| 1. |
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| 2. |
- Anderzén, Johan
(author)
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Differences in glycemic control in type 1 diabetes children and adolescents : in a national and international perspective and the effect on microvascular complications in young adults
- 2023
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Doctoral thesis (other academic/artistic)abstract
- This thesis focuses on glycemic control measured as HbA1c in type 1 diabetes (T1D) patients during childhood and especially during adolescence, both in a Swedish and an international context, and relates the glycemic control to the risk of complications in young adults. In studies I and II, the Swedish Pediatric Diabetes Quality Register (SWEDIABKIDS) and the Swedish National Diabetes Register (NDR) were used. More than 4000 young adults with T1D and data on HbA1c in NDR both in 2011 and 2012 as well as data on HbA1c in SWEDIABKIDS were used. The T1D patients with poor glycemic control during their teenage period had a risk for retinopathy several times higher than those with good glycemic control. The risk for micro- and macroalbuminuria was also higher in those with poor glycemic control and was most pronounced in the T1D patients with high HbA1c in both registers. Females had worse glycemic control than males during the teenage period and an increased risk of retinopathy as young adults. In studies III and IV, pediatric diabetes quality register data from, respectively, eight and seven Western high-income countries were collected in the year 2013. Data on about 60 000 T1D patients were analyzed according to mean HbA1c levels in the countries and related to actual age and T1D duration to determine if there were differences in glycemic control between the countries. There were large differences in mean HbA1c between the countries, both when related to age and T1D duration. Despite the differences in mean HbA1c, the increase in mean HbA1c with increasing age and T1D duration was very similar in all countries. The overall picture of these studies is that good glycemic control is very important to avoid complications of T1D as young adults, and it seems particularly important to maintain a good glycemic control during adolescence. Furthermore large differences in glycemic control in T1D patients in Western high-income countries were found. Despite the differences in glycemic control, the pattern of rising HbA1c with increasing age and duration of T1D was very similar in all countries. Females have worse glycemic control than males during their teenage period, both in Sweden and internationally, and they also have more retinopathy as young adults. This thesis shows that it is of the utmost importance to treat T1D patients intensively directly after diagnosis, to treat the young T1D patients intensely and to reduce the rise in HbA1c with increasing age and duration of T1D in order to avoid complications early in life. Diabetes quality registers give the opportunity to compare results and share experiences, both within and between countries, so treatment of T1D can be designed in the best possible way and thereby minimize T1D complications.
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| 3. |
- Anderzen, J., et al.
(author)
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Teenagers with poor metabolic control already have a higher risk of microvascular complications as young adults
- 2016
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In: Journal of Diabetes and Its Complications. - : Elsevier BV. - 1056-8727 .- 1873-460X. ; 30:3, s. 533-536
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Journal article (peer-reviewed)abstract
- Aims: To evaluate how HbA1c in adolescents with type 1 diabetes affects microvascular complications in young adults. Methods: All individuals registered in the Swedish paediatric diabetes quality registry (SWEDIABKIDS) 13-18 years of age, and as adults registered in the Swedish National Diabetes Registry (NDR) in both the years 2011 and 2012 were included, in total 4250 individuals. Results: Of the individuals with mean HbA1c >78 mmol/mol in SWEDIABKIDS 83.4% had retinopathy, 15.8% had microalbuminuria and 4.9% had macroalbuminuria in NDR. The logistic regression analysis showed that the OR to develop macroalbuminuria as a young adult was significantly higher in the group with mean HbA1c >78 mmol/mol in SWEDIABKIDS (p < 0.05). Among the patients with mean HbA1c above 78 mmol/mol in both registries there was a significantly higher proportion that had retinopathy, microalbuminuria (p < 0.001) and/or macroalbuminuria (p < 0.01) compared to the group with HbA1c below 57 mmol/mol in both registries. Only 6.5% of the persons in this study were over 30 years of age. Conclusions: Paediatric diabetes teams working with teenagers must be aware of the impact of good metabolic control during adolescence, and should intensify the care during this vulnerable period of life to reduce the risk of microvascular complications in young adults.
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| 4. |
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| 5. |
- Charalampopoulos, Dimitrios, et al.
(author)
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Exploring Variation in Glycemic Control Across and Within Eight High-Income Countries: A Cross-sectional Analysis of 64,666 Children and Adolescents With Type 1 Diabetes
- 2018
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In: Diabetes Care. - : AMER DIABETES ASSOC. - 0149-5992 .- 1935-5548. ; 41:6, s. 1180-1187
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Journal article (peer-reviewed)abstract
- OBJECTIVE International studies on childhood type 1 diabetes (T1D) have focused on whole-country mean HbA(1c) levels, thereby concealing potential variations within countries. We aimed to explore the variations in HbA(1c) across and within eight high-income countries to best inform international benchmarking and policy recommendations. RESEARCH DESIGN AND METHODS Data were collected between 2013 and 2014 from 64,666 children with T1D who were amp;lt; 18 years of age across 528 centers in Germany, Austria, England, Wales, U.S., Sweden, Denmark, and Norway. We used fixed-and random-effects models adjusted for age, sex, diabetes duration, and minority status to describe differences between center means and to calculate the proportion of total variation in HbA(1c) levels that is attributable to between-center differences (intraclass correlation [ICC]). We also explored the association between within-center variation and childrens glycemic control. RESULTS Sweden had the lowest mean HbA(1c) (59mmol/mol [7.6%]) and together with Norway and Denmark showed the lowest between-center variations (ICC amp;lt;= 4%). Germany and Austria had the next lowest mean HbA(1c) (61-62 mmol/mol [7.7-7.8%]) but showed the largest center variations (ICC similar to 15%). Centers in England, Wales, and the U.S. showed low-to-moderate variation around high mean values. In pooled analysis, differences between counties remained significant after adjustment for children characteristics and center effects (P value amp;lt; 0.001). Across all countries, children attending centers with more variable glycemic results had higher HbA(1c) levels (5.6mmol/mol [0.5%] per 5mmol/mol [0.5%] increase in center SD of HbA(1c) values of all children attending a specific center). CONCLUSIONS A tsimilar average levels of HbA(1c), countries display different levels of center variation. The distribution of glycemic achievement within countries should be considered in developing informed policies that drive quality improvement.
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| 6. |
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| 7. |
- Ekberg, Joakim, et al.
(author)
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Web 2.0 Systems Supporting Childhood Chronic Disease Management: Design Guidelines Based on Information Behaviour and Social Learning Theories
- 2010
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In: JOURNAL OF MEDICAL SYSTEMS. - : Springer Science and Business Media LLC. - 0148-5598 .- 1573-689X. ; 34:2, s. 107-117
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Journal article (peer-reviewed)abstract
- Self-directed learning denotes that the individual is in command of what should be learned and why it is important. In this study, guidelines for the design of Web 2.0 systems for supporting diabetic adolescents every day learning needs are examined in light of theories about information behaviour and social learning. A Web 2.0 system was developed to support a community of practice and social learning structures were created to support building of relations between members on several levels in the community. The features of the system included access to participation in the culture of diabetes management practice, entry to information about the community and about what needs to be learned to be a full practitioner or respected member in the community, and free sharing of information, narratives and experience-based knowledge. After integration with the key elements derived from theories of information behaviour, a preliminary design guideline document was formulated.
