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  • Public defence: 2019-11-22 09:00 Örebro universitet, Campus USÖ, hörsal C1, Örebro
    Fägerstad, Anida
    Örebro University, School of Health Sciences.
    No-shows in dental care: perspectives on adolescents' attendance pattern2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    All children and adolescents living in Sweden have free dental care with regular check-ups. Yet, missed and cancelled dental appointments are not unusual. The overall aim was to explore potential explanatory factors associated with non-regular dental care and to seek a deeper understanding of why some adolescents fail to attend their dental appointments.

    An integrative review (Paper I) identified and summarized different sets of environmental, individual and situational factors that could be associated with dental avoidance or non-attendance. Paper II found similar levels of dental fear between children and adolescents (8-19 yrs) with a Swedish or a non-Swedish background. The occurrence and patterns of missed dental appointments among 16–19-year-olds were investigated in Paper III, where we report that 13.1% of 23 522 booked dental appointments were missed in 2012. Boys had more missed appointments than girls, while no age differences were found. In a case-control design, adolescents with missed appointments more often had sociodemographic load, dental fear or dental behaviour management problems, poor oral health, emergency visits, tooth extractions, operative treatments, and over the past years, more missed and cancelled appointments. A history of missed and cancelled dental appointments predicted future missed and cancelled appointments. Twelve adolescent girls with missed appointments were interviewed in Paper IV and described several potential barriers or facilitators to accessing dental care. They highlighted that knowing what will happen during the dental visit was decisive to whether or not they would attend their appointments.

    In conclusion, factors specifically associated with dental avoidance still need to be investigated. Dental fear should still be seen as potential causal factor for dental avoidance. Missed and cancelled dental appointments should never be ignored since they could predict future missed and cancelled appointments. The results indicate that missed dental appointments among adolescents remain a challenge for Swedish dental care.

    List of papers
    1. Understanding avoidance and non-attendance among adolescents in dental care: an integrative review
    Open this publication in new window or tab >>Understanding avoidance and non-attendance among adolescents in dental care: an integrative review
    2016 (English)In: Community Dental Health, ISSN 0265-539X, Vol. 33, no 3, p. 195-207Article in journal (Refereed) Published
    Abstract [en]

    Objective: To review articles exploring manifestations of avoidance of or non-attendance to dental care, to identify background and concomitant factors specifically associated with dental avoidance among adolescents.

    Methods: PubMed, CINAHL and PsychINFO were searched using MeSH terms and keywords covering dental avoidance, non-attendance and non-utilization. Searches were limited to peer-reviewed studies in English, published in 1994– 2014. Twenty-one research articles were included. Data were extracted, ordered, coded, categorized, and summarized according to the integrative review method.

    Results: The identified factors formed three common major themes: Environmental, Individual and Situational factors. Only seven studies, all from Sweden or Norway, investigated factors associated with dental avoidance. The remaining 14 studies were geographically widespread. Regarding avoidance, the main focus was found to be on individual and situational factors, while environmental factors were more often investigated for the outcome non-attendance.

    Conclusions: Although a wide variety of environmental, individual and situational factors could be summarized in this review, factors specifically associated with dental avoidance in a context of free dental care still need to be investigated. The possible impacts of cultural background, of tobacco, alcohol or drug use and of psycho-social circumstances deserve further research. Clinical implications of today’s knowledge may be to pay attention to the adolescents’ individual background and everyday life situation, to offer agreed and individualized treatment, taking fears and attitudes into consideration, to avoid painful treatments, and to be alert for early signs of avoidance.

    Place, publisher, year, edition, pages
    Suffolk, United Kingdom: FDI World Dental Press Ltd., 2016
    Keywords
    Dental health services, health care utilization, adolescent, review
    National Category
    Dentistry
    Identifiers
    urn:nbn:se:oru:diva-47374 (URN)10.1922/CDH_3829Fagerstad13 (DOI)000390932100005 ()
    Note

    Funding Agency:

    Public Dental Service, Region Orebro County, Sweden

    Available from: 2016-01-11 Created: 2016-01-11 Last updated: 2019-10-28Bibliographically approved
    2. Dental fear among children and adolescents in a multicultural population: a cross-sectional study
    Open this publication in new window or tab >>Dental fear among children and adolescents in a multicultural population: a cross-sectional study
    2015 (English)In: Swedish Dental Journal, ISSN 0347-9994, Vol. 39, no 2, p. 109-120Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to explore dental fear in a multicultural population of child and adolescent dental patients, with background, gender, age, and socioeconomic status taken into account. A specific aim was to investigate whether the level of DF differed between patients with a non- Swedish background and patients with a Swedish background.

    In conjunction with a routine visit to the dental clinic, 301 patients (8-19 years old) assessed their dental fear on the Children's Fear Survey Schedule - Dental Subscale, using self-ratings. Following an interview protocol, patients' and their parents' country of birth, and parents' education and occupation/employment were registered. An interpreter was present when needed.

    Self-rated dental fear was almost equal among patients coming from a non-Swedish background and patients with a Swedish background. Girls scored higher than boys and younger children scored slightly higher compared to older children, but the pattern of dental fear variation was inconsistent. Socioeconomic status differed between the groups with a non- Swedish vs. a Swedish background, but no impact on dental fear was revealed. When children and adolescents with a non-Swedish vs. a Swedish background were modelled separately, female gender and younger age had an impact on dental fear only in the group with a Swedish background.

    No differences in dental fear were found between children and adolescents from non-Swedish vs. Swedish backgrounds. Dental fear variations according to gender and age were more pronounced in the group with a Swedish background compared to the group with a non-Swedish background. No impact of socioeconomic status could be revealed.

    Place, publisher, year, edition, pages
    Stockholm: Swedish Dental Journal, 2015
    Keywords
    Dental fear, questionnaires, cultural diversity
    National Category
    Dentistry
    Identifiers
    urn:nbn:se:oru:diva-51417 (URN)000377057900006 ()26529836 (PubMedID)2-s2.0-84937907216 (Scopus ID)
    Note

    Funding Agency:

    Public Dental Service of Örebro County Council, Örebro, Sweden

    Available from: 2016-07-27 Created: 2016-07-19 Last updated: 2019-10-28Bibliographically approved
    3. Dental avoidance among adolescents: a retrospective case–control study based on dental records in the public dental service in a Swedish county
    Open this publication in new window or tab >>Dental avoidance among adolescents: a retrospective case–control study based on dental records in the public dental service in a Swedish county
    2019 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 77, no 1, p. 1-8Article in journal (Refereed) Published
    Abstract [en]

    Objective: This study aimed to investigate the occurrence of missed dental appointments among 16–19-year-old adolescents in a Swedish county. A second aim was to explore associations between background and concomitant factors and missed appointments and to investigate if these associations differed between areas with different sociodemographic profiles.

