using EXAFS, XANES and HAXPES. It was shown that Li0.5Ni0.25TiOPO4 lost most of its long-range-order during lithiation, and that both Ni and Ti were involved in the charge compensation mechanism during lithiation/delithiation of Ni0.5TiOPO4, with small clusters of metal-like Ni forming during lithiation.Finally, in situ XRD studies were also made of the reaction pathways to form LiFeSO4F from two sets of reactants: either FeSO4·H2O and LiF, or Li2SO4 and FeF2. During the heat treatment, Li2SO4 and FeF2 react to form FeSO4·H2O and LiF in a first step. In a second step LiFeSO4F is formed. This underlines the importance of the structural similarities between LiFeSO4F and FeSO4·H2O in the formation process of LiFeSO4F.
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| 6. |
- Phoosuwan, Nitikorn, 1982-
(author)
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Perinatal Depressive Symptoms among Women in North-Eastern Thailand : Risk Factors, Support and Prevention
- 2020
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Doctoral thesis (other academic/artistic)abstract
- Perinatal depressive symptoms among women remain a global burden. Improvements in self-efficacy among public health professionals (PHPs) in primary healthcare settings to detect and manage perinatal depressive symptoms among women are needed.The aims of this thesis were to: identify prevalence and risk factors associated with perinatal depressive symptoms among women; to explore and describe life situation and support among women with antenatal depressive symptoms (ADS) and their partners; and to improve self-efficacy of PHPs in detection and management of perinatal depressive symptoms in Sakonnakhon province in Thailand. Qualitative and quantitative studies with different types of data collection methods were used.Study I determined prevalence of ADS and associated risk factors among 449 Thai women in late pregnancy using the Edinburgh Postnatal Depression Scale (EPDS). The prevalence was 46.8% and associated risk factors were insufficient money, being a teenager, low psychological well-being, low self-esteem and low sense of coherence.Study II explored and described life situation and support during pregnancy among women with ADS and their partners using semi-structured interviews. Four categories emerged: Having obstacles in life, Facing life situation, Enhancing confidence and Dissatisfaction with help.Study III determined risk factors associated with postpartum depressive symptoms at one month among 319 women and at three months among 276 women. Risk factors at one month were antenatal psychological well-being, non-exclusive breastfeeding, low personal income and caregiver not a mother; risk factors at three months were unintended pregnancy, low personal income/month, low self-esteem, low psychological well-being and low maternal competence.Study IV evaluated a self-efficacy improvement programme (SIP) intended to increase PHPs’ self-efficacy in efforts to detect and manage perinatal depressive symptoms among women. After the SIP, PHPs in the intervention group (n=33) had higher self-efficacy scores than PHPs in the control group (n=33). Four categories emerged in qualitative evaluation: Having confidence, Changing knowledge and attitudes, Increasing perception of an important role, and Increasing awareness of performed function.Women who are at increased risk for perinatal depressive symptoms should be screened using the EPDS. Health care professionals should involve expectant fathers in ANC process. The SIP enhances PHPs’ ability to detect and manage perinatal depressive symptoms.
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| 7. |
- Quennerstedt, Mikael, 1966-
(author)
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Att lära sig hälsa
- 2006
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Doctoral thesis (other academic/artistic)abstract
- The aim of this dissertation is to contribute to an understanding of the subject content in Physical Education (PE) foremost from a health perspective. By using an approach deriving from John Dewey’s transactional perspective on meaningmaking (Bentley & Dewey 1949), and a discourse theoretical position, the discourses identified in the dissertation’s studies are consequently regarded as participants in pupils’ meaning-making. This makes it possible to discuss the results of the studies in terms of the institutional content and conditions of meaning-making in PE. The thesis consists of three different discourse analyses, where the institutionalised aspect of meaning-making in PE is examined by analysing local curriculum documents from 72 Swedish compulsory schools. The results of the dissertation show that in the study of subject content in PE a dominance of an activity discourse can be identified, although a social development discourse is also identified as being important in the documents. The results, thus, suggest that the subject content of PE can be characterised by a wide variety of activities, where pupils are expected to be active participants in the sense of being physically active. The content is also characterised by actions promoting good relationships, co-operation and consideration for others. Actions privileged within the discourses in PE are movement, physical activity, trying many different activities together, active participation, good relations and enjoyment. The results also show that health is explicitly constituted as fitness training, life-long physical activity and knowledge about physical training based on scientific facts from physiology and anatomy. Learning health in PE thus mainly consists of a pathogenic health discourse. But from a salutogenic perspective, health is also constituted as the possibility to participate in movement, physical leisure activities and social relations, and enjoy a life-long engagement in different movement and sport activities. The analysis also shows, however, that within the frame of the subject content of PE, it is also possible to regard health in terms of a commitment to health- and environmental issues, a sense of well-being in ongoing activities and an active involvement in subject content matters within PE. Health can therefore be constituted in different ways within PE, although this is not always made explicit in the local curriculum documents.