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| 8. |
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| 9. |
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| 10. |
- Forsner, Maria, 1954-, et al.
(author)
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Questionnaires to Measure Process and Structure of Quality Indicators for Pediatric Nursing
- 2021
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In: Pediatric quality & safety. - : Lippincott Williams & Wilkins. - 2472-0054. ; 6:1
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Journal article (peer-reviewed)abstract
- Introduction: The quality of nursing care has a significant impact on the outcomes of care. The specific needs of children requiring hospital care make it essential to monitor and compare data not only on the medically oriented outcome measure but also on nursing care, structure, and process, requiring perspectives from registered nurses (RNs) and nurse managers (NMs). Thus, this project aimed to evaluate the structure and process of nursing quality indicators in pediatric hospital care with questionnaires distributed to RN and NM.Methods: We developed separate questionnaires for NMs and RNs to assess the process and structure of the quality indicators of breastfeeding, management of pain, venous access, medication management, and provision of a child-oriented environment. Nine NMs and 113 RNs from 9 pediatric wards answered the questionnaires.Result: Local guidelines were available for 3 out of the 5 quality indicators: pain management, venous access, and medication management. RNs reported varying levels of adherence to pain management (62%), and venous access management (72%). Satisfaction with the conditions for safe medication management was 90%. Approximately, two-thirds (67%) of RN reported sufficient knowledge regarding the impact of the child-oriented environment and less than half (44%) regarding how to support breastfeeding.Conclusion: Structure and process is a prerequisite for quality of care outcomes. This study discloses areas for quality improvement and offers instruments to compare structure and process in pediatric nursing care to discuss with consumers, managers, staff, and other stakeholders.
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| 11. |
- Göthesson, Johanna, et al.
(author)
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Children's and adolescent's narratives about pain and negative experiences in diabetes treatment
- 2023
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In: Journal for Specialists in Pediatric Nursing. - : John Wiley & Sons. - 1539-0136 .- 1744-6155. ; 28:1
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Journal article (peer-reviewed)abstract
- Pain and fear associated with needle procedures have been found to be more common among children and adolescents treated for type 1 diabetes (T1D) than among others in their age group. Furthermore, high glycated haemoglobin (HbA1c) values are associated with needle-related fear.Aim: To describe negative experiences of needle procedures in childhood diabetes treatment from children's and adolescents' own perspectives. Methods: Short written narratives (n = 83) and drawings (n = 2) from children and adolescents treated for T1D, aged 7–18 years, were subjected to inductive qualitative content analysis.Results: Negative experiences with needle procedures had many facets, such as pain and fear, changing over time and affecting everyday life. All kinds of needle procedures caused difficulties, but venipunctures were described as the worst.Conclusion: All needle procedures involved in diabetes treatment are potentially experienced as creating pain and fear, but the negative experiences are multifaceted and vary between individuals. These experiences create suffering for children and adolescents, and influence their daily lives. Besides finding techniques to decrease the number of needle procedures in the treatment, research should focus on implementing methods to decrease pain, fear, and other negative experiences as well as to promote self-coping. This is urgent, since needle-related fear has an impact on glycaemic control and therefore increases the risk of long-term complications. Clinical Implications: When caring for children and adolescents with diabetes, their previous experiences with needle procedures need to be considered.
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| 12. |
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| 13. |
- Hanberger, Anders, et al.
(author)
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Audit and Accountability
- 2017
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In: Blom, B., Evertsson, L. & Perlinski, M. (Eds.) Social and Caring Professions in European Welfare States.. - Bristol, UK. : Policy Press. - 9781447327196
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Book chapter (peer-reviewed)
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| 14. |
- Hanberger, Anders, 1953-, et al.
(author)
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Auditing and accountability
- 2017
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In: Social and caring professions in European welfare states. - Bristol : Policy Press. - 9781447327196 ; , s. 83-97
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Book chapter (peer-reviewed)abstract
- This chapter consists of two parts. First, two accountability dilemmas are identified, key concepts are defined, and a framework for exploring the interplay among democratic governance, audit systems, and accountability is presented. Second, two different but dominant audit systems used in Swedish eldercare are described and analysed in light of this framework, and consequences of auditing and accountability for key actors involved are discussed, as well as possible ways of resolving the two accountability dilemmas. In relation to the volume, this chapter explores conditions, trends, and challenges in today's audit society and their implications for welfare professions and other key actors. Swedish eldercare is an illustrative case of a phenomenon occurring in most policy sectors.
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| 15. |
- Hanberger, Anders, 1953-, et al.
(author)
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Evaluation of Swedish eldercare : a local perspective
- 2016
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Conference paper (peer-reviewed)abstract
- Many countries institutionalize evaluation systems at different levels of governance to enhance quality in eldercare. In Sweden, which is the focus of this paper, the Health and Social Care Inspectorate (IVO) (www.iwo.se) is responsible for improving quality in eldercare through state supervision, and the National Board of Health and Welfare (www.socialstyrelsen.se) and the Swedish Association of Local Authorities and Regions (SALAR) run a national indicator-based benchmarking evaluation system for improving eldercare. In addition, local evaluation systems are set up to monitor and evaluate eldercare. Although evaluation systems are built to support public policy and governance in different ways (Hanberger, 2011; Hood, 1991; Pollitt and Boukaert, 2011; Kusek and Rist, 2004; Radin, 2006; Van Dooren et al, 2010), ultimately they are aimed to improve quality of care but the ways to achieve this differ.Researchers are concerned about the growing accountability pressure that professionals are subjected to (Ubels, 2015), and if external supervision is doing more harm than good (Beddoe, 2012; Furness, 2009). Disputes concern the value of hard evaluation systems (e.g. state supervision) and soft forms (e.g. benchmarking systems), for improving quality in eldercare, and that performance measures do not reflect care provided to concrete persons in concrete situations (Jerak-Zuiderent 2015). Braithwaite et al (2007) demonstrate that external inspection of nursing homes often fails because of “a variety of kinds of regulatory ritualism” (p.11). Inspections tend to prioritize paper-work, to fill in forms on outputs and other required information instead of 'pick important problems and fix them'.While policy makers generally convey high expectations to external evaluation professionals convey lower expectations or even resistance. This reflects a tension between political (hierarchical) accountability (Behn, 2001), which implies that performance of social services is monitored against politically and administratively predefined standards, and professional accountability, where good performance is based on trust in the professional agent being qualified to make situated judgment and improve practice (Evans, 2011; Evetts, 2009). While evaluation for political accountability conveys an inbuilt distrust in professionals, it relies on professionals to improve the performance of services (Van Dooren et al, 2010). Although evaluation systems are key components in eldercare governance (Clarkson & Challis, 2006; Johansson et al, 2015; Munro, 2004; Szebehely and Trydegård 2012) they have been scarcely researched, particularly how different systems operate in practice. If and how national and local evaluation systems, one by one and together, contribute to improve quality in eldercare is here further explored.This paper scrutinizes how two national evaluation systems and one local system operate in a Swedish municipality. National evaluation systems are the same for all communities whereas local evaluation systems vary (Lindgren, 2015). The three evaluation systems are all intended to support and maintain quality in eldercare. The focus is on the accountability and quality improvement functions, and the evaluation systems’ consequences for key-actors. A close look at one case, a Swedish municipality, allows for analyzing and comparing how the accountability and quality improvement function of three radically different evaluation system evolve and interplay at different local levels.
