| 1. |
- Diderichsen, Saima, 1981-
(författare)
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It's just a job : a new generation of physicians dealing with career and work ideals
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Today, women constitute about half of medical students. However, women are still underrepresented in prestigious specialties such as surgery. Some suggest that this could be explained by women being more oriented towards work-life balance.Aim: The overall aim of this dissertation was to explore aspects of gender in work-life priorities, career plans, clinical experiences and negotiations of professional ideals among medical students and newly graduated doctors, all in a Swedish setting.Method: We based the analysis on data from two different sources: an extensive questionnaire exploring gender and career plans among medical students (paper I-III) and interviews with newly graduated doctors (study IV).In paper I, four classes of first- and final-year medical (N=507, response rate 85%) answered an open-ended question about their future life, 60% were women. We conducted a mixed methods design where we analyzed the answers qualitatively to create categories that could be analyzed quantitatively in the second stage.In paper II, five classes of final-year medical students were included (N = 372, response rate 89%), and 58% were women. We studied their specialty preference and how they rated the impact that the motivational factors had for their choice. In order to evaluate the independent impact of each motivational factor for specialty preference, we used logistic regression. In paper III, final-year medical students answered two open-ended questions: “Can you recall an event that made you interested of working with a certain specialty?” and “Can you recall an event that made you uninterested of working with a certain specialty?”. The response rate was 62% (N = 250), and 58% were women. The analysis was similar to paper I, but here we focused on the qualitative results.In paper IV, thematic interviews were conducted in 2014 and 2015. We made a purposeful sampling of 15 junior doctors, including nine women and six men from eight different hospitals. Data collection and analysis was inspired by constructivist grounded theory methodology.Results: When looking at the work-life priorities of medical students and junior doctors it is clear that both men and women want more to life than work in their ideal future. The junior doctors renounced fully devoted and loyal ideal and presented a self-narrative where family and leisure was important to cope and stay empathic throughout their professional lives.The specialty preferences and the highly rated motives for choosing them were relatively gender neutral. However, the gender neutrality came to an end when the final-year medical students described clinical experiences that affected their specialty preference. Women were more often deterred by workplace cultures, whereas men were more often deterred by knowledge area, suggesting that it is a male privilege to choose a specialty according to interest.Among the newly graduated doctors, another male privilege seemed to be that men were able to pass more swiftly as real doctors, whereas the women experienced more dissonance between their self-understanding and being perceived as more junior and self-doubting.Conclusions: The career plans and work-life priorities of doctors-to-be were relatively gender neutral. Both female and male doctors, intended to balance work not only with a family but also with leisure. This challenges the health care system to establish more adaptive and flexible work conditions.Gender segregation in specialty choice is not the result of gender-dichotomized specialty preferences starting in medical school. This calls for a re-evaluation of the understanding where gender is seen as a mere background characteristic, priming women and men for different specialties.
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| 2. |
- Jonzon, Robert, 1952-
(författare)
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Health assessments of asylum seekers within the Swedish healthcare system : a study of the interface between control and care, and how structure and procedures may influence access and coverage
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Despite lack of evidence, there is a common notion that diseases are brought along with migrants, and thus a threat to people in the host country. In Sweden asylum seekers are to be offered a health assessment (HA), but national statistics show that the coverage is less than 50%. It has been assumed that asylum seekers do not want to attend, but this research data instead indicate structural barriers.Objectives: To explore to what extent the Swedish healthcare system provides optimal conditions for asylum seekers to access the HA and how the HA could meet their own perceived health needs, as well as society’s demand on detecting contagious diseases, from a public health perspective.Methods: This research project adopted a mixed method approach. A quantitative cross-sectional design was applied where different questionnaires were used, targeting administrators and healthcare professionals as well as former asylum seekers. In addition a qualitative, interpretative and descriptive research approach was applied, guided by grounded theory. Individual interviews were carried out among former asylum seekers.Results: This research revealed that there is no coherent national system for the HAs on asylum seekers in Sweden. The structures, organizations, procedures and outcomes vary significantly between the 21 counties, and the reasons for the low coverage seemed multifold. The former asylum seekers stated feelings of ambiguity and mistrust due to lack of information on the purpose of the HA and how it might influence their asylum application. Poor communication was identified as one of several barriers to access healthcare. The attitude was positive to the HA as such, but it was considered to be just a communicable disease control, without focus on their own perceived health needs, thus an imbalance between control and care.Conclusions: Although being an important contribution, the HA does not suffice to fulfill the right to health of asylum seekers, due to shortcomings regarding accessibility and acceptability of the information, procedures and services that it includes.
