DiVA - Academic Archive On-line

Atrial fibrillation : inflammatory and pharmacological studies

Henrik Almroth — Thu, 19 Apr 2012 10:11:00 +0200

Mångfald som demokratins utmaning : en studie av hur socialtjänsten som välfärdsbyråkrati och moralisk samhällsinstitutiion förstår och hanterar kulturell mångfald

Rúna Í Baianstovu — Wed, 25 Apr 2012 15:53:00 +0200

This dissertation deals with how Swedish society is confronting the democratic challenge of finding ways to integrate individuals and groups with a diversity of cultural and religious beliefs and social practices. The idea that democracy must include all members of society is central in contemporary welfare states. In Sweden this idea is closely related to a concept of social justice and equality. This means that this study deals with aspects of integration processes. Social services are one of the societal institutions that institutionalize the moral conceptions of how life should be lived. Therefore, its function in the integration processes mirrors the ethos of society as a whole. The chief characteristics of a democratic state are that it represents every member of society and that it is transparent, communicative, and reflexive. But this is not easily performed. The State may exercise oppression in the form of forced assimilation through the culturally detached design of law and policy, and with the politics of diversity, minority groups may exert internal oppression of vulnerable elements within the group. This tension expresses a tension that is called the Paradox of Democracy in this thesis. Social workers deal with the paradox while handling society’s moral panic regarding “others’” traditions that are perceived as difficult to comprehend. Therefore, their investigative work is of great importance in a society that aspires to treat all citizens as equals. But the framework for such investigations is narrow and tightly controlled. A qualitative change in the scope of social workers’ ability to work in the service of communicative action within the complex areas discussed in this study could be a step towards broadening and deepening democratic practices. When the public institutions take their clients’ diverse wishes and needs seriously, and treat them as indicators of the actual needs of members of society, the public institutions receive a foundation for reciprocal and communicatively anchored integration work.

Musik oss emellan : identitetsdimensioner i ungdomars musikalilska deltagande i vardagen

Annika Danielsson — Mon, 21 May 2012 15:58:00 +0200

CYP26B1 as regulator of retinoic acid in vascular cells and atherosclerotic lesions

Ali Elmabsout — Thu, 10 May 2012 11:33:00 +0200

Optimization of the perioperative anaesthetic care for prostate cancer surgery : clinical studies on pain, stress response and immunomodulation

Fredrica Fant — Thu, 10 May 2012 15:36:00 +0200

Prostate cancer (PC) is the most common cancer form in men. Surgery is the treatment of choice for localized form of PC and half of all surgical procedures are radical retropubic prostatectomies (RRP). In the first two studies, we compared the efficacy of thoracic epidural analgesia to patientcontrolled analgesia (PCA) with intravenous morphine (I) and to patientcontrolled local analgesia by intra-abdominal injection of local anaesthetic(LA) (II) in treating postoperative pain after RRP. In studies III and IV we evaluated the effects of thoracic epidural analgesia compared to PCA with morphine in reducing the surgical stress reaction, inflammatory response (III) as well as the immune suppression (IV) following RRP. In studies I and II, we found better pain relief both at rest and on coughing, lower morphine consumption and better respiratory function postoperatively in patients having epidural analgesia. However, we did not register differences in time to home readiness or length of hospital stay. Painmanagement did not significantly affect health-related quality of life. In study III, early surgical stress response (plasma glucose and cortisol) was reduced two hours after the skin incision in patients having epidural analgesia compared with those having intravenous morphine analgesia but no differences in inflammatory mediators were seen except IL-17 which was lower in the epidural group. In study IV, no differences were found between epidural and PCA groups in leucocyte subpopulations, immunecell activation after mitogen stimulation or in natural killer cell cytotoxicityas a measure of innate immunity. We observed a low incidence of side effects and postoperative complications in all studies with no differences between the groups. In summary, thoracic epidural analgesia provided better postoperative pain relief, improved respiratory function and reduction in early stress response to radical retropubic prostatectomy, without any significant effects on inflammation or immune suppression.

I föränderliga och slutna rosa rum : En etnografisk studie av kön, ålder och andlighet i en svensk waldorfförskola

Sara Frödén — Fri, 23 Mar 2012 08:59:00 +0200

The aim of this study is to generate new knowledge of the educationalpractice of a pre-school and of how it may contribute to the understandingof doing gender. The ethnographic study examines the place and practiceof a Steiner Waldorf pre-school, and it focuses specifically on materiality,age, spirituality and the intentions of the pre-school teachers. Fieldworkhas been conducted for a period of one and a half years in one pre-school.The methods used are mainly participant observation and interviews withthe pre-school teachers. The results highlight the importance of the materialand spatial dimensions of the pre-school for the constitution of children’sgender. The concepts of performativity and ritualization have beenused as the main analytical tools. The study draws on the scope of theseconcepts as understood by Judith Butler and Catherine Bell.