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| 16. |
- Hanberger, Anders, 1953-, et al.
(author)
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Evaluation systems in local eldercare governance
- 2019
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In: Journal of Social Work. - : SAGE Publications. - 1468-0173 .- 1741-296X. ; 19:2, s. 233-252
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Journal article (peer-reviewed)abstract
- This article explores how three evaluation systems in eldercare governance, two national and one local, operate and interact at the municipal, administrative, and service levels in a Swedish municipality. The case study focuses on the three systems' contributions to accountability and to improving eldercare quality. It is based on multiple sources, including 28 interviews with local key actors involved in local eldercare governance, and the results derive from a directed content analysis guided by four research questions. Findings The study demonstrates that the three evaluation systems support accountability and quality improvement in different ways and have different consequences for local actors. The systems create multiple accountability problems and have multiple constitutive effects, for example, creating different notions of what quality in eldercare means. The systems' contributions to improving eldercare quality differed: the net effect of the two national systems was negative, whereas the local system has helped improve eldercare quality without any identified negative effects so far. Applications The article broadens our theoretical understanding and knowledge of regulatory mechanisms in eldercare governance. It has significance for eldercare policy by finding that policymakers and service providers must be aware of and manage multiple evaluation systems and accountability problems. Its implication for eldercare practice is that local actors must build evaluation capacity to manage existing evaluation systems in order to improve their own practices.
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| 17. |
- Hanberger, Anders, 1953-, et al.
(author)
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Hur kan granskning av äldreomsorg studeras?
- 2019. - 1
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In: Perspektiv på granskning inom offentlig sektor. - Malmö : Gleerups Utbildning AB. - 9789151100654 ; , s. 39-54
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Book chapter (other academic/artistic)
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| 18. |
- Hanberger, Anders, et al.
(author)
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Hur kan granskning av äldreomsorgen studeras?
- 2018
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In: Perspektiv på granskning inom offentlig sektor : Med äldreomsorgen som exempel. - Malmö : Gleerups Utbildning AB. - 9789151100654
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Book chapter (other academic/artistic)
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| 19. |
- Hanberger, Anders, 1953-, et al.
(author)
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Inledning
- 2019. - 1
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In: Perspektiv på granskning inom offentlig sektor. - Malmö : Gleerups Utbildning AB. - 9789151100654 ; , s. 9-23
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Book chapter (other academic/artistic)
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| 20. |
- Hanberger, Anders, 1953-, et al.
(author)
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Navigating the evaluation web : evaluation in Swedish local school governance
- 2016
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In: Education Inquiry. - : Co-Action Publishing. - 2000-4508. ; 7:3, s. 259-281
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Journal article (peer-reviewed)abstract
- This paper explores the use, functions and constitutive effects of evaluation systems in local school governance, and identifies how contextual factors affect various uses of evaluation in this context. This case study of three Swedish municipalities demonstrates that local evaluation systems are set up to effectively sustain local school governance and ensure compliance with the Education Act and other state demands. Local decision makers have learned to navigate the web of evaluations and developed response strategies to manage external evaluations and to take into account what can be useful and what cannot be overlooked in order to avoid sanctions. The study shows that in contexts with high issue polarisation, such as schooling, the use of evaluation differs between the political majority and opposition, and relates to how schools perform in national comparisons and school inspections. Responses to external evaluations follow the same pattern. Some key performance indicators from the National Agency of Education and the School Inspectorate affect local school governance in that they define what is important in education, and reinforce the norm that benchmarking is natural and worthwhile, indicating constitutive effects of national evaluation systems.
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| 21. |
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| 22. |
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| 23. |
- Hanberger, Anders, 1953-, et al.
(author)
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School evaluation in Sweden: a local perspective
- 2016
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Conference paper (peer-reviewed)abstract
- Evaluation has expanded at all levels of governance as part of the broad doctrine of New Public Management (NPM) (Hood 1991; Pollitt and Bouckaert 2011). According to this doctrine, market mechanisms should be introduced to enhance efficiency and, in the context of school governance, to support competition between schools, free school choice, improved educational quality, and school effectiveness (Lubienski 2009; Lundahl 2013 et al; Merki 2011). Education systems guided by NPM and characterized by results-based management and local autonomy increasingly rely on evaluation at all levels (Mintrop and Trujillo 2007; OECD 2013). Strengthened accountability is assumed to enhance education quality and promote school development (OECD 2015; SOU 2015:22), and a combination of control- and improvement-oriented evaluation systems has been institutionalized at various levels of the school system to promote school development and enhance education quality. However, this development is contested by research claiming that the consequences of growing accountability pressure are problematic for school practice (Hoyle and Wallace 2009; Ravitch 2010). It may create multiple accountability problems, i.e. uncertainty among target groups as to which evaluation system is supposed to do what and for whom and with what authority (Schillemans and Bovens, 2011). Teachers are subjected to too much accountability that can have negative effects on professionals and education (Green 2011; Koretz 2009; Lingard and Sellar, 2013; Hargreaves 1994, Day 2002, Ball 2003, Mausethagen 2013a, 2013b).Although evaluation is a cornerstone in local school governance it has not been studied much in this context. Local school governance refers to all the public and private school actors’ and institutions’ (e.g. education committees, opposition parties, school principals, teachers and parents) steering of local schools and education. We need more knowledge of the role and consequences of evaluation systems at the local governance level, and into how local school actors respond to these systems. What local decision makers, school providers, principals, and teachers consider relevant, useful, and actionable knowledge (Stehr & Grundmann 2012) is crucial in understanding the role of evaluation in local school governance.This paper explores how local school actors in Swedish compulsory education have responded to prevailing evaluation systems and the growing accountability pressure emerging from the recentralization, marketization, and globalization of education governance. It synthesizes results from a Swedish research project (see method) and aims to improve our understanding of the role and consequences of evaluation in local school governance. It contributes with knowledge of the role and consequences of evaluation at the municipal, school, classroom, and parent/citizen levels. Special attention is paid to the value and consequences of various evaluations for local school development. A close look at evaluation in Sweden is an illustrative case as the education evaluation arena is overcrowded and the decentralised education system provides freedom of choice that actors operating in other education systems in Europe (OECD, 2015; Lawn, 2011) and elsewhere can learn from.The paper is developed as part of a larger research project; Consequences of evaluation for school praxis –steering, accountability and school development, financed by the Swedish Research Council (2012-2015). The project explores evaluation in compulsory schools (age 13-15) in four municipalities, and this paper synthesises and discusses the results presented in detail five separate papers.MethodsThe conceptual framework, developed in a separate article (Hanberger, manuscript), pays attention to the role of evaluation in three models of decentralised governance, the state model, the local government and the multi-actor model. It focuses on three main possible functions that evaluation can have in local school governance, steering, accountability and school development. It presumes that a governance model intends to steer evaluation to meet the governance models’ and governing actors’ evaluation needs, and that evaluations (performance measurements, stand-alone evaluations, synthesis reports and informal/concrete evaluations) can contribute to these functions. Evaluations may also affect governance in unintended and unexpected ways (Hanberger, 2012). Hence, the framework also accounts for constitutive effects (Dahler-Larsen, 2013) of