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| 3. |
- Karlberg, Eva
(författare)
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Organizing the Voice of Women : A study of the Polish and Swedish women's movements' adaptation to international structures
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The European Union has become an important arena for international politics. Various actors try to influence the European-level executive and legislative authorities. Lobbyists in Brussels are not the only type of actors promoting the interests of others. Today, national-level social movement actors too are present at the European level, pushing the interests of various citizen groups and social issues. To do so, however, they need to adapt to the European Union’s multilevel governance system by speaking with one voice. As this thesis demonstrates, at the national level this adaptation may entail a number of organizational challenges for movements.Organizing the Voice of Women regards national-level social movements adapting to international structures. Taking the cases of the Swedish and the Polish women’s movements and their relation to the European Union as examples, the analysis follows two separate, yet similar, processes of forming and maintaining nationwide meta-organizations – that is, organizations of organizations – that can speak for the two respective movements. Through the cases of the two women’s movements’ adaptation to international structures, the study explores the challenges involved when a new layer of organization is added to a social movement.The results show that organizing the voice of the Swedish and the Polish women’s movements has been particularly challenging when conditions such as a tradition of umbrella organizing and stable financial resources are absent at national level. The results also show that competition and conflicts are apparent in both cases and inherent in meta-organizations, and that they have been possible to deal with differently depending on the two movements’ national settings. With an organizational perspective on social movement coalitions, this study contributes to the classic question of institutionalization, formalization and bureaucratization of social movements. It ultimately asks what it means to organize a field of social movement actors and what happens at the junction of organization and social movement, at the intersection of national and international interests. A wider implication of the study is that the issues it highlights are to be expected whenever the internationalization of national movement activities takes the form of meta-organization.
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| 4. |
- Sävje, Fredrik, 1986-
(författare)
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What would have happened? : Four essays investigating causality
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation consists of four self-contained essays.Essay 1. A common method to reduce the uncertainty of causal inferences from experiments is to assign treatments in fixed proportions within groups of similar units: blocking. Previous results indicate that one can expect substantial reductions in variance if these groups are formed so to contain exactly as many units as treatment conditions. This approach can be contrasted to threshold blocking which, instead of specifying a fixed size, requires that the groups contain a minimum number of units. In this essay, I investigate the advantages of respective method. In particular, I show that threshold blocking is superior to fixed-sized blocking in the sense that it always finds a weakly better grouping for any objective and sample. However, this does not necessarily hold when the objective function of the blocking problem is unknown, and a fixed-sized design can perform better in that case. I specifically examine the factors that govern how the methods perform in the common situation where the objective is to reduce the estimator's variance, but where groups are constructed based on covariates. This reveals that the relative performance of threshold blocking improves when the covariates become more predictive of the outcome.Essay 2. Inferences from randomized experiments can be improved by blocking: assigning treatment in fixed proportions within groups of similar units. The use of the method, however, is limited by the difficulty in deriving these groups. Current blocking methods are restricted to special cases or run in exponential time; are not sensitive to clustering of data points; and are often heuristic, providing an unsatisfactory solution in many common instances. This essay introduces an algorithm that implements a new, widely applicable class of blocking—threshold blocking—that solves these problems. Given a minimum required group size and a distance metric, we study the blocking problem of minimizing the maximum distance between any two units within the same group. We prove this is a NP-hard problem and derive an approximation algorithm that yields a blocking where the maximum distance is guaranteed to be at most four times the optimal value. This algorithm runs in O(n log n) time with O(n) space complexity. This makes it the first blocking method with an ensured level of performance that works in massive experiments. While many commonly used algorithms form pairs of units, our algorithm constructs the groups flexibly for any chosen minimum size. This facilitates complex experiments with several treatment arms and clustered data. A simulation study demonstrates the efficiency and efficacy of our blocking algorithm; tens of millions of units can be blocked using a desktop computer in a few minutes.Essay 3. Scholars study political incumbency effects to disentangle how office