On the basis of the analysis of the empirical material, a theoretical concept,situated decoding of gender, is suggested. It is argued that what atfirst glance can be interpreted as a ‘female universe’, turns out to be a placewhere gender is made non-relevant through an unintentional, yet powerfulongoing process of naturalization. The situated decoding of gender is madepossible because of certain features in this pre-school. Firstly, a repetitivestructure characterizing educational practice has been observed. This isbased on a principle of rhythm reciprocally related to the alternations betweencontinuity and change. Secondly, there is a clear spatial and materialdemarcation that the study argues makes the pre-school an enclosed space,in the sense of being a place of nurturing and protection, where the boundariesbetween home and pre-school are maintained. Thirdly, the performativeforce of the ritualized preschool practices further enhances the decodingof gender. The ritualization highlights and supports the spiritual dimensionin the pedagogy, which sidelines the doing of gender. Fourthly, theteachers contributed to the decoding of gender through the consistency oftheir everyday actions.

Mental dynamisk prestation : påverkansprocessen utifrån ett idrottsligt perspektiv

Anders Hedén — Thu, 10 May 2012 12:43:00 +0200

A support group programme for family members : an interverntion during ongoing palliative care

Anette Henriksson — Fri, 16 Mar 2012 10:43:00 +0200

Family members are central in providing care for patients with lifethreatening illness, but they often experience a lack of necessary preparation and knowledge, with a need for information and psychosocial support. The overall aim of this thesis was to investigate participant’s experiences as well as effects of a support group programme for family members of patients with life-threatening illness during ongoing palliative care.

Methods: A mixed method design was used. Study I was retrospective descriptive and used a phenomenological method to analyse 10 face-to-face interviews about experiences of participating in the programme. Study II was retrospective descriptive and used qualitative content analysis to analyse 29 telephone interviews about experiences of the programme design. Study III was correlational and used a confirmatory factor analysis to psychometrically evaluate the preparedness for caregiving scale(PCS), caregiver competence scale(CCS) and rewards of caregiving scale(RCS) in 124 family members. Study IV was prospective quasi-experimental and used interferential statistics to investigate effects of the programme, assessing preparedness, competence, rewards, anxiety, depression, hope and health in 125 family members.

Results: The main experiences of participation in the programme were; a sense of safety and belonging, confirmation, insight into the gravity of the illness, and a moment of rest. The programme was experienced as covering topics of interest, structured to make participants feel invited by the caring team and using an open approach that fostered a warm atmosphere. The Swedish versions of PCS, CCS and RCS were shown to be valid and reliable. Family members who participated in the programme significantly increased in preparedness, competence and rewards in relation to caregiving. No significant changes were shown for anxiety, depression, hope and health.

Clinical implications: The results should provide encouragement in the challenging work to develop and deliverer interventions, with the explicit purpose of supporting family members in palliative care.

Urinary catheter policies for short-term bladder drainage in hip surgery patients

Maria Hälleberg Nyman — Thu, 12 Apr 2012 12:23:00 +0200

The overall aim of this thesis was to evaluate methods for urinary catheter handling in patients undergoing hip surgery. The intention was to gain knowledge in order to provide optimal and cost- effective care regarding urinary catheterisation in this group of patients.

In Study I , 45 of the 86 catheterised patients (52%) contracted nosocomial urinary tract infections (UTIs). Diabetes was a risk factor for developing UTI, and cloxacillin as a perioperative antibiotic prophylaxis seemed to offer a certain protection. Study II was a randomised controlled trial on the effect of clamping (n = 55) or not (n = 58) of the indwelling urinary catheter before removal. No significant differences were found between the groups with respect to time to normal bladder function, need for recatheterisation, or length of hospital stay. Study III was a randomised controlled trial among patients with hip fracture and hip arthroplasty, in which the patients were randomised to intermittent (n = 85) or indwelling (n = 85) urinary catheterisation. No significant differences in nosocomial UTIs (9% vs. 12%) or cost-effectiveness were shown. The patients in the intermittent group regained normal bladder function significantly sooner after surgery. Fourteen percent of the patients in the intermittent group did not need any catheterisation. In Study IV , 30 patients were interviewed about their experiences of bladder emptying and urinary catheterisation. The patients’ views were described through the main category ‘An issue but of varying impact’. Both bladder emptying through micturition and bladder emptying through catheterisation were described as convenient, but also as uncomfortable and an intrusion on dignity. The patients were aware of risks and complications of urinary catheterisation.