evaluation systems, that is, to tacit or indirect effects, for example, how evaluation (systems) can shape discourses, defining what is important in education and school systems.Four medium-sized municipalities with populations of 75,000–100,000 were selected strategically to reflect differing local conditions and contextual factors that may affect education and the role of evaluation in local school governance. The municipalities differ in political majority, school performance, and share of independent schools, and eight schools were selected for in-depth interviews. The municipalities are anonymized, being referred to as “North”, “West”, “East”, and “South”.The paper is based on the analysis of documents, reports, and studies treating global and national evaluation systems, national and municipal policy documents treating school governance and evaluation, minutes from municipal education committee meetings (2011–2013), municipal websites, and 76 interviews. Four politicians from majority parties and three from opposition parties, 10 administrators (i.e. Head of the Education Department, senior administrators, and evaluation experts), five politically elected local auditors, three representatives of independent schools, eight school principals, and 43 teachers were interviewed in person or, in a few cases, by phone. In addition, an electronic questionnaire sent to teachers was used to complement the interviews with them, to obtain an overview of teachers’ experiences of evaluation in the studied municipalities. Conclusions about the functions, effects, and consequences of evaluation were generated by interpreting interviewees’ responses and various texts (e.g. policy documents, minutes, and websites).Expected outcomesThis study shows that multiple accountability problems emerge as a result of overlapping evaluation systems and that local decision makers set up their own evaluation systems to meet the needs of municipal school governance.Most of the evaluation systems identified in Swedish compulsory education (for students aged 13–15 years) produce quantitative data capturing measurable aspects of education, whereas data capturing other parts of the curriculum, more difficult or impossible to measure (e.g. how schools have succeeded in achieving democracy, sustainability, and solidarity objectives), are lacking. A few key performance measures are used in several systems.The identified evaluation systems induce local school actors and institutions to think and act according to the principles of NPM; these are aligned with most decision makers’ and managerial-oriented principals’ endeavours but not with those of all local school actors. This indicates that evaluations in local school governance serve to support and legitimize the applied governance model and current education policy. Stakeholder evaluations that can provide a more multifaceted understanding, including critical accounts that school actors can use for informed deliberation about the status of schools, consequences of current school policy, and where to go in the future, are not found in our case communities.The workload and accountability pressure have increased for both principals and teachers. The consequences have been the most negative for teachers, however, as external evaluations have questioned their professional competence and authority, unintentionally damaging teacher motivation. The external evaluation systems had little or no value in terms of helping teachers improve their teaching practice. Instead, teachers used their own evaluations regarding what works for various groups and students to continuously improve teaching and schools. A few school providers and principals succeeded in developing evaluations addressing the needs of teachers and were used in developing teaching and daily practices.
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| 24. |
- Hanberger, Anders, 1953-, et al.
(author)
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School evaluation in Sweden in a local perspective : a synthesis
- 2016
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In: Education Inquiry. - : Co-Action Publishing. - 2000-4508. ; 7:3, s. 349-371
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Journal article (peer-reviewed)abstract
- This article synthesises the role of evaluation at the municipal, school, classroom and parental levels of governance, and discusses the results of the articles appearing in this special issue. The discussion concerns the role of evaluation in school governance, the value of evaluation for local school development, the constitutive effects of evaluation, what explains the present results, how knowledge produced by evaluation can be used, and methodological issues. The results indicate that evaluation systems legitimise and support governance by objectives and results, parental school choice, and accountability for fairness and performance. Evaluation systems emphasise measurable aspects of curricula and foster a performance-oriented school culture. The most important evaluations for improving teaching and schools are teachers' own evaluations. The article suggests two explanations for the actual roles of evaluation in local school governance. First, both the governance structure and applied governance model delimit and partly shape the role of evaluation at local governance levels. Second, how local school actors use their discretion and interpret their role in the education system, including how they respond to accountability pressure, explains how their roles are realised and the fact that actors at the same level of governance can develop partly different roles.
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| 25. |
- Hanberger, Anders, 1953-, et al.
(author)
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Tillsyn och öppna jämförelser : exemplet äldreomsorgen
- 2015
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Conference paper (pop. science, debate, etc.)abstract
- Äldreomsorg har genom olika former av utvärdering fått avsevärt ökad uppmärksamhet i media och politisk debatt. I denna session diskuteras vilka konsekvenser som två dominerande former av utvärdering – tillsyn och öppna jämförelser – har för äldreomsorgens styrning, ansvarsutkrävande och verksamhetsutveckling. Sessionen utgår från resultat från ett Forte-finansierat forskningsprojekt om användning av utvärdering i äldreomsorgen.
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| 26. |
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| 27. |
- Hanberger, Anders, et al.
(author)
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Utvärderingssystem i lokal äldreomsorg
- 2018
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In: Perspektiv på granskning inom offentlig sektor : Med äldreomsorgen som exempel. - Malmö : Gleerups Utbildning AB. - 9789151100654
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Book chapter (other academic/artistic)
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| 28. |
- Hanberger, Anders, 1953-, et al.
(author)
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Utvärderingssystem i lokal äldreomsorg
- 2019. - 1
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In: Perspektiv på granskning inom offentlig sektor. - Malmö : Gleerups Utbildning AB. - 9789151100654 ; , s. 87-102
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Book chapter (other academic/artistic)
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| 29. |
- Hanberger, Anders, et al.
(author)
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Äldreomsorgsgranskning i förändring
- 2018
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In: Perspektiv på granskning inom offentlig sektor: med äldreomsorgen som exempel. - Malmö : Gleerups Utbildning AB. - 9789151100654
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Book chapter (other academic/artistic)
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| 30. |
- Hanberger, Anders, 1953-, et al.
(author)
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Äldreomsorgsgranskning i förändring
- 2019. - 1
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In: Perspektiv på granskning inom offentlig sektor. - Malmö : Gleerups Utbildning AB. - 9789151100654 ; , s. 137-152
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Book chapter (other academic/artistic)
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| 31. |
- Hanberger, Lena, et al.
(author)
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AlC in children and adolescents with diabetes in relation to certain clinical parameters - The Swedish Childhood Diabetes Registry SWEDIABKIDS
- 2008
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In: Diabetes Care. - : American Diabetes Association. - 0149-5992 .- 1935-5548. ; 31:5, s. 927-929
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Journal article (peer-reviewed)abstract
- OBJECTIVE - We explored the relationship between AlC and insulin regimen, duration of diabetes, age, sex, and BMI as well as the differences between clinical mean AlC levels at pediatric diabetes clinics in Sweden. RESEARCH DESIGN AND METHODS - Data from 18,651 clinical outpatient visits (1,033 girls and 1,147 boys) at 20 pediatric clinics during 2001 and 2002 registered in the Swedish Childhood Diabetes Registry SWEDIABKIDS, a national quality registry, were analyzed. RESULTS - AlC was < 7.0% (target value similar to 8% per Diabetes Control and Complications Trial/National Glycohemoglobin Standardization Program standards) at 35% of the visits. Girls had significantly higher mean AlC than boys during adolescence. High mean AlC was correlated with high mean insulin dose, long duration of diabetes, and older age. Mean AlC varied between clinics (6.8-8.2%). Differences between centers could not be explained by differences in diabetes duration, age, BMI, or insulin dose. CONCLUSIONS - Adolescents with a high insulin dose and a long duration of diabetes, especially girls, need to be focused on, Differences in mean values between centers remained inexplicable and require further investigation.