holding affects subsequent election results. Several types of effects have been discussed and investigated in this time-honored literature, but few have been formally defined. The recent popularity of the regression discontinuity design to investigate the topic has, however, converged the focus to one particular effect: the party incumbency effect. That is, the effect on parties from being an incumbent party. In this essay, I introduce a causal model with which most of the previously discussed effect can be defined. In particular, I can give formal definitions of the incumbent legislator effect—the effect on parties of having an incumbent office holder as candidate—and the personal incumbency effect—the effect on candidates of being the incumbent office holder. Using the model, I decompose the party incumbency effect into these newly defined effects, thereby providing a link between the different effects. The model also allows me to revisit previous estimator and derive which effect they estimate. This investigation reveals that the legislator effect has been in focus in much of the past literature. Motivated by the lack of identification strategies for the personal effect, I introduce several strategies which, under suitable assumptions, can identify the effect. Last, to illustrate these strategies, I investigate the personal incumbency effect in recent Brazilian mayoral elections.Essay 4. Recent research has reported positive effects on schooling, particularly for girls, due to in utero protection from iodine deficiency resulting from iodized oil capsule distribution in Tanzania. These results suggest that similar health interventions might have contributed to the reduction of the educational gender gap and, more generally, unveiled a mechanism through which the natural health environment affects social and economic development. In this essay, we revisit the Tanzanian experience by investigating how these effects differ over time and across surveys; across different treatment specifications; and across additional educational outcome measures. Contrary to previous studies, we find that the estimated effects tend to be small and not robust across specifications or samples. Using all available data and a medically motivated iodine depletion function, we find no evidence of a positive long-run effect of iodine deficiency protection on educational attainment.
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| 5. |
- Choi, Sun-Kyoung, 1967-
(författare)
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Kraften att älska, makten att tjäna : religion, emancipation och den kvinnliga skapande kraften i Jeanna Oterdahls sagor 1908–1927
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation studies the Swedish author Jeanna Oterdahl (1879–1965), and the fairy tales and stories she wrote in the period 1908–1927. Oterdahl was a well-known Christian public intellectual in her day. Besides being an author, she worked as a teacher and a lecturer, and was importantly involved in a number of organizations for societal development, such as the Association of the Christian Social Life [Förbundet för kristet samhällsliv] and the Settlement Movement [Hemgårdsrörelsen].The purpose of this study is to investigate the religious elements in her fairy tales and stories, and to study how these elements relate to the ideology of the early Swedish women’s emancipation movement. This movement rejected the conservative Christian faith of the Lutheran State Church, and aligned itself with the liberal form of Christianity that, to a greater extent, recognized the equality of men and women before God.Part I deals with the Christian message of love and its relation to emancipatory elements in Otherdahl’s stories. The point of departure for the analysis is Bremer’s interpretation of the Virgin Mary’s response to God’s calling, "Behold, the Lord’s servant" [Se, Herrens tjänarinna] and its emancipatory meaning. The women of Oterdahl’s stories take the role of servants of the Lord – not Lords [Herrens tjänarinna, inte herrarnas]Part II studies the female characters’ quest for their true (female) selves and their true home where alienation between the sexes will cease to exist and a spiritual kinship can take its place. This true home need not necessarily be a physical place; it can be in the form of an idea or a faith in something higher – such as God – where the self can live and reach its full personal potential. Part II analyzes Oterdahl’s understanding of the female characters’ quest against the background of Emilia Fogelklou’s interpretation of the role of Eve in the Genesis creation narrative (presented in her work “Two fairy tales” [Två sagor]), and against the background of one of Oterdahl’s own lectures, “How We Create a Home” [Hur vi skapa ett hem].The study ends with a discussion of how the concepts of freedom and power figure in Oterdahl’s stories. “Freedom” in Oterdahl’s stories is not a pursuit of power, but has to do with the use of one’s special gifts and with service to others. Freedom, in other words, means to take on responsibilities not only in the private home, but also in the community. Fogelklou describes this as a “human cause” [människosak] – something for women and men to strive for together.By examining how the Christian message of love is expressed through the emancipatory efforts of the female protagonists in Oterdahl’s stories, the dissertation highlights a new dimension in her work, and puts in question the common description of her stories as reactionary. Reinterpreted against the background of the Christian concept of calling/vocation and the ideology of the early emancipationist movement, the seemingly reactionary stories can be understood as emphasizing the importance of women in a changing society.