In conclusion, this thesis indicates that UTI is common in hip surgery patients. Clamping of indwelling catheters seems not necessary. There is no preference for either intermittent or indwelling urinary catheterisation according to the results of this thesis, either for the development of nosocomial UTI or, for cost-effectiveness, or from the patient perspective. Nurses should be aware that catheterisation might make the patients feel exposed, and it is essential that their practice reflect the best available evidence.

Vården av de arbetsoförmögna : reumatikervårdens framväxt i den tidiga välfärdsstaten

Henrik Karlsson — Thu, 29 Mar 2012 08:18:00 +0200

This dissertation is about the development of care for the chronically ill, particularly rheumatics, from 1900 to 1960. Two aspects, economic support and medical care, are discussed regarding the efforts made by society to improve the situation for the chronically ill. The aim is to investigate the underlying motives for the care, and the interests of the state and the medical profession in the matter. The development of the care takes place in a historical context in which the state increased its responsibility for the social security of the citizens. Primarily this was seen in the creation of a social insurance system. There is a focus on the introduction of a national basic pensions scheme in 1913, which apart from giving old age pension would also give economic security to those who were struck with disablement. To reduce the costs for early retirement disability pensions, where rheumatics were the largest group, economic resources were set aside for the purpose of combating and curing disablement. As a consequence of this initiative, specialist care for rheumatics was built up within the framework of the basic pensions scheme. At the same time, doctors were arguing that the care for rheumatics should have been organised in the public health service.

The dissertation follows the institutional development of specialist care for rheumatics up to the 1960s, when the National Social Insurance Board took over the pension board’s duties and powers, and the decision was taken to transfer the specialist care for rheumatics to the county councils. In the organisational development, the influence of the medical profession and medical science in the shaping of the work is discussed. In addition, other factors such as changes in the labour market, where the motive was to rehabilitate the sick so that they could work and be self-supporting, are put forward as an important explanation for the organisational structuring that the care of rheumatics underwent during the twentieth century. This meant that social work became an important complement to the medical care itself.

Modulation of cellular innate immune responses

Mattias Karlsson — Fri, 16 Mar 2012 13:08:00 +0200

Civic experiences and public connection : media and young people in Estonia

Anne Kaun — Wed, 28 Mar 2012 09:12:00 +0200

How do young people in Estonia experience the political, politics and citizenship? How are these civic experiences connected to young peoples’ experiences with the media? Anne Kaun’s thesis Civic Experiences and Public Connection presents a theoretical and empirical investigation of how civic experiences, particularly public connection, emerge in the context of contemporary Estonia. Employing open-ended online diaries and in-depth interviews, she aims to develop an in-depth understanding of how young people experience democracy today, and how they express themselves as citizens; expression not only through the physical performance of citizenship, but also through orientation, interest in, and reflection about issues that are of common concern or should be seen as such. The empirical investigation of public connection as critical media connection, playful public connection and historical public connection, is based on narrative analysis and embedded in a theoretical exploration of key concepts in the context of civic culture studies, namely the political, politics and citizenship.

Combining Chantal Mouffe’s conflict theory with Paul Ricoeur’s narrative identity, Kaun aims to shed light on contemporary democracy from the citizens’ perspective. The author proposes a holistic approach to both civic experiences and the role that media might play in relation to them. Following a non-media- centric approach, she shows that media, despite their ubiquity, are an important but not exclusive source of the civic experiences of young adults in Estonia.

Applicability of the ICF-CY to describe functioning and environment of children with disabilities

Nina Klang — Thu, 19 Apr 2012 10:30:00 +0200

The aim of the thesis, with four empirical studies, was to explore the applicability of the International Classification of Functioning, Disability and Health, version for children and youth (ICF-CY) to describe functioning and environment of children with disabilities. The components and categories in the ICF-CY were explored by studying items in ICF-CY based questionnaires in studies I and II and by linking texts of individual habilitation plans to the ICF-CY in studies III and IV. Professionals’ perceptions of the applicability of the ICF-CY and the ICFCY questionnaire were investigated in study II. In study IV changes in focus on ICF-CY components in documentation of individual habilitation plans were explored after in-service training in the ICF-CY. Studies I and II found variations in ratings of questionnaire items based on the performance qualifier in component Activities and participation. The variations may be explained by the context in which ratings were made and by expectations and perceptions of those who made ratings. The results indicated challenges in constructing universal measures of the performance qualifier. The studies also indicated limitations in the use of items based on Environmental factors, when used separately from items in Activities and participation. Studies II and III found that the categories in the components Body functions and Activities and participation were interrelated. Study III indicated challenges in describing family situation and children’s psychosocial environment in the Environmental factors. In study II the professionals described advantages and challenges in the use of the ICFCY and suggested necessary changes to the ICF-CY questionnaire. Study IV found that the professionals in child and youth habilitation described children’s functioning more precisely and in more detail after in-service training. Overall, the results suggest both advantages and challenges of the ICFCY when used to describe functioning and environment of children with disabilities. The results call for a need of a combined use of the categories from all the ICF-CY the components.