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| 32. |
- Hanberger, Lena, et al.
(author)
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Childhood diabetes in the nordic countries : a comparison of quality registries.
- 2014
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In: Journal of diabetes science and technology. - : Sage Publications. - 1932-2968. ; 8:4, s. 738-44
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Journal article (peer-reviewed)abstract
- In 2008 a Nordic collaboration was established between the quality registries in Denmark, Iceland, Norway, and Sweden to improve quality of care for children with diabetes. This study aimed to describe those registries and confirm that the registry variables are comparable. Selected variables were used to demonstrate outcome measurements. The organization of the registries and methodology are described. Cross-sectional data for patients between birth and 14.9 years with type 1 diabetes mellitus in 2009 (n = 6523) from 89 centers were analyzed. Variables were age, gender, and diabetic ketoacidosis at onset, together with age, gender, HbA1c, insulin regimen, and severe hypoglycemia at follow-up in 2009. All 4 registries use a standardized registration at the onset of diabetes and at follow-up, conducted at the local pediatric diabetes centers. Methods for measuring HbA1c varied as did methods of registration for factors such as hypoglycemia. No differences were found between the outcomes of the clinical variables at onset. Significant variations were found at follow-up for mean HbA1c, the proportion of children with HbA1c < 57 mmol/mol (NGSP/DCCT 7.4%), (range 15-31%), the proportion with insulin pumps (range 34-55%), and the numbers with severe hypoglycemia (range 5.6-8.3/100 patient years). In this large unselected population from 4 Nordic countries, a high proportion did not reach their treatment target, indicating a need to improve the quality of pediatric diabetes care. International collaboration is needed to develop and harmonize quality indicators and offers possibilities to study large geographic populations, identify problems, and share knowledge.
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| 33. |
- Hanberger, Lena, et al.
(author)
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Glycated haemoglobin variations in paediatric type 1 diabetes: the impact of season, gender and age
- 2014
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In: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 103:4, s. 398-403
-
Journal article (peer-reviewed)abstract
- AimTo study whether monthly variations in type 1 diabetes incidence are related to monthly glycated haemoglobin (HbA1c) levels at diagnosis and if high HbA1c at diagnosis is related to certain clinical variables at diagnosis and during the clinical course of the disease. MethodsData from 4430 boys and 3590 girls registered in the Swedish paediatric diabetes quality registry, Swedish paediatric diabetes quality registry, from 2000 to 2010 were analysed. ResultsMonth of onset varied (pless than0.001), with 53% diagnosed during September to February, and mean HbA1c at diagnosis was highest in May (10.9%, 96mmol/mol) and lowest in (October 9.4%, 88mmol/mol) (pless than0.001). Girls showed higher HbA1c at onset than boys (pless than0.001). More than half (53%) with an annual mean HbA1c of greater than9.3% (78mmol/mol) and 4% of those with an annual mean of less than7.4% (57mmol/mol) in 2007 had greater than9.3% (78mmol/mol) in 2010. ConclusionPatients with high HbA1c levels during a certain period have the same high levels several years later. This group, perhaps including those with high HbA1c level at diagnosis, may need more intensive care, including extra support from the diabetes teams and other forms of medical treatment.
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| 34. |
- Hanberger, Lena, et al.
(author)
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Health-related quality of life in intensively treated young patients with type 1 diabetes
- 2009
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In: Pediatric Diabetes. - : Hindawi Limited. - 1399-543X .- 1399-5448. ; 10:6, s. 374-381
-
Journal article (peer-reviewed)abstract
- This study aimed to analyse the impact of the disease and treatment on health-related quality of life (HRQOL) in intensively treated young patients with diabetes. Our main hypothesis was that metabolic control, gender, age and socio-economic status predict HRQOL. All children and adolescents (n = 400, 191 girls) and parents in a geographic population of two paediatric clinics in Sweden [mean age 13.2 yr, ±SD 3.9, range 2.6-19.6; mean duration of diabetes 5.1 yr, ± SD 3.8, range 0.3-17.6; yr mean haemoglobin A1c (HbA1c) 7.1%, ±SD 1.2, range 4.0-10.7] received the DISABKIDS questionnaire, a validated combined chronic generic and condition-specific HRQOL measure for children, and the EuroQol-5D questionnaire. Parents as proxy perceived HRQOL lower than their children. Adolescents with separated parents reported lower generic HRQOL (GeHRQOL) and diabetes-specific HRQOL (DiHRQOL) than those with parents living together (p = 0.027 and p = 0.043, respectively). Adolescent girls reported lower GeHRQOL (p = 0.041) and DiHRQOL (p = 0.001) than boys did. Parents of girls less than8 yr of age reported lower DiHRQOL (p = 0.047) than did parents of boys less than8 yr. In addition, a difference was found in HRQOL between centres. Intensive insulin therapy did not seem to lower HRQOL. If anything, along with better metabolic control, it increased HRQOL. A correlation between DiHRQOL and HbA1c was found in adolescents (r = -0.16, p=0.046) and boys aged 8-12 yr (r = -0.28, p = 0.045). We conclude that the diabetes team can influence the HRQOL of the patients as there was a centre difference and because HRQOL is influenced by glycaemic control and insulin regimen. Girls seem to need extra support.
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| 35. |
- Hanberger, Lena, et al.
(author)
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Needle-Related Pain, Affective Reactions, Fear, and Emotional Coping in Children and Adolescents With Type 1 Diabetes : A Cross-Sectional Study
- 2021
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In: Pain Management Nursing. - : Elsevier. - 1524-9042 .- 1532-8635. ; 22:4, s. 516-521
-
Journal article (peer-reviewed)abstract
- Background: The self-care of type 1 diabetes (T1D) includes undergoing procedures with needles several times daily, which may cause pain and fear.Aims: The aim was to identify the degree of perceived pain, affective reactions, fear, and emotional coping among children and adolescents with T1D.Design: A cross-sectional survey was performed.Methods: Children and adolescents 7-18 years of age (n = 197) and their parents (n = 123) completed the Coloured Analogue Scale (CAS), the Facial Affective Scale (FAS), the Diabetes Fear of Injection Questionnaire (D-FISQ), and the Faces Emotional Coping Scale (FECS) in relation to needle procedures.Results: The higher the values of the CAS, FAS and D-FISQ scores, the lower values for coping were reported by children and adolescents regarding treatment with insulin pen or pump, blood glucose test, and venipuncture (p < .001). Patients reported strong negative affect regarding insulin injections (35%) and blood glucose tests (32%), as well as negative affect (48%, 69%) and substantial pain (27%, 50%) for inserting a pump needle and venipuncture, respectively. Parents reported significantly higher values than children on all scales and procedures except D-FISQ (blood glucose tests) and FECS (venipuncture).Conclusions: Children and adolescents who perceive greater pain during needle-related procedures have poorer coping ability. Pediatric diabetes teams need to identify those in need of extra support to develop pain coping strategies.