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| 6. |
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| 7. |
- Belfrage, Anna Karin, 1977-, et al.
(författare)
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Pan-NS3 protease inhibitors of hepatitis C virus based on an R3-elongated pyrazinone scaffold
- 2018
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Ingår i: European Journal of Medicinal Chemistry. - : Elsevier. - 0223-5234 .- 1768-3254. ; 148, s. 453-464
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Tidskriftsartikel (refereegranskat)abstract
- Herein, we present the design and synthesis of 2(1H)-pyrazinone based HCV NS3 protease inhibitors and show that elongated R-3 urea substituents were associated with increased inhibitory potencies over several NS3 protein variants. The inhibitors are believed to rely on beta-sheet mimicking hydrogen bonds which are similar over different genotypes and current drug resistant variants and correspond to the beta-sheet interactions of the natural peptide substrate. Inhibitor 36, for example, with a urea substituent including a cyclic imide showed balanced nanomolar inhibitory potencies against genotype la, both wild-type (K-i=30 nM) and R155K (K-i=2 nM), and genotype 3a (K-i=5 nM).
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| 8. |
- Brännström, Sara, et al.
(författare)
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Enzymatically Synthesized Vinyl Ether-Disulfide Monomer Enablingan Orthogonal Combination of Free Radical and Cationic Chemistry toward Sustainable Functional Networks
- 2019
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Ingår i: Biomacromolecules. - : American Chemical Society (ACS). - 1525-7797 .- 1526-4602. ; 20:3, s. 1308-1316
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Tidskriftsartikel (refereegranskat)abstract
- This work demonstrates a versatile and environmentally friendly route for the development of new orthogonal monomers that can be used for postfunctionalizable polymer networks. A monomer containing both vinyl ether (VE) and cyclic disulfide moieties was synthesized via enzyme catalysis under benign reaction conditions. The bifunctional monomer could be polymerized to form macromolecues with differing architectures by the use of either cationic or radical photo polymerization. When cationic polymerization was performed, a linear polymer was obtained with pendant disulfide units in the side chain, whereas in the presence of radical initiator, the VE reacted with the disulfide to yield a branched structure. The monomer was thereafter used to design networks that could be postfunctionalized; the monomer was cross-linked with cationic initiation together with a difunctional VE oligomer and after cross-linking the unreacted disulfides were coupled to RhodamineVE by radical UV-initiation.