Unmanned operation of load-haul-dump vehicles in mining environments

Johan Larsson — Wed, 28 Mar 2012 08:40:00 +0200

Underground mines typically do not represent the best working conditions for humans, and many mining companies have the intent to remove all humans from the ore extraction areas. To achieve this goal automation of the mining machinery is required. One of the riskier jobs in a mine is to operate the Load-Haul-Dump (LHD) vehicles that are used to transport the ore from the blast site to a truck, lorry or directly to a crusher. Today these vehicles are typically controlled by an on-board manual operator. The purpose of the work presented in this thesis is to develop and evaluate algorithms and methods to enable high productivity unmanned operation of LHDs, including two different operating modes.

The first mode is fully autonomous navigation, applicable to static environments, where the LHDs are repeatedly driven along the same paths for extended periods. Here, an existing framework for reactive navigation based on fuzzy logic has been extended with novel feature detection algorithms for tunnel following and topological localisation based on 2D laser range scanner data. These algorithms have been verified in quantitative tests to be fast, reliable and tolerant to noise in the sensor data. Moreover, the whole navigation system has been evaluated in qualitative tests in indoor environments using an ordinary research robot. The autonomous navigation system for LHDs currently commercialized by Atlas Copco is partly based on the experiences gained from the work presented here.

The second mode explored is semi-autonomous operation, where local-autonomy functionality on-board the machine assists a tele-remote operator in driving the vehicle along a collision-free path. This mode is intended for mines where the driving path of the machine changes frequently, so the setup needed for a fully autonomous system becomes impractical. In this part of the work a user study in a real mine has been performed, showing that local autonomy has the potential to significantly improve the productivity of a tele-remote operated LHD. Based on these results, a commercial tele-operating system for underground mines has been extended with a novel local autonomy functionality, inspired by existing autonomous navigation systems. The performance of this system has been verified in experiments performed on a real 38 tonnes LHD in a test mine, and in simulations aimed to show that the system works in arbitrary underground mine environments.

Spänning och motstånd : en studie av samtal i karaktärsämnet på ett elprogram

Fredrik Lundström — Fri, 11 May 2012 11:59:00 +0200

Risc factors and complications of celiac disease

Karl Mårild — Fri, 16 Mar 2012 12:09:00 +0200

Background: Celiac disease (CD) is an immune-mediated enteropathy induced by dietary gluten. CD is prevalent in some 1 % of the general population. In recent decades there has been a marked increase in CD prevalence that may be influenced by environmental risk factors. Aims: The aim of this thesis was to examine possible risk factors for CD and to gain information on associated disorders of CD.

Methods: In study I we used regional cohort-data from ~11,000 children to examine the association between psychological stress in early life and subsequent CD. In studies II-IV we used nationwide histopathology data to identify individuals with CD (i.e. villous atrophy). In study II we linked data on ~29,000 CD patients to the National patient register to examine the risk of hospital admission for influenza. In studies III-IV we linked data on ~11,000 CD patients to several Swedish registries, including the Medical birth register, to examine neonatal risk factors in CD (study III) and the risk of CD in patients with Down syndrome (study IV).

Results: Psychological stress in the first years of life was not associated with subsequent CD. We found a two-fold increased risk of hospital admission for influenza in patients with CD (95 % confidence interval [CI] = 1.6-2.7).While elective cesarean delivery was associated with an increased risk of later CD (adjusted Odds Ratio [OR] = 1.15; 95 % CI = 1.04-1.26), emergency cesarean delivery was not (adjusted OR = 1.02; 95 % CI = 0.92-1.13). Finally, in study IV we found a six-fold increased risk of CD in children with Down syndrome (95 % CI = 5.09-7.43).

Conclusion: This thesis supports the hypothesis that certain environmental risk factors, such as mode of delivery, but possibly not early psychological stress, influence the risk of CD. The increased risk of hospital admission for influenza indicate that individuals with CD may benefit from influenza immunization. The highly increased risk of CD in Down syndrome supports CD screening in Down syndrome patients.

Reliable autonomus navigation in semi-structured environments using the three-dimensional normal distributions transform (3D-NDT)

Todor Dimitrov Stoyanov — Wed, 7 Mar 2012 20:43:00 +0200

Professional support in childbearing : a challenging act of balance

Stina Thorstensson — Thu, 29 Mar 2012 13:09:00 +0200

Topos som meningsskapare : retorikens topiska perspektiv på tänkande

Maria Wolrath Söderberg — Mon, 21 May 2012 14:50:00 +0200