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| 36. |
- Hanberger, Lena, 1957-, et al.
(author)
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Quality of care from the patient's perspective in pediatric diabetes care
- 2006
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In: Diabetes Research and Clinical Practice. - : Elsevier BV. - 0168-8227 .- 1872-8227. ; 72:2, s. 197-205
-
Journal article (peer-reviewed)abstract
- This study aimed to investigate perceived quality of diabetes care. A geographic population of 400 type 1 diabetes patients <20 years received the validated questionnaire quality of care from the patient's perspective (QPP) including additional context-specific items. Primary endpoints were perceived reality of care by specific items and factors and their subjective importance, respectively. Relations to severe hypoglycemia, HbA1c, insulin dose, BMI, age, duration and sociodemographic factors were also studied. On average, a high perceived quality of care was reported from both parents and adolescents (response rate 285/400 (71%) and 155/237 (65%), respectively), highest regarding possibility to talk to nurse/doctor in privacy, respect, general atmosphere, continuity in patient-physician relationship and patient participation. Lower perceived reality with higher subjective importance was seen for information about results from medical examinations and treatments and information about self-care, access to care and waiting time. While parents' and their adolescents' mean ratings correlated well for reality r = 0.95 (p < 0.001) and importance r = 0.53 (p = 0.023), parents rated reality level higher (p = 0.012) and importance even higher (p < 0.001). The QPP instrument used with additional context-specific items can provide specific information to be used in quality of care development. In our setting, improvements are needed regarding patient information, access to care and waiting time. © 2005 Elsevier Ireland Ltd. All rights reserved.
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| 37. |
- Hanberger, Lena
(author)
-
Quality of Care in Children and Adolescents with Type 1 Diabetes : Patients’ and Healthcare Professionals’ Perspectives
- 2010
-
Doctoral thesis (other academic/artistic)abstract
- Background: Type 1 diabetes is a chronic disease for which there is currently no cure, and high quality care is essential if acute and long-term complications are to be avoided. Many children and adolescents have inadequate metabolic control with increased risk for complications later in life, and adolescent girls have reported low quality of life. Differences in metabolic control between treatment centres have been found but the reasons for this are unclear. Diabetes is a largely self-managed disease. Patient education is central to successful self-management but little is known about how to make best use of diabetes communities on the Internet and integrate them into a practitioner-driven service.Aim: The main objective of this thesis was to gain better understanding of how to improve the quality of diabetes care for children and adolescents, aiming to have near-normal blood glucose, to prevent both acute and late complications and to have good quality of life.Methods: The geographic populations of two paediatric centres (n=400) received validated questionnaires on perceived quality of care and Health-Related Quality of Life (HRQOL). An intervention with a web portal containing diabetes-related information and social networking functions was carried out within the same population. Clinical variables from 18 651 outpatient visits registered in the Swedish paediatric diabetes quality registry, SWEDIABKIDS were analysed. Using data from SWEDIABKIDS, five centres with the lowest mean HbA1c, five with the highest, and five with the largest decrease in centre mean HbA1c between 2003 and 2007 were identified. Team members (n=128) were asked about structure, process, policy, and the messages given to patients about important diabetes issues.Results: Specific areas that were identified as needing improvement included information about self-care, waiting time at outpatient clinics and for treatment, and access to care. Diabetes seemed to reduce HRQOL. Subjects with better metabolic control and with higher frequency of injections reported slightly higher HRQOL, as did those living with both parents compared to those with separated parents. Only 35% of children and adolescents with diabetes in Sweden had an HbA1c level below the treatment target value. Mean HbA1c showed a correlation with mean insulin dose, diabetes duration, and age. A difference between centres was found, but this could not be explained by differences in insulin dose, diabetes duration, or age. Adolescent girls reported lower HRQOL, as did parents of girls aged < 8 years. Girls also had poorer metabolic control, especially during adolescence.In teams with the lowest and the most decreased mean HbA1c, members gave a clear message to patients and parents and had a lower HbA1c target value. Members of these teams appeared more engaged, with a more positive attitude and a greater sense of working as a team. Members of teams with the highest mean HbA1c gave a vaguer message, felt they needed clearer guidelines, and had a perception of poor collaboration within the team. High insulin dose, large centre population, and larger teams also seemed to characterize diabetes centres with low mean HbA1c. The most frequently visited pages on the web portal were the social networking pages, such as blogs, stories and discussions, followed by the diabetes team pages. Those who used the portal most actively were younger, had shorter diabetes duration, and lower HbA1c, and were more often girls. The web portal was not found to have any significant beneficial or adverse effects on HRQOL, empowerment or metabolic control.Conclusions: The quality of diabetes care for children and adolescents in Sweden is not sufficiently good and needs to improve further if complications in later life are to be avoided. Psychosocial support for children and adolescents with diabetes should be appropriate for age and gender. The attitudes of the members in the diabetes care team and the message they give to patients and their parents seem to influence metabolic control in children and adolescents. A clear and consistent message from a unified team appears to have beneficial effects on metabolic control. A web portal that includes comprehensive information about diabetes, and the opportunity to communicate with other people with diabetes and with healthcare professionals may be a useful complement to traditional patient education tools. Members of the diabetes team should encourage its use.
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| 38. |
- Hanberger, Lena, et al.
(author)
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The influence of process, structure and policy on Haemoglobin A1c levels in treatment of children and adolescents with type 1 diabetes
- 2012
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In: Diabetes Research and Clinical Practice. - : Elsevier BV. - 0168-8227 .- 1872-8227. ; 96:3, s. 331-338
-
Journal article (peer-reviewed)abstract
- Objective: We aimed to identify factors for improvements of mean A1C at centres treating children and adolescents with diabetes.research Design and methods: Through data from the Swedish paediatric diabetes quality registry, SWEDIABKIDS, five centres with the lowest mean A1C (Low group), five with the highest (High group), and five with the largest decrease in centre mean A1C (Decrease group) were identified. The diabetes team members completed a questionnaire, response rate 85%, (109/128) and reported team structure and process. Open-ended questions regarding messages to patients about important diabetes matters were analysed with summative content analysis.Results: Compared to the High group, the Low and Decrease groups showed shorter professional experience and lower proportion of special diabetes-educated team members, and higher compliance with guidelines. Trends for higher mean insulin dose, larger centre size and larger team size were found. The content analysis indicated that the Low and Decrease groups gave a clear message and had lower A1C target value. The team members in these groups were engaged, had a positive attitude and a perception of a well-functioning team. The High group gave a vague message, needed more frames and had a perception of lack of cooperation in the team.Conclusions: The team members' approach seems to affect metabolic control in children and adolescents. The team members need to be aware of their approach and how it affects patients and parents, and also of the importance of the possibility of using resources and competence within the team.
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| 39. |
- Hanberger, Lena, 1957-, et al.
(author)
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Type 1 diabetes during adolescence : International comparison between Germany, Austria, and Sweden.