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| 8. |
- Ristilä, Mikael
(author)
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Vitamin B6 as a potential antioxidant : a study emanating from UV-B-stressed plants
- 2006
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Doctoral thesis (other academic/artistic)abstract
- Increased influx of solar UV-B radiation (280-320 nm), due to a decreasing stratospheric ozone layer, impacts severely on plants. Some of the UV-B effects on plants are related to stress induced by produced reactive oxygen species (ROS). Pyridoxine (vitamin B6) has been reported to be a potential quencher of ROS.Previous studies have shown that the PDX1.3 gene (encoding a key enzyme in vitamin B6 biosynthesis) is up-regulated by UV-B. We showed that this up-regulation also occurs at the protein level in UV-B exposed Col-0 wild-type plants. Studies performed using pdx1 knock-out mutants of Arabidopsis thaliana showed elevated transcripts levels for LHCB1*3 and PR-5 compared with the Col-0 wild-type. The pdx1 knock-out mutants showed an increased sensitivity towards H2O2-stress, but no increased sensitivity towards low dose UV-B-stress.To study the postulated role of pyridoxine as quencher of ROS in more detail, both theoretical and experimental studies were performed. Theoretical and experimental UV absorption spectra obtained at different protonation/deprotonation states of pyridoxine showed a very close resemblance at low and high pH. However, for the computational studies at physiological pH addition of counterions were required to accurately describe the experimental spectra.When theoretically studying the reactivity of pyridoxine towards three different ROS, .OH, .OOH and .O2-, the hydroxyl radical (.OH) was shown to be the most reactive species, while the superoxide radical (.O2-) showed no reactivity towards pyridoxine.In order to study the role of G-proteins in UV-B signal transduction pathways, UV-B irradiated G-protein mutants of Arabidopsis thaliana were studied. The regulation of the PDX1.3 gene was not affected in the G-protein mutants, regardless of the developmental stage of the plant. However, the expression of CHS was affected in the Ga subunit mutants.
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| 9. |
- Rudbeck, Maria, 1979-
(author)
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The Beauty of the Bitter Devils : A Theoretical Study on Phosphate Molecules
- 2011
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Doctoral thesis (other academic/artistic)abstract
- Phosphate transfer reactions are catalyzed by a large number of enzymes comprising kinases, mutases and phosphatases. These enzymes play a fundamental role in controlling numerous life processes and it is therefore important to understand the origin of their potent catalytic power. An example is the Ca2+-ATPase. In the E2P-state, this enzyme hydrolyses the phosphorylated amino acid, Asp351, 106 to 107 fold faster than when the model compound, acetyl phosphate, is hydrolyzed in in water.This thesis explores the catalytic power of Ca2+-ATPase using theoretical method based on quantum mechanics. The studies of this protein were made by performing quantum chemical calculations on models of phosphoric monoesters as well as on the explicit reaction pathway of the hydrolysis. The studies show the importance of electrostatic interactions as well as the role of the specific active site residue Glu183, a residue that acts as a base in the catalytic pathway. Furthermore, based on the calculations, the interpretation of the experimental infrared spectrum of the E2P-state of Ca2+-ATPase, could be further elucidated as well as modified.The experimental infrared spectrum of phosphoenol pyruvate in water has also been elucidated through calculations. This molecule is converted into pyruvate in the last step of the glycolytic pathway, a reaction that is catalyzed by pyruvate kinase (PK). These results further enabled the interpretation of the experimental spectrum of the PK's catalytic reaction.These two processes, the transport of Ca2+ into the sarcoplasmatic reticulum against a concentration gradient and the glycolysis, are two important actions of a muscle cell.
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| 10. |
- Sequeira, Movin
(author)
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Decision support for multi-criteria evaluation of manufacturing reshoring decisions
- 2023
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Doctoral thesis (other academic/artistic)abstract
- Reshoring decisions in the manufacturing sector have received increasing attention due to their potential to improve overall quality, flexibility, or reduce risk. Contemporary events such as the pandemic and the supply crisis have made manufacturing reshoring decisions a timely and important topic to study. Particularly, the decision support deserves attention as there is limited knowledge on tools for reshoring decisions. The purpose of this study is to investigate the feasibility of decision support for reshoring decisions. The purpose is addressed through three research questions (RQ). The first question (RQ1) is “What criteria should be considered in evaluating a manufacturing reshoring decision?” and should guide companies in identifying factors in a reshoring decision. The second one (RQ2) is “How do decision-makers reason with respect to criteria in manufacturing reshoring decisions?” and describes the importance of the identified criteria that come into play during the decision. The third one (RQ3) is “How can the criteria be modeled in decision-support tools for evaluating manufacturing reshoring decisions?” and explores the feasibility of decision support. The research methods involve systematic literature review, multiple case study, modeling, and archival research. The findings show that reshoring is a multi-criteria decision with cost, quality, and delivery time criteria are considered to be more important (high weight) than sustainability criteria (low weight). The reasoning is manifested by inference rules pertaining to the important criteria. Multi-criteria decision-making techniques such as fuzzy inference, AHP, fuzzy-AHP and fuzzy-TOPSIS are feasible for evaluating manufacturing reshoring decisions. While these techniques rely on decision-makers’ ability to specify weights and rules, rule mining is used to extract rules from large datasets. This research contributes through increased knowledge regarding the criteria, reasoning, and modeling of reshoring decisions. Furthermore, the research extrapolates on the theories that are required to move forward when investigating this topic. For practitioners, this research develops tools that can be used in different stages of the decision-making process. For society, the support tools mean making rational decisions on reshoring rather than emotional or politically motivated ones.
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