    Materials and methods: A list of booked, and missed, appointments for 10,158 individuals during 2012 was used for assessments. Based on the total sample, 522 cases with, and 522 matched controls without, dental avoidance behavior in 2012 were identified. Data on previous missed and cancelled appointments, oral health status, dental treatment, fear or behavior problems, and medical, and, where available, psychosocial or lifestyle factors were extracted from the dental records using a preset protocol covering the period 2009–2012.

    Results: In 2012, 13.1% of 23,522 booked appointments were missed, with a higher proportion of missed appointments among boys than girls. Cases with avoidance behavior more often had a record of sociodemographic load and dental fear or behavior management problems. They also had more oral health problems, more invasive dental treatments, and, in the past, more missed and canceled appointments.

    Conclusion: To enable good oral health and continued regular dental care, we need to pay more attention to adolescents’ individual situation and be observant of early signs of avoidance.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2019
    Keywords
    Dental care, utilization, adolescent
    National Category
    Dentistry
    Identifiers
    urn:nbn:se:oru:diva-68444 (URN)10.1080/00016357.2018.1489978 (DOI)000455890400001 ()30022701 (PubMedID)2-s2.0-85050359378 (Scopus ID)
    Note

    Funding Agencies:

    Public Dental Service, Region Örebro County, Örebro University, Örebro  

    Swedish Dental Hygienist Association (SDHA), Sweden 

    Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2019-10-28Bibliographically approved
    4. Barriers and facilitators for adolescent girls to take on adult responsibility for dental care: a qualitative study
    Open this publication in new window or tab >>Barriers and facilitators for adolescent girls to take on adult responsibility for dental care: a qualitative study
    2019 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 14, no 1, article id 1678971Article in journal (Refereed) Published
    Abstract [en]

    Purpose: This study aims to explore and describe experiences of the dental care system among adolescent dental patients with a recent history of missed dental appointments at public dental clinics (PDCs) in a Swedish county.

    Methods: Twelve adolescent girls participated in the study. Data were collected by individual, semi-structured, open-ended interviews and analysed with qualitative content analysis.

    Results: The study findings could be summed into the theme ?Triggers for adolescent girls to take on or not take on adult responsibility for dental care?. The experience of free dental care could be summarized in five main categories: Pain and discomfort; Attractive and healthy teeth; Feeling safe and secure; Taking on the responsibility; and Free of charge. These five categories consisted of 15 subcategories.

    Conclusions: The results of this study should increase the knowledge on how to meet and treat adolescent girls in dental care. Knowing what will happen during the dental visit was highlighted by the participants as decisive to whether or not they would attend their dental appointments. Therefore, we should as far as possible ensure that our patients feel safe at their dental visits and by trying to avoid painful treatments.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2019
    Keywords
    Dental care, dental attendance, adolescent, content analysis
    National Category
    Nursing Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:oru:diva-77601 (URN)10.1080/17482631.2019.1678971 (DOI)000490054100001 ()31608818 (PubMedID)2-s2.0-85073161662 (Scopus ID)
    Note

    Funding Agencies:

    Public Dental Service, Region Örebro County, Sweden  

    Örebro University, Örebro, Sweden 

    Available from: 2019-10-25 Created: 2019-10-25 Last updated: 2019-10-29Bibliographically approved
  • Public defence: 2019-11-22 13:00 Örebro universitet, Campus USÖ, hörsal C3, Örebro
    Fischer, Per
    Örebro University, School of Medical Sciences.
    Hemi and total wrist arthroplasty2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Aim: To study implant survival and implant loosening following primary total wrist arthroplasty (TWA) using four different implants. To report outcome following wrist revision arthroplasty. To evaluate a new radial wrist hemi arthroplasty (RWHA) design clinically and biomechanically.

    Method: The studies included 136 primary TWAs and 16 revision TWAs, both studies with prospectively collected data. Six fresh frozen cadaveric wrist specimen were used for biomechanical analysis. The RHWA was evaluated clinically in a pilot series of 20 cases.

    Results: Total implant survival was 92% but with high frequency of implant loosening of surviving Re-Motion implants. None of the surviving Maestro implants were considered radiographically loose. Implant survival following revision arthroplasty was 75%, considerably lower than following primary TWAs. However, none of the patients with surviving revision implants had pain at rest and little or no pain in activity. The surgical procedure and placement of the RHWA was feasible. Overall, the kinematic and functional changes appeared acceptable compared to the native wrist. None of the patients underwent revision following RHWA but reoperation was performed in 7 patients on the indication of persistent pain. However, patients reported relief of pain and improvement of patient-reported outcome measures.

    Conclusion: High long-term implant survival and no signs of radiographic loosening was found for the Maestro implant. However, the Maestro implant is no longer available on the market and we believe there is a need for new TWA designs. Revision arthroplasty is a valid option in the management of failed TWA. However, implant survival is lower than for primary TWAs and as many as 25% require additional surgery. Promising results were found using the new RHWA design but the implant needs modification before further testing.

    List of papers
    1. Total wrist arthroplasty, a 10 year follow-up
    Open this publication in new window or tab >>Total wrist arthroplasty, a 10 year follow-up
    (English)Manuscript (preprint) (Other academic)
    National Category
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-77452 (URN)
    Available from: 2019-10-18 Created: 2019-10-18 Last updated: 2019-10-18Bibliographically approved
    2. Revision Arthroplasty of the Wrist in Patients With Rheumatoid Arthritis, Mean Follow-Up 6.6 Years
    Open this publication in new window or tab >>Revision Arthroplasty of the Wrist in Patients With Rheumatoid Arthritis, Mean Follow-Up 6.6 Years
    2018 (English)In: Journal of Hand Surgery-American Volume, ISSN 0363-5023, E-ISSN 1531-6564, Vol. 43, no 5, p. 489.e1-489.e7Article in journal (Refereed) Published
    Abstract [en]

    PURPOSE: Management of failed total wrist arthroplasty (TWA) can be challenging; surgical treatment options include salvage arthrodesis, revision arthroplasty, and resection arthroplasty. There are few studies regarding salvage arthrodesis, and revision arthroplasty has been infrequently investigated. The aim of the study was to report the outcome after revision arthroplasty of the wrist.

    METHODS: A retrospective cohort of 16 revision TWAs was evaluated between 2003 and 2016. Data were collected before surgery and 1 and 5 years after surgery. The indication for revision arthroplasty was failed TWA. The primary end point was implant survival. Secondary outcome measures included visual analog scale (VAS) pain scores, range of motion, handgrip strength, and functional scoring with the Canadian Occupational Performance Measure (COPM), Patient-Rated Wrist Evaluation (PRWE), and Disabilities of the Arm, Shoulder, and Hand (DASH).

    RESULTS: Mean follow-up was 6.6 years. Synthetic bone graft was used in 9 cases, allograft corticocancellous bone graft in 1 case, and cement in 6 cases. Of the 16 revision TWAs, 4 were re-revised, 1 because of infection, and 3 cases underwent total wrist arthrodesis. In the non-re-revised cases, range of motion and grip strength was preserved compared with preoperative results. The VAS pain score in activity improved, but not significantly, at 1 (median, 1; range, 0-4.5) and 5 years after surgery (median, 0) compared with before surgery (median, 5). The COPM performance and satisfaction as well as PRWE scores improved significantly at 1 year (median COPM performance, 4.8; COPM satisfaction, 5.6; and PRWE, 24) and improved, but not significantly, at the 5-year follow (median COPM performance, 4.8; COPM satisfaction, 5.0; and PRWE, 37) in the non-re-revised cases.

    CONCLUSIONS: Revision arthroplasty of the wrist is a valid motion-preserving option to wrist arthrodesis in the management of failed TWA. However, the outcome is uncertain and as many as 25% require additional surgery.

    TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

    Place, publisher, year, edition, pages
    Elsevier, 2018
    Keywords
    Total wrist arthroplasty, osteoarthritis, rheumatoid arthritis
    National Category
    Orthopaedics Surgery
    Identifiers
    urn:nbn:se:oru:diva-67046 (URN)10.1016/j.jhsa.2017.10.038 (DOI)000432437100018 ()29224946 (PubMedID)2-s2.0-85044505797 (Scopus ID)
    Note

    Funding Agency:

    Örebro County Council Research Committee

    Available from: 2018-05-18 Created: 2018-05-18 Last updated: 2019-10-18Bibliographically approved
    3. Functional and Kinematic Analysis of a Wrist Radial Hemiarthrosplasty Design
    Open this publication in new window or tab >>Functional and Kinematic Analysis of a Wrist Radial Hemiarthrosplasty Design
    Show others...
    2018 (English)In: Journal of Musculoskeletal Research, ISSN 0218-9577, Vol. 21, no 1, article id 1850005Article in journal (Refereed) Published
    Abstract [en]

    Purpose: A biomechanical functional assessment was performed on a newly designed wrist hemiarthroplasty implant with aimed to identifying differences between the native wrist and wrist following the hemiarthroplasty procedure with (Hemi+PRC) and without a proximal row carpectomy (Hemi).

    Methods: Six cadaveric wrists were mounted on a custom testing fixture and underwent a series of functional tests to investigate differences in range of motion, muscles moment arms, and axis of rotation between the intact and post-operative wrists. The tested movements included manually-driven flexion-extension, radial-ulnar deviation, dart throwers motion, and circumduction.

    Results: The only significant change in range of motion was a decrease in flexion between the intact (77.75±14.40°) and both the Hemi (65.97±17.72°) and Hemi+PRC (60.08±17.18°) conditions. Minor differences in the mean position and variability of the axis of rotation's piercing point were identified. A statistically significant decrease in the flexion moment arm of the flexor carpi radialis was identified between the intact (16.1±2.6mm) and Hemi+PRC (14.0±3.4mm) conditions. Statistically significant decreases were also identified in the radial deviation moment arms of the extensor carpi radialis brevis' between the intact (15.3±7.8mm) and Hemi+PRC (7.3±12.5mm) conditions and the flexor carpi radialis' between the intact (15.3±3.2mm) and Hemi (12.0±5.7mm) conditions as well as in the ulnar deviation moment arm of the extensor carpi ulnaris between the intact (34.9±11.3mm) and Hemi (13.2±21.9mm) conditions.

    Conclusions: While some statistically significant functional changes were identified between the native and hemiarthroplasty wrist, the findings suggest that post-operative function is equally acceptable in hemiarthroplasty with and without resection of the proximal carpal row. © 2018 World Scientific Publishing Company.

    Place, publisher, year, edition, pages
    World Scientific, 2018
    Keywords
    Functional and kinematic analysis, Wrist, Wrist radial hemiarthroplasty design, article, carpal bone, flexor carpi radialis muscle, hemiarthroplasty, human, range of motion, rotation, ulna
    National Category
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-77453 (URN)10.1142/S0218957718500057 (DOI)2-s2.0-85044274774 (Scopus ID)
    Available from: 2019-10-18 Created: 2019-10-18 Last updated: 2019-10-25Bibliographically approved
    4. Clinical, radiographic and patient-perceived outcome after radial hemi-wrist arthroplasty of the wrist with a new implant. A pilot study
    Open this publication in new window or tab >>Clinical, radiographic and patient-perceived outcome after radial hemi-wrist arthroplasty of the wrist with a new implant. A pilot study
    (English)Manuscript (preprint) (Other academic)
    National Category
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-77454 (URN)
    Available from: 2019-10-18 Created: 2019-10-18 Last updated: 2019-10-18Bibliographically approved
  • Public defence: 2019-11-29 09:15 Örebro universitet, Långhuset, Hörsal L2, Örebro
    Grylin, Hanna
    Örebro University, School of Law, Psychology and Social Work.
    Passivitetsrätten vid skattetillägg2019Doctoral thesis, monograph (Other academic)
    Abstract [en]

    When a taxpayer fails to fulfill the obligation in Chapter 30 Section 1 and Chapter 31 Section 3 of the Swedish Tax Procedure Act, skatteförfarandelagen (2011:1244), the STPA, to submit information about his or her taxable income, he or she becomes liable to pay a tax surcharge. Decisions about tax surcharges can be made in both administrative and criminal proceedings. In fact, decisions on tax surcharges may be made due to a taxpayer’s passiveness during a criminal tax procedure, regardless of the intent. However, the European Court on Human Rights has established that a person’s silence is not, in itself, sufficient proof for a conviction. This causes a tension between the obligation to submit information about taxable income and the right to silence and the right against self-incrimination in the Swedish tax surcharge procedure.

    The purpose of this thesis is to analyze the relationship between the Swedish system of tax surcharge and the right to silence and the right against self-incrimination according to the ECHR, the EU Charter, Article 3 Section 1 (e) of Directive 2012/13/EU and Article 7 of Directive 2016/343/EU. The method used to analyze these problems and discuss solutions combines a legal dogmatic method with an autonomous interpretation of the right to silence and the right against self-incrimination. The analysis shows that problems occur after the point where a taxpayer has been charged with a criminal offence according to the autonomous meaning of the concept. This point in time corresponds to the point in time when action is taken by the Swedish Tax Agency that has a substantial impact on the taxpayer. The analysis also shows that if a tax surcharge is levied only because of a taxpayer’s silence, after that point, there has been a violation of the right to silence and the right against self-incrimination according to the autonomous meaning.

    The conclusion of the thesis is that there is a need for an amendment to the STPA, which reinforces the autonomous meaning of the right to silence and the right against self-incrimination in the Swedish tax surcharge procedure. This includes new rules in the STPA, which define 1) a duty for the Swedish Tax Agency to inform taxpayers about the right to silence and the right against selfincrimination, 2) the scope of the taxpayer’s obligation to submit information about taxable income in relation to the right to silence and the right against selfincrimination and 3) rules on exemption from tax surcharge when it violates the right to silence and the right against self-incrimination.

  • Public defence: 2019-12-03 13:00 Örebro universitet, Hörsalen, Musikhögskolan, Örebro
    Twizeyimana, Jean Damascene
    Örebro University, Örebro University School of Business.
    E-Government and Value Creation in the Context of a Least Developed Country: A perspective on public value and information infrastructure2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis is in the field of information systems (IS), more specifically about IS impact. This thesis uses literature review and interpretive case study methods to investigate the phenomenon of value creation through e-government.

    The research was carried out from 2014 to 2019. Data was collected through interviews, participant observations, and document review. The main research question is "How do we create value through e-government in the context of an LDC?” It embodies the sub-questions: what is the value of e-government? And how do we attain such value?

    This thesis comprises four studies.

    The thesis found that value creation of e-government is a process of understanding: the value that e-government creates; the context in which egovernment resides because a process involves a context; and strategic actions to create that value within the context surrounds e-government.

    From the findings, this thesis argues that the value of public affairs including e-government refers to public value. The latter would mean citizens' collective expectations about public policies and services. Also, the findings reveal research needs about the public value of e-government in the LDCs in Sub-Saharan Africa and on methods of measuring and creating the public value of e-government.

    As original contribution, this thesis suggests a framework of six overarching and overlapping areas of e-government for the public value. The anticipation-reality gaps and their inter-relationships are identified, and five inter-related critical success factors are suggested. Also, the information infrastructure (II) framework, particularly, the notion of the cultivation of the installed-base is suggested as a promising avenue in the management of the public value creation in general, and in an LDC in particular.

    List of papers
    1. The public value of E-Government: A literature review
    Open this publication in new window or tab >>The public value of E-Government: A literature review
    2019 (English)In: Government Information Quarterly, ISSN 0740-624X, E-ISSN 1872-9517, Vol. 36, no 2, p. 167-178Article, review/survey (Refereed) Published
    Abstract [en]

    This study organizes existing research on the public value of e-government in order to investigate the current state and what value e-government is supposed to yield. The two questions that guided the research were: (1) What is the current state of research on the public value of e-government? And (2) What value is e-government supposed to yield? Six, sometimes overlapping, values were found: Improved public services; improved administrative efficiency; Open Government (OG) capabilities; improved ethical behaviour and professionalism; improved trust and confidence in government; and improved social value and well-being. These six public value dimensions were thereafter generalized into three overarching, and also overlapping, public value dimensions of Improved Public Services, Improved Administration, and Improved Social Value. The improved public services dimension influences other dimensions. Hence, this literature study theorizes a descriptive and multidimensional framework that can improve our understanding of the public value of e-government from different viewpoints, and the overlap between them in actual e-government designs and implementations. Regarding the current state of research on the public value this study found a lack of research on the public value of e-government, especially, in the context of developing countries – and more importantly – a total absence of this kind of research in the Least Developed Countries (LDCs). There is also a lack of comparative studies at national, regional, and project level; and a lack of research on the generative perspective.

    Place, publisher, year, edition, pages
    Elsevier, 2019
    Keywords
    E-Government, Public value, IT value, Framework, Literature review
    National Category
    Information Systems, Social aspects
    Research subject
    Informatics
    Identifiers
    urn:nbn:se:oru:diva-73688 (URN)10.1016/j.giq.2019.01.001 (DOI)000467194300001 ()2-s2.0-85061541488 (Scopus ID)
    Available from: 2019-04-12 Created: 2019-04-12 Last updated: 2019-11-11Bibliographically approved
    2. The public value of e-Government: anticipations in the IREMBO project in Rwanda
    Open this publication in new window or tab >>The public value of e-Government: anticipations in the IREMBO project in Rwanda
    (English)Manuscript (preprint) (Other academic)
    National Category
    Information Systems, Social aspects
    Identifiers
    urn:nbn:se:oru:diva-77826 (URN)
    Available from: 2019-11-11 Created: 2019-11-11 Last updated: 2019-11-11Bibliographically approved
    3. E-government in Rwanda: Implementation, Challenges and Reflections
    Open this publication in new window or tab >>E-government in Rwanda: Implementation, Challenges and Reflections
    2018 (English)In: Electronic Journal of e-Government, ISSN 1479-439X, E-ISSN 1479-439X, Vol. 16, no 1, p. 19-31Article in journal (Refereed) Published
    Abstract [en]

    E‑government is currently high on the agenda in many developing countries (DCs). While e‑government is well‑established in many developed countries it is new to least developed countries. Countries that start implementing e‑government today can benefit from easy import of modern technologies, but adaptation to local conditions and the organizational change that is required cannot be imported, but must be developed at home. By using examples of an ongoing initiative by the Government of Rwanda to digitalize all G2C and G2B into a single window platform, the current study investigated the important challenges in the implementation of e‑government in Rwanda. An interpretive case study was followed. Data was collected through interviews and participatory observations during August to December 2015. Data analysis was inductive, the analysis method was content analysis, and the coding followed open‑coding. NVivo software has been used to handle data and facilitate the analysis. The study found six overarching categories of aspects that challenge a successful implementation of e‑government in Rwanda. They include information infrastructure for e‑government, social inclusion, governance, management, trust in the new system, and languages. However, challenges to e‑government implementation should not be taken as of the same extent, neither their degree of mitigation. Rather, they influence and are influenced by various contextual factors which include political support, nature of the e‑government project, implementation strategies, human and socio‑economic development, existing information infrastructure, and operational capabilities. Having said this, we also argue that countries should learn from one another of their experiences, success stories, and mistakes. Despite a number of associated challenges, the adopted public‑private partnership (PPP) approach to e‑Government implementation in Rwanda might indeed seem as a suitable catalyst for e‑government success in the country.

    2.5.0.0

    Place, publisher, year, edition, pages
    UK: Academic Conferences Limited, 2018
    Keywords
    information infrastructure, e-government, implementation, public-private partnership (PPP), least developed countries (LDCs), sub-Saharan Africa, Rwanda
    National Category
    Electrical Engineering, Electronic Engineering, Information Engineering
    Research subject
    Informatics
    Identifiers
    urn:nbn:se:oru:diva-70165 (URN)
    Projects
    E-Government Implementation in Rwanda: the value and context
    Note

    2.5.0.0

    Available from: 2018-11-13 Created: 2018-11-13 Last updated: 2019-11-11Bibliographically approved
    4. Towards Realization of the Public Value of e-Government: anticipation-reality gap and critical success factors in the context of Rwanda
    Open this publication in new window or tab >>Towards Realization of the Public Value of e-Government: anticipation-reality gap and critical success factors in the context of Rwanda
    (English)Manuscript (preprint) (Other academic)
    National Category
    Information Systems, Social aspects
    Identifiers
    urn:nbn:se:oru:diva-77827 (URN)
    Available from: 2019-11-11 Created: 2019-11-11 Last updated: 2019-11-11Bibliographically approved
  • Public defence: 2019-12-05 13:15 Örebro universitet, Forumhuset, Biografen, Örebro
    Mukamurenzi, Solange
    Örebro University, Örebro University School of Business.
    E-Government Service Evaluation in Rwanda: A Design Perspective2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Rwanda has embraced e-government. As the first step of implementation, services are being developed and provided online. As e-government matures over time, due to challenges and opportunities presented by developments in technology, legislation, economy, standards anduser expectations, an important management challenge is to understand future challenges and to be prepared to address them. The present research addresses the problem of moving from e-government service quantity to service quality in Rwanda by using a design science research approach to answer the question: How can e-government service evaluation be improved in Rwanda?

    This thesis provides an integrated view of e-government maturity. The empirical studies explain the challenges facing e-government implementation in Rwanda and involve service providers in investigating e-government service quality. Building on these, an evaluation process redesign is suggested and a prototype of a web-based evaluation approach called Rwanda Online Service Evaluation (ROSE) is developed in order to convey the proposed changes. It is also tested with managers and users in Rwanda. The evaluation process redesign consists of information, social and technology components. The present research contributes to the e-government body of knowledge through study cases of a Least Developed Country (LDC), namely Rwanda. Theoretical contributions include an e-government maturity model and an e-government service development framework, which could also be used in other research. The findings and the developed prototype contribute to practice in terms of evaluating e-government services and may serve as an inspiration for other LDC.

    List of papers
    1. Evaluating eGovernment Evaluation: Trend and Issues
    Open this publication in new window or tab >>Evaluating eGovernment Evaluation: Trend and Issues
    2016 (English)In: Electronic Government and Electronic Participation, Amsterdam: IOS Press, 2016, p. 123-134Conference paper, Published paper (Refereed)
    Abstract [en]

    Evaluating e-government has proven difficult. Reasons include the complex nature of e-government, difficulties in measuring outcomes and impact, and the evolving nature of the phenomenon itself. Practical and effective evaluation methods would be useful to guide the development. To gauge the state of the art in the field, a review of contemporary literature investigated the status of research on e-government evaluation. We found the issues involved to be described by five critical factors: maturity levels, evaluation object, type of indicators, evaluation timing, and stakeholder involvement. The review suggests that there is no best model but rather that e-government evaluation must be situated and take a formative approach to guide the next step. However in doing so there is a need for a clear perspective on where e-government development is going. On this point research is more in agreement, and we provide a model to conceptualize this development.

    Place, publisher, year, edition, pages
    Amsterdam: IOS Press, 2016
    Series
    Innovation and the Public Sector, ISSN 1871-1073 ; 23
    Keywords
    E-government, evaluation, e-government models, evaluation models, literature review
    National Category
    Information Studies Political Science
    Identifiers
    urn:nbn:se:oru:diva-53016 (URN)10.3233/978-1-61499-670-5-123 (DOI)000383380900013 ()978-1-61499-670-5 (ISBN)978-1-61499-669-9 (ISBN)
    Conference
    15th IFIP Electronic Government (EGOV) / 8th Electronic Participation (ePart) Conference, Univ Minho, Guimaraes, Portugal, September 5-8, 2016
    Available from: 2016-10-18 Created: 2016-10-18 Last updated: 2019-11-12Bibliographically approved
    2. Challenges in Implementing Citizen-centric e-Government Services in Rwanda
    Open this publication in new window or tab >>Challenges in Implementing Citizen-centric e-Government Services in Rwanda
    2019 (English)In: Electronic Government, an International Journal, ISSN 1740-7494, E-ISSN 1740-7508, Vol. 15, no 3, p. 283-302Article in journal (Refereed) In press
    Abstract [en]

    Electronic government (e-government) faces challenges impeding its successful implementation. In the least developed countries, where e-government initiatives are developing but little research is done, it is difficult to know how to move forward with the development. As a contribution to increased knowledge, this study identifies e-government challenges in Rwanda. To this end, the study takes an interpretive approach and, from interviews and document analysis, identifies key e-government challenges. Those challenges include lack of a change management strategy, limited cooperation, language and literacy barriers, incomplete automation, difficulties with system integration, and a lack of intermediaries' management mechanisms. This paper analyses the challenges service providers would have to manage for e-government to improve and informs policymakers of the areas that need their attention for Rwanda to evolve towards the desired e-government. The study contributes to the yet scarce literature of e-government in Rwanda.

    Place, publisher, year, edition, pages
    InderScience Publishers, 2019
    Keywords
    challenges, citizen-centric e-government, developing country, digital government, East Africa, electronic government, e-government development, e-government services, Rwanda
    National Category
    Information Systems, Social aspects
    Identifiers
    urn:nbn:se:oru:diva-70148 (URN)10.1504/EG.2019.10016243 (DOI)
    Available from: 2018-11-12 Created: 2018-11-12 Last updated: 2019-11-12Bibliographically approved
    3. Improving qualities of e‐government services in Rwanda: A service provider perspective
    Open this publication in new window or tab >>Improving qualities of e‐government services in Rwanda: A service provider perspective
    2019 (English)In: Electronic Journal of Information Systems in Developing Countries, ISSN 1681-4835, E-ISSN 1681-4835, Vol. 85, no 5, article id e12089Article in journal (Refereed) Published
    Abstract [en]

    E‐government implementation is growing worldwide. In the context of developed countries, as well as some developing ones, research provides tools to evaluate e‐government services and reflect on e‐government performance. However, in the least developed countries (LDCs), where the preconditions are in many ways more challenging, little is known about those services. While information technology can be imported, social, organizational, and infrastructural arrangements conducive to high‐quality service delivery must be developed locally. In contributing to understanding the challenges as well as opportunities involved, this paper explores the qualities of e‐government services in Rwanda, an East African LDC. The investigation focuses on service providers' views of the qualities, as it is only through their understanding of the situation that service quality can be improved. This is a qualitative study based on interviews with employees of government organizations and document analysis. We identify and discuss 28 e‐government service quality factors, which are grouped into nine quality dimensions—accessibility, availability, awareness, responsiveness, information quality, information security, ease of use, support, and cost. This research contributes to raising awareness about the qualities of e‐government services in Rwanda in particular but may also have relevance for other LDCs.

    Place, publisher, year, edition, pages
    John Wiley & Sons, 2019
    Keywords
    East Africa, e‐government service quality, evaluation, least developed country, Rwanda, service provider
    National Category
    Information Systems
    Research subject
    Informatics
    Identifiers
    urn:nbn:se:oru:diva-73680 (URN)10.1002/isd2.12089 (DOI)000486071500006 ()2-s2.0-85063811265 (Scopus ID)
    Available from: 2019-04-12 Created: 2019-04-12 Last updated: 2019-11-13Bibliographically approved
    4. Designing eGovernment Service Evaluation in Rwanda
    Open this publication in new window or tab >>Designing eGovernment Service Evaluation in Rwanda
    (English)Manuscript (preprint) (Other academic)
    National Category
    Information Systems, Social aspects
    Identifiers
    urn:nbn:se:oru:diva-77836 (URN)
    Available from: 2019-11-12 Created: 2019-11-12 Last updated: 2019-11-12Bibliographically approved
  • Public defence: 2019-12-06 09:00 Örebro universitet, Campus USÖ, hörsal C1, Örebro
    Månsson, Emeli
    Örebro University, School of Medical Sciences.
    Molecular epidemiology of Staphylococcus epidermidis in prosthetic joint infections2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Staphylococcus epidermidis is ubiquitous in the human microbiota, but also an important pathogen in healthcare-associated infections, such as prosthetic joint infections (PJIs). In this thesis, aspects of the molecular epidemiology of S. epidermidis in PJIs were investigated with the aim of improving our understanding of the pre- and perioperative measures required to reduce the incidence of S. epidermidis PJIs.

    In Paper I, S. epidermidis retrieved from air sampling in the operating field during arthroplasty was characterized by multilocus sequence typing and antibiotic susceptibility testing. No isolates belonging to sequence types (STs) 2 and 215, previously associated with PJIs, were found in the air of the operating field. During air sampling, several Staphylococcus pettenkoferi isolates were identified, and as a spin-off of Paper I, the genomic relatedness of these isolates to S. pettenkoferi isolates from blood cultures was described in Paper II.

    In Paper III, genetic traits distinguishing S. epidermidis isolated from PJIs were determined using genome-wide association study accounting for population effects after whole-genome sequencing (WGS) of a population- based 10-year collection of S. epidermidis isolates from PJIs and of nasal isolates retrieved from patients scheduled for arthroplasty. Genes associated with antimicrobial agents used for prophylaxis in arthroplasty, i.e., beta-lactam antibiotics, aminoglycosides, and chlorhexidine, were associated with PJI origin. S. epidermidis from PJIs were dominated by the ST2a, ST2b, ST5, and ST215 lineages.

    In Paper IV, selective agar plates were used to investigate colonization with methicillin resistant S. epidermidis (MRSE) in patients scheduled for arthroplasty. MRSE were further characterized by WGS. A subset of patients was found to harbour PJI-associated S. epidermidis lineages in their microbiota before hospitalization, but no isolates belonging to the ST2a lineage nor any rifampicin-resistant isolates were retrieved.

    List of papers
    1. Sequence types of Staphylococcus epidermidis associated with prosthetic joint infections are not present in the laminar airflow during prosthetic joint surgery
    Open this publication in new window or tab >>Sequence types of Staphylococcus epidermidis associated with prosthetic joint infections are not present in the laminar airflow during prosthetic joint surgery
    2015 (English)In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 123, no 7, p. 589-595Article in journal (Refereed) Published
    Abstract [en]

    Molecular characterization of Staphylococcus epidermidis isolates from prosthetic joint infections (PJIs) has demonstrated a predominance of healthcare-associated multi-drug resistant sequence types (ST2 and ST215). How, and when, patients acquire these nosocomial STs is not known. The aim was to investigate if sequence types of S. epidermidis associated with PJIs are found in the air during prosthetic joint surgery. Air sampling was undertaken during 17 hip/knee arthroplasties performed in operating theaters equipped with mobile laminar airflow units in a 500-bed hospital in central Sweden. Species identification was performed using MALDI-TOF MS and 16S rRNA gene analysis. Isolates identified as S. epidermidis were further characterized by MLST and antibiotic susceptibility testing. Seven hundred and thirty-five isolates were available for species identification. Micrococcus spp. (n = 303) and coagulase-negative staphylococci (n = 217) constituted the majority of the isolates. Thirty-two isolates of S. epidermidis were found. S. epidermidis isolates demonstrated a high level of allelic diversity with 18 different sequence types, but neither ST2 nor ST215 was found. Commensals with low pathogenic potential dominated among the airborne microorganisms in the operating field during prosthetic joint surgery. Nosocomial sequence types of S. epidermidis associated with PJIs were not found, and other routes of inoculation are therefore of interest in future studies.

    Place, publisher, year, edition, pages
    Hoboken, USA: Wiley-Blackwell, 2015
    Keywords
    Staphylococcus epidermidis, ST2, ST215, prosthetic joint infections, airborne transmission
    National Category
    Infectious Medicine Immunology in the medical area
    Research subject
    Immunology; Microbiology; Pathology
    Identifiers
    urn:nbn:se:oru:diva-44704 (URN)10.1111/apm.12392 (DOI)000356972400007 ()25951935 (PubMedID)2-s2.0-84932196136 (Scopus ID)
    Note

    Funding Agencies:

    Örebro County Council Research Committee, Örebro Sweden

    Centre for Clinical Research, Västerås

    County Council of Västmanland Research Fund

    Available from: 2015-05-27 Created: 2015-05-27 Last updated: 2019-11-12Bibliographically approved
    2. Genomic relatedness of Staphylococcus pettenkoferi isolates of different origins
    Open this publication in new window or tab >>Genomic relatedness of Staphylococcus pettenkoferi isolates of different origins
    Show others...
    2017 (English)In: Journal of Medical Microbiology, ISSN 0022-2615, E-ISSN 1473-5644, Vol. 66, no 5, p. 601-608Article in journal (Refereed) Published
    Abstract [en]

    Purpose: The aim of the study was to characterize clinical and environmental Staphylococcus pettenkoferi isolates with regard to genomic diversity and antibiotic susceptibility pattern. Repetitive-sequence-based PCR and core genome phylogenetic analysis of whole-genome sequencing (WGS) data verified the presence of distinct clades comprising closely related S. pettenkoferi isolates from different geographical locations and origins.

    Methodology: Phylogenetic relationships between 25 S. pettenkoferi isolates collected from blood cultures and intra-operative air sampling were determined by repetitive-sequence-based PCR typing and analysis of similar to 157 000 SNPs identified in the core genome after WGS. Antibiotic susceptibility testing and tests for biofilm production (microtitre plate assay) were performed.

    Results: Repetitive-sequence-based PCR as well as WGS data demonstrated the close relatedness of clinically significant blood culture isolates to probable contaminants, as well as to environmental isolates. Antibiotic-susceptibility testing demonstrated a low level of antimicrobial resistance. The mecA gene was present in two cefoxitin-resistant isolates. No isolates were found to produce biofilm.

    Conclusion: Close genomic relatedness of S. pettenkoferi isolates from different geographical locations and origins were found within clades, but with substantial genomic difference between the two major clades. The ecological niche of S. pettenkoferi remains unconfirmed, but the presence of S. pettenkoferi in the air of the operating field favours the suggestion of a role in skin flora. Identification of S. pettenkoferi in clinical samples should, in a majority of cases, most likely be regarded as a probable contamination, and its role as a possible pathogen in immunocompromised hosts remains to be clarified.

    Place, publisher, year, edition, pages
    Microbiology Society, 2017
    Keywords
    Staphylococcus pettenkoferi, genotypic relatedness, repetitive-sequence based PCR typing, whole-genome sequencing
    National Category
    Microbiology in the medical area
    Identifiers
    urn:nbn:se:oru:diva-58000 (URN)10.1099/jmm.0.000472 (DOI)000401984900007 ()28530888 (PubMedID)2-s2.0-85019900525 (Scopus ID)
    Note

    Funding Agencies:

    Örebro County Council Research Committee, Örebro, Sweden

    Centre for Clinical Research, Västerås  

    County Council of Västmanland Research Fund 

    Available from: 2017-06-13 Created: 2017-06-13 Last updated: 2019-11-12Bibliographically approved
    3. Genomic traits in Staphylococcus epidermidis associated with prosthetic joint infections
    Open this publication in new window or tab >>Genomic traits in Staphylococcus epidermidis associated with prosthetic joint infections
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    General Practice
    Identifiers
    urn:nbn:se:oru:diva-77834 (URN)
    Available from: 2019-11-12 Created: 2019-11-12 Last updated: 2019-11-12Bibliographically approved
    4. Methicillin resistant Staphylococcus epidermidis lineages in the nasal and skin microbiota of patients scheduled for arthroplasty surgery
    Open this publication in new window or tab >>Methicillin resistant Staphylococcus epidermidis lineages in the nasal and skin microbiota of patients scheduled for arthroplasty surgery
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    General Practice
    Identifiers
    urn:nbn:se:oru:diva-77835 (URN)
    Available from: 2019-11-12 Created: 2019-11-12 Last updated: 2019-11-12Bibliographically approved
  • Public defence: 2019-12-06 13:15 Örebro universitet, Långhuset, Hörsal L1, Örebro
    Grosinger, Jasmin
    Örebro University, School of Science and Technology.
    On Making Robots Proactive2019Doctoral thesis, monograph (Other academic)
    Abstract [en]

    The question addressed in this thesis is: Can we make robots proactive? Proactivity is understood as self-initiated, anticipatory action. This entails the ability to generate own goals and pursue them. Our work is based on the assumption that proactivity makes robots more acceptable in human-inhabited environments. Proactive behavior is opposed to reactive behavior which is merely responding to external events and explicit requests (by the user). We approach the question of how to make robots proactive by first identifying the necessary cognitive capabilities, how they relate and interact. We find that to enable proactive behavior one needs to bridge the gap between context, planning, acting and goal reasoning. We then propose a model of opportunity which formalizes and relates these cognitive capabilities in order to create proactivity. In order to make the model of opportunity computational we introduce a framework called equilibrium maintenance. We show formally and empirically that the framework can make robots act in a proactive way. We can make guarantees about the behavior of a robot acting based on equilibrium maintenance: we prove that given certain assumptions a system employing our framework is kept within desirable states. Equilibrium maintenance is instantiated in different scenarios, both theoretically and in practice by deploying it in a number of systems including both robots and humans. More specifically, we conduct experimental runs in simulation in the domain of robotic disaster management and we implement the framework on a real robot in a domestic environment. The latter is done by integration in different levels, from conceptual examples to closing the loop with a full robotic system. Empirical results confirm that equilibrium maintenance creates proactive behavior and leads to preferable outcomes.

  • Public defence: 2019-12-13 13:00 Örebro universitet, Hörsalen, Musikhögskolan, Örebro
    Ullsten, Alexandra
    Örebro University, School of Music, Theatre and Art.
    Singing, sharing, soothing: Family-centred music therapy during painful procedures in neonatal care2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    To sing is to communicate. The soothing, comforting and emotional regulating properties of a lullaby are well-known cross-culturally and historically. This doctoral thesis addresses neonatal pain management from a novel and groundbreaking perspective, studying the efficacy of live music therapy on infants’ pain responses during venepuncture. New research is needed to advance the non-pharmacological interventions in neonatal pain care, and neonatal music therapy (NICU MT) offers active methods to involve the parents in pain management. The doctoral thesis includes two empirical and two theoretical articles. In paper I, preterm and term infants (n=38) were subjected to venepuncture with and without live lullaby singing, in a randomised order with a crossover design. Parent-preferred lullabies were performed live by a music therapy student and standard care was provided for all infants. The results did not show any significant pain-alleviating effects, however, the live singing was not stressful for the infants.

    In paper II, the microanalysis disclosed that live lullaby singing is a communicative reciprocal intervention that also applies to premature infants during painful procedures. Live lullaby singing is a tool suitable as a means to optimise the homeostatic mechanisms. The results from the theoretical papers III and IV are further developed and synthesised in the thesis into a theoretical strategy; The Nordic NICU MT pain management strategy, featuring the parents and their singing voices as mediators for pain relief. The role of the music therapist in neonatal pain management is as a facilitator and an educator for the parents. Coaching parents to better meet their infant’s attachment needs during a painful procedure may lead to more efficacious interventions. The biopsychosocial parental infant-directed singing is presumably an applicable parent-driven non-pharmacological intervention, which promotes pain relief and attachment formation during painful procedures. Neonatal music therapy is still in its infancy in the Nordic countries, but the societal and healthcare contexts afford important prerequisites to further develop NICU MT as a truly family-centred approach. This doctoral thesis will hopefully contribute to the important interdisciplinary endeavour worldwide of involving and integrating parents in neonatal pain management.

    List of papers
    1. Efficacy of Live Lullaby Singing During Procedural Pain in Preterm and Term Neonates
    Open this publication in new window or tab >>Efficacy of Live Lullaby Singing During Procedural Pain in Preterm and Term Neonates
    Show others...
    2017 (English)In: Music and Medicine, ISSN 1943-8621, Vol. 9, no 2, p. 73-85Article in journal (Refereed) Published
    Abstract [en]

    This clinical trial tested the pain relieving effect of live lullaby singing on behavioral and physiological pain responses during venepuncture in 38 preterm and full term neonates. Acute and repeated pain, as well as the use of analgesic drugs, may have long-term negative impact on infants’ development and future behaviour. This emphasizes the need for complementary approaches to pain management such as music therapy.

    Parent-preferred lullabies were performed live and standard care was provided for all neonates. Behavioral responses with regard to pain were assessed with Premature Infant Pain Profile-Revised (PIPP-R) and Behavioral Indicators of Infant Pain (BIIP). Heart rate, respiratory rate and oxygen saturation were measured each tenth second.

    Although the live lullaby singing did not show a statistically significant effect on the infants’ pain score, there was a significantly calmer breathing pattern in the lullaby intervention versus the control condition in the pre-needle stage, showing a non-significant trend towards higher oxygen saturation levels and calmer heart rate in the lullaby intervention versus the control condition in the pre-needle stage. There were non-significant indications of fewer and shorter skin punctures with lullaby singing. More research is needed to explore such positive trends in the data.

    Place, publisher, year, edition, pages
    PKP Publishing Services, 2017
    Keywords
    newborn infant, preterm infant, pain, music therapy, lullaby
    National Category
    Pediatrics
    Research subject
    Musicology
    Identifiers
    urn:nbn:se:oru:diva-68308 (URN)
    Available from: 2018-07-31 Created: 2018-07-31 Last updated: 2019-11-19Bibliographically approved
    2. Live music therapy with lullaby singing as affective support during painful procedures: a case study with microanalysis
    Open this publication in new window or tab >>Live music therapy with lullaby singing as affective support during painful procedures: a case study with microanalysis
    2017 (English)In: Nordic Journal of Music Therapy, ISSN 0809-8131, Vol. 26, no 2, p. 142-166Article in journal (Refereed) Published
    Abstract [en]

    During the most vulnerable period in a child’s life, preterm and sick infants are exposed to a high number of painful procedures, sometimes without the comfort and affection of their parents. Since repeated pain and frequent use of analgesic drugs may have consequences for the neurological and behaviour-oriented development of the infant, it is vital to identify effective non-pharmacological interventions with regard to procedural pain. This paper reviews the use of live lullaby singing as an adjuvant to the control of premature infant pain. The objectives of this case study were to analyse the live lullaby singing for two premature infants during venipuncture in comparison to standard care only, and the infants’ physiological and affective responses emerging before, during and after this procedure. The empirical data stem from a quantitative clinical study. From this larger study, two premature infants were selected. Through microanalysis, with in-depth analysis of video footage, and pain assessment with Behavioral Indicators of Infant Pain (BIIP), painful standard care procedures with and without live lullaby singing, were analysed. The results show that live lullaby singing with premature infants is a communicative interaction which may optimize the homeostatic mechanisms of the infant during painful procedures. This case study shows the importance of predictability of the affective support, right from the start of the live singing intervention. It is important in a painful context that vocal interactions provide regular and comforting intensity, shape and temporal structures.

    Place, publisher, year, edition, pages
    Oxon, United Kingdom: Routledge, 2017
    Keywords
    Pain management, premature infants, music therapy, infant directed singing, lullaby
    National Category
    Musicology
    Research subject
    Health and Medical Care Research
    Identifiers
    urn:nbn:se:oru:diva-49326 (URN)10.1080/08098131.2015.1131187 (DOI)000394440800004 ()2-s2.0-84988566335 (Scopus ID)
    Note

    Funding Agencies:

    Värmland County Council, Sweden

    Queen Silvia's Jubilee Fund, Sweden

    Karin and Erik Gerdens Foundation, Sweden

    Berit and Carl-Johan Wettergrens Foundation, Sweden

    Available from: 2016-03-13 Created: 2016-03-13 Last updated: 2019-11-19Bibliographically approved
    3. Singing, sharing, soothing: Biopsychosocial rationales for parental infant directed singing in neonatal pain management: A theoretical approach
    Open this publication in new window or tab >>Singing, sharing, soothing: Biopsychosocial rationales for parental infant directed singing in neonatal pain management: A theoretical approach
    2018 (English)In: Music & Science, ISSN 2059-2043, Vol. 1, p. 1-13Article in journal (Refereed) Published
    Abstract [en]

    Infant-directed singing is a medium for parents and infants to communicate in a mutual relationship. Parental infant-directed singing is a multisensory, biopsychosocial communication that applies to ill and vulnerable hospitalised infants. The primary musical features of infant-directed singing are ideal for emotional coordination and sharing between parent and infant without the risk of over-stimulation. In this article, we suggest that parental infant-directed singing is regarded as a nonpharmacological emotion regulation intervention, which may modify the painful experience for both the infant and the parent before, during and after painful procedures in the neonatal intensive care context. Parents have the biopsychosocial resources to alleviate their infant’s pain through infant-directed singing, if they are empowered to do so and coached in this process. A music therapist specialised in neonatal music therapy methods can mentor parents in how to use entrained and attuned live lullaby singing in connection to painful procedures. Pain and the vast amount of painful procedures early in infancy, combined with early parent–infant separation and lack of parental participation in the care of the infant during neonatal intensive care, place arduous strain on the new family’s attachment process and on the infant’s and parents’ mental health, both from a short and long-term perspective. Therefore, we argue with biopsychosocial rationales, that live parental infant-directed singing should be promoted in neonatal pain care worldwide. Consequently, parents should be welcomed round the clock and invited as prescribed pain management for their infant.

    Place, publisher, year, edition, pages
    Sage Publications, 2018
    Keywords
    Affect attunement, biopsychosocial, infant, infant-directed singing, music therapy, pain management, parent, vitality affects
    National Category
    Musicology
    Research subject
    Health and Medical Care Research
    Identifiers
    urn:nbn:se:oru:diva-67535 (URN)10.1177/2059204318780841 (DOI)
    Available from: 2018-06-27 Created: 2018-06-27 Last updated: 2019-11-19Bibliographically approved
    4. Development of family-centred care informing Nordic neonatal music therapy
    Open this publication in new window or tab >>Development of family-centred care informing Nordic neonatal music therapy
    2019 (English)In: Music in paediatric hospitals – Nordic perspectives / [ed] Lars Ole Bonde, Kjersti Johansson, Oslo: CREMAH, Norwegian Academy of Music , 2019, p. 1-25Chapter in book (Refereed)
    Abstract [en]

    Since the 1990s, the concept of family-centred care, where the family and healthcare staff share responsibility for the infant’s hospital care, has been part of an ongoing paradigm shift in neonatal care globally. The public health care system with family-friendly parental leave policies might be one of the reasons that the Nordic countries today are at the forefront of welcoming and including parents and partners in the care of their infant round the clock. When implementing neonatal music therapy (NICU MT) in the context of Nordic health care, music therapy models of practice as well as research ought to be defined and shaped by the family-centred care model, which today is considered best practice. The Nordic context also offers favourable conditions for further developing NICU MT approaches in line with family-centred care. NICU MT was first developed in the USA in the 1980s and the interventions were infantfocused, emphasising the infant’s physical and medical needs, which was the existing care focus in neonatal care at that time. Neonatal music therapy and research in the Nordic countries is still in its infancy. Systematic implementation work was first initiated in Karlstad, Sweden in 2010 and in Akershus and Oslo, Norway in 2017. 

    This essay provides the international music therapy field as well as other professionals in paediatric and neonatal health care an insight into the evolving Nordic approach of NICU MT. The conclusion of this essay is that the familycentred care approach in the Nordic NICUs, combined with the progressive family politics in the Nordic countries with generous parental leave schemes and gender equality in childcare, afford important prerequisites to further develop NICU MT as a truly family-centred approach.

    Place, publisher, year, edition, pages
    Oslo: CREMAH, Norwegian Academy of Music, 2019
    Series
    CREMAH Anthology ; 11
    Keywords
    neonatal music therapy, Nordic perspective, family-centred care, infants, pain management
    National Category
    Musicology
    Research subject
    Musicology
    Identifiers
    urn:nbn:se:oru:diva-77701 (URN)
    Note

    Funding Agency:

    Centre for Clinical Research, Region Värmland, Karlstad, Sweden

    Available from: 2019-11-03 Created: 2019-11-03 Last updated: 2019-11-19Bibliographically approved
    The full text will be freely available from 2019-11-21 14:15
  • Public defence: 2019-12-20 13:00 Örebro universitet, Konsertsalen, Musikhögskolan, Örebro
    Larsson, Christina
    Örebro University, School of