- 2018
-
In: Pediatric Diabetes. - : John Wiley & Sons. - 1399-543X .- 1399-5448. ; 19:3, s. 506-511
-
Journal article (peer-reviewed)abstract
- OBJECTIVES: By using pediatric diabetes quality registries in Austria, Germany, and Sweden treatment of type 1 diabetes and the outcome of care during the vulnerable adolescence period were compared.METHODS: Data in DPV, broadly used in Austria and Germany, and Swediabkids used in Sweden, from clinical visits in the year 2013 on 14 383 patients aged 11 to 16 years regarding hemoglobin A1c (HbA1c), insulin regimen, body mass index (BMI)-SD score (SDS), blood pressure, hypoglycemia, ketoacidosis, and smoking habits were analyzed.RESULTS: Patients in Sweden had fewer clinical visits per year (P < .05), lower insulin dose per kg (P < .001), and lower proportion of fast acting insulin compared with Germany and Austria (P < .001). The proportion of pump users was higher in Sweden (P < .001). Patients in Sweden had lower mean HbA1c levels (Austria: 64 mmol/mol, Germany: 63 mmol/mol, and Sweden: 61 mmol/mol [8.0%, 7.9%, and 7.7%, respectively]; P < .001). The frequency of severe hypoglycemia was higher in Sweden while it was lower for ketoacidosis (3.3% and 1.1%, respectively) than in Austria (1.1% and 5.3%) and Germany (2.0% and 4.4%) (P < .001). Girls in all 3 countries had higher HbA1c and BMI-SDS than boys.CONCLUSIONS: Sharing data between diabetes registries and nations enables us to better understand differences in diabetes outcome between countries. In this particular comparison, pediatric patients with diabetes in Sweden were more often treated with insulin pump, had lower HbA1c levels and a higher rate of severe hypoglycemia. Patients in Austria and Germany used rapid acting insulin analogs more often and had a lower rate of ketoacidosis.
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| 40. |
- Hanberger, Lena, et al.
(author)
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Use of a Web 2.0 Portal to Improve Education and Communication in Young Patients With Families: Randomized Controlled Trial
- 2013
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In: Journal of Medical Internet Research. - : Journal of Medical Internet Research / JMIR Publications. - 1438-8871. ; 15:8
-
Journal article (peer-reviewed)abstract
- Background: Diabetes requires extensive self-care and comprehensive knowledge, making patient education central to diabetes self-management. Web 2.0 systems have great potential to enhance health information and open new ways for patients and practitioners to communicate. less thanbrgreater than less thanbrgreater thanObjective: To develop a Web portal designed to facilitate self-management, including diabetes-related information and social networking functions, and to study its use and effects in pediatric patients with diabetes. less thanbrgreater than less thanbrgreater thanMethods: A Web 2.0 portal was developed in collaboration with patients, parents, and practitioners. It offered communication with local practitioners, interaction with peers, and access to relevant information and services. Children and adolescents with diabetes in a geographic population of two pediatric clinics in Sweden were randomized to a group receiving passwords for access to the portal or a control group with no access (n=230) for 1 year. All subjects had access during a second study year. Users activity was logged by site and page visits. Health-related quality of life (HRQOL), empowerment (DES), and quality of information (QPP) questionnaires were given at baseline and after 1 and 2 study years. Clinical data came from the Swedish pediatric diabetes quality registry SWEDIABKIDS. less thanbrgreater than less thanbrgreater thanResults: There was a continuous flow of site visits, decreasing in summer and Christmas periods. In 119/233 families (51%), someone visited the portal the first study year and 169/484 (35%) the second study year. The outcome variables did not differ between intervention and control group. No adverse treatment or self-care effects were identified. A higher proportion of mothers compared to fathers visited once or more the first year (Pandlt;.001) and the second year (Pandlt;.001). The patients who had someone in the family visiting the portal 5 times or more, had shorter diabetes duration (P=.006), were younger (P=.008), had lower HbA1c after 1 year of access (P=.010), and were more often girls (Pandlt;.001). Peer interaction seems to be a valued aspect. less thanbrgreater than less thanbrgreater thanConclusions: The Web 2.0 portal may be useful as a complement to traditional care for this target group. Widespread use of a portal would need integration in routine care and promotion by diabetes team members.
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| 41. |
- Hanberger, Lena, et al.
(author)
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Use of a web 2.0 portal to improve education and communication in young diabetes patients with families – A CASE STUDY
-
Other publication (other academic/artistic)abstract
- AIM: To develop a web portal designed to facilitate self-management, including diabetes-related information and social networking functions, and study its use and effects in young patients with diabetes. DESIGN AND METHOD: A Web 2.0 portal was developed in collaboration with patients, parents and their practitioners. It offered communication with local practitioners, interaction with peers and access to relevant information and services. Children and adolescents with diabetes in a geographic population of two paediatric clinics in Sweden were randomized to a group (n=233) receiving passwords for access to the portal, or a control group with no access (n=230) for one year. All subjects had access during a second study year. The portal was used on users’ own initiative only without directions from health care professionals or researchers. Measures: User activity by site visits and page visits logged per user. Health-related quality of life (HRQOL), empowerment (DES), and quality of information (QPP) questionnaires at baseline and after one and two study years. Clinical data from the Swedish paediatric diabetes quality registry SWEDIABKIDS. RESULTS: There was a continuous flow of site visits, but decreasing in summer and Christmas periods. In 119/233 families (51%) someone visited the portal the first study year and in 169/484 (35%) the second study year. More frequent page visits were seen on social networking with peers, such as blogs, stories and discussions, followed by news from the local diabetes teams. No differences were found regarding outcome variables between intervention and control group. No adverse effects related to the treatment or self-care were identified. A higher proportion of mothers compared to fathers visited once or more the first (p<0.001) and the second year (p<0.001). Those patients where someone in the family visited five times or more (active users), n=68, had shorter diabetes duration (p= 0.006), were younger (p=0.008), had lower HbA1c after one year of access (p=0.010), and were more often girls (p<0.001). Conclusions: The Web 2.0 portal appears useful as a complement to traditional care for this target group. Peer interaction seems to be a valued aspect. The use of a portal probably needs to be integrated in routine care and promoted e.g. by diabetes team members, advertisements and newsletters. Research on electronic communication targeting young people with long-term health problems need to focus more on use of Web 2.0 including gender aspects.
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| 42. |
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| 43. |
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| 44. |
- Lindgren, Lena, 1954, et al.
(author)
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Evaluation Systems in a Crowded Policy Space : Implications for Local School Governance
- 2016
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In: Education Inquiry. - : Taylor & Francis. - 2000-4508. ; 7:3, s. 237-258
-
Journal article (peer-reviewed)abstract
- Evaluation systems of various types are an integral part of a country’s education policy space, within which they are supposed to have the basic functions of enhancing accountability and supporting school development. Here we argue that in a crowded policy space evaluation systems may interfere with each other in a way that can have unintended consequences and create new ‘policies by the way’ that are not the result of intentional policy decisions. To shed light on this argument, we examine five of approximately 30 evaluation systems operating in the Swedish education system. Our analysis examines a situation in which many evaluation systems are doing almost the same thing, i.e. collecting a similar and limited set of quantitative data, and addressing the same local governance actors with the primary goal of supporting school development in the same direction. By doing so, these evaluation systems could thus give rise to several unintended consequences, including a scaling down of the school law and curriculum, multiple accountability problems, increased administration and new intermediary job functions at the level of local education governance.
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| 45. |
- Lindgren, Lena, et al.
(author)
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Overcrowding on the Swedish education evaluation arena : consequences for accountability
- 2014
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In: 11th EES Biennial Conference. ; , s. 60-60
-
Conference paper (peer-reviewed)abstract
- In some public sector areas, like education, evaluation “took off” a long time ago as an essential management and policy instrument. A feature of this evaluative megatrend that has taken a high flight in recent years is performance measurement systems that collect, record and publish, often in league tables, numerical data on an on-going basis about predetermined indicators that signify a well-functioning school or education system. A recent OECD report, summing up experience from 28 countries, demonstrates that performance measurement is regarded as an indispensible tool for improvement, policy development and accountability purposes. At the same time, an increasing amount of literature suggest that performance measurement may not always or seldom produce the results anticipated, but may in fact generate a number of negative effects – dysfunctions some would call it. Catchphrases like governance by targets and policy as numbers are used to describe this development.Performance measurement systems flourish at all levels in the education area – local, national, international – perhaps more prominently than in other public sector areas. Interestingly enough, there is also what some authors have pointed out, a tendency for the ownership and use of the aforesaid performance regimes to become more diffuse over time. This diffusion has helped to create and sustain a “performance industry” made up of various non-official organizations that make use of publicly produced data, repack and reinterpret them, add their own commentaries, and publish (or sell) it for their own ends.In this paper we argue that there is a risk of overcrowding on the education evaluation arena that is likely to have negative, but yet unexplored effects. In addition to the more general dysfunctions of performance measurement pointed out in the literature, the proliferation and competition between various actors and league tables may confuse users of performance information. The overcrowding may also, and this is our main hypothesis, obscure, complicate and maybe work against the ambition of strengthening accountability through performance measurement. The paper does not attempt to find out whether the potential risks associated with evaluation overcrowding are empirically valid, which would indeed have been an important issue to resolve. Our humble aim is to take a first step towards resolving this issue. We will describe and discuss performance measurement systems and actors operating on one particular evaluation arena, the Swedish education, in relation to a theoretical scheme comprising core elements of accountability. In brief, the scheme sees accountability as a relationship between an actor and a forum, in which the actor has an obligation to explain and justify his or her conduct, the forum can pose questions and pass judgement, and the actor may face consequences. Sweden is a particularly information-rich case in regards to the paper’s aim. Political reforms over last two decades have made the education system more decentralized and market-like than in most other countries. All schools – whether owned and administered by municipalities or private, independent providers – are entirely tax funded. Hence, the reforms have made accountability a focus of interest.
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| 46. |
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| 47. |
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| 48. |
- Nilsson, John, et al.
(author)
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High HbA1c at onset cannot be used as a predictor for future metabolic control for the individual child with type 1 diabetes mellitus.
- 2017
-
In: Pediatric Diabetes. - : John Wiley & Sons. - 1399-543X .- 1399-5448. ; 18:8, s. 848-852
-
Journal article (peer-reviewed)abstract
- BACKGROUND: To study how metabolic control at onset of type 1 diabetes correlates to metabolic control and clinical parameters during childhood until transition from pediatric care to adult diabetes care.MATERIALS AND METHODS: Data at onset, three months, one, three, and five years after diagnosis and at transition, on HbA1c and clinical parameters, on 8084 patients in the Swedish pediatric quality registry, SWEDIABKIDS, were used. Of these patients, 26% had been referred to adult diabetes care by 2014.RESULTS: Children with HbA1c < 72 mmol/mol (8.7%) (20% of patients, low group) at diagnosis continued to have good metabolic control during childhood, in contrast to children with HbA1c > 114 mmol/mol (12.6%) (20% of patients, high group) at diagnosis, who continued to have high HbA1c at follow-up. For the individual, there was no significant correlation between high HbA1c at onset and during follow-up. During follow-up, children in the high group were more often smokers, less physically active, and more often had retinopathy than children in the low group (P < .01, .01, .03 respectively).CONCLUSION: High HbA1c at onset was associated with high HbA1c during follow-up on a group level, but it cannot be used as a predictor of future metabolic control on an individual level. These results emphasize the important work done by the diabetes team in the first years after diagnosis. It is important to continuously set high goals for the achievement of tight metabolic control, in order to decrease the risk of microvascular complications.
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| 49. |
- Nilsson, Stefan, 1972, et al.
(author)
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The Faces Emotional Coping Scale as a self-reporting instrument for coping with needle-related procedures : An initial validation study with children treated for type 1 diabetes
- 2017
-
In: Journal of Child Health Care. - : SAGE Publications. - 1367-4935 .- 1741-2889. ; 21:4, s. 392-403
-
Journal article (peer-reviewed)abstract
- The aim of this study was to determine the concurrent and content validity, sensitivity and inter-rater reliability of the Faces Emotional Coping Scale (FECS) to evaluate the children's anticipation of the level of emotional coping in conjunction with a venepuncture. A total of 153 children with type 1 diabetes and 86 of their parents participated in the study. The age of the children, 76 of whom were boys, ranged from 7 to 18 years. The child and his or her parent reported the child's coping ability, and the child reported the pain intensity and unpleasantness of a venepuncture. The child also wrote a short narrative about his or her experience of the needle procedure. The FECS correlated negatively with the Coloured Analogue Scale and the Facial Affective Scale and positively with the FECS by proxy. The narratives of 90 children correlated negatively with the FECS. Younger children reported significantly lower scores than older children did regarding their ability to cope with a venepuncture. The children's scores on the FECS showed good agreement with the parents' scores. In this study, the FECS was deemed valid for measuring children's ability to cope with their emotions when undergoing needle-related procedures like venepuncture.
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| 50. |
- Nordfeldt, Sam, 1957-, et al.
(author)
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Development of a PC-based diabetes simulator in collaboration with teenagers with Type 1 diabetes
- 2007
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In: Diabetes Technology & Therapeutics. - : Mary Ann Liebert Inc. - 1520-9156 .- 1557-8593. ; 9:1, s. 17-25
-
Journal article (peer-reviewed)abstract
- Background: The main aim of this study was to develop and test in a pilot study a PC-based interactive diabetes simulator prototype as a part of future Internet-based support systems for young teenagers and their families. A second aim was to gain experience in user-centered design (UCD) methods applied to such subjects. Methods: Using UCD methods, a computer scientist participated in iterative user group sessions involving teenagers with Type 1 diabetes 13-17 years old and parents. Input was transformed into a requirements specification by the computer scientist and advisors. This was followed by gradual prototype development based on a previously developed mathematical core. Individual test sessions were followed by a pilot study with five subjects testing a prototype. The process was evaluated by registration of flow and content of input and opinions from expert advisors. Results: It was initially difficult to motivate teenagers to participate. User group discussion topics ranged from concrete to more academic matters. The issue of a simulator created active discussions among parents and teenagers. A large amount of input was generated from discussions among the teenagers. Individual test runs generated useful input. A pilot study suggested that the gradually elaborated software was functional. Conclusions: A PC-based diabetes simulator may create substantial interest among teenagers and parents, and the prototype seems worthy of further development and studies. UCD methods may generate significant input for computer support system design work and contribute to a functional design. Teenager involvement in design work may require time, patience, and flexibility. © Mary Ann Liebert, Inc.
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