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| 9. |
- Hannuksela, Matias, 1969-
(författare)
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Familial thoracic aortic aneurysms and dissections : studies on genotype and phenotype
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Thoracic aortic aneurysms and dissections (TAAD) have a genetic component with an estimated 20-25% of the patients having a positive family history. An aneurysm often precedes a dissection. Acute aortic dissections are associated with high mortality and morbidity, even when operated on. Complications due to prophylactic surgery are considerably fewer. Therefore, patients at risk for dissection should be identified, followed-up and evaluated for prophylactic intervention.Aims: 1. To establish reference values for ascending (AoA) and descending aortic (AoD) diameters measured by computed tomography. 2. To study the effectiveness of phenotypic cascade screening in families with an inherited form of thoracic aortic aneurysms and dissections (FTAAD) and to address questions that arise when screening for a genetic disorder is applied. 3. To study the agreement of aortic diameters obtained by TTE and MRI and to study aortic stiffness in individuals from families with FTAAD. 4. To perform exome sequencing in order to identify pathogenic sequence variants causing FTAAD, to characterize the phenotype, and to compare thoracic aortic diameter and stiffness in mutation carriers and non-carriers.Results: Paper I: The diameter of the thoracic aorta increased by 0.17 mm (0.12 – 0.20 mm) per year. The mean sex-related difference in diameter was 1.99 mm (1.28 – 2.60 mm) with men having larger aortas than women. The mean difference in aortic diameter per unit BMI was 0.27 mm (0.14 – 0.44 mm). Upper normal limits for the AoA can be calculated by the formula D (mm)=31+0.16*age and for the AoD by D (mm)=21+0.16*age.Paper II: Of 106 individuals from families with FTAAD but without known thoracic aortic disease, 19 individuals (18%) were identified to have a dilated AoA. The expected number of individuals in this group with an autosomal dominant disease would have been 40 (p<0.0001). In first-degree relatives younger than 40, we found only one individual with a dilated aorta although the expected number of individuals with disease causing mutation would have been 10.Paper III: Of 116 individuals investigated, 21 were identified with thoracic aortic dilatation and 95 individuals with normal thoracic aortic diameter. Aortic stiffness increased with age and diameter. The individuals with aortic dilatation were older than those without (49 vs. 37 years, p=0.001) and showed lower aortic elastic properties. The diameters measured by TTE and MRI correlated strongly (r2=0.93). The mean difference in diameters between the two methods was 0.72 mm (95% CI 0.41-1.02) with TTE giving larger diameters than MRI.Paper IV: From exome sequencing and segregation analysis, a 2-bp deletion in the MYLK gene (c.3272_3273del) was identified to cause FTAAD. The age and the aortic diameter at dissection or rupture varied in the family members. We did not find any differences in aortic diameter, aortic stiffness, or pulse wave velocity between carriers and non-carriers.Conclusions: Thoracic aortic diameter increases with age, and sex and body size are also associated with the diameter. In FTAAD, screening identifies family members with a previously unknown aortic dilatation. However, a normal aortic diameter does not exclude an individual from being a carrier of FTAAD. TTE can be used in follow-up for the ascending aorta. Individuals identified to have a dilated thoracic aorta have increased aortic stiffness compared to individuals with normal thoracic aortic diameter. The MYLK mutation (c.3272_3273del) causes thoracic aortic dissections with variable clinical expression. No differences in aortic stiffness were identified between MYLK mutation carriers and non-carriers.
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| 10. |
- Nemeth, Zsuzsanna, et al.
(författare)
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Heme oxygenase-1 in macrophages controls prostate cancer progression
- 2015
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Ingår i: Oncotarget. - : Impact Journals, LLC. - 1949-2553. ; 6:32, s. 33675-33688
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Tidskriftsartikel (refereegranskat)abstract
- Innate immune cells strongly influence cancer growth and progression via multiple mechanisms including regulation of epithelial to mesenchymal transition (EMT). In this study, we investigated whether expression of the metabolic gene, heme oxygenase-1 (HO-1) in tumor microenvironment imparts significant effects on prostate cancer progression.We showed that HO-1 is expressed in MARCO-positive macrophages in prostate cancer (PCa) xenografts and human prostate cancers. We demonstrated that macrophage specific (LyzM-Cre) conditional deletion of HO-1 suppressed growth of PC3 xenografts in vivo and delayed progression of prostate intraepithelial neoplasia (PIN) in TRAMP mice. However, initiation and progression of cancer xenografts in the presence of macrophages lacking HO-1 resulted in loss of E-cadherin, a known marker of poor prognosis as well as EMT. Application of CO, a product of HO-1 catalysis, increased levels of E-cadherin in the adherens junctions between cancer cells. We further showed that HO-1-driven expression of E-cadherin in cancer cells cultured in the presence of macrophages is dependent on mitochondrial activity of cancer cells.In summary, these data suggest that HO-1-derived CO from tumor-associated macrophages influences, in part, E-cadherin expression and thus tumor initiation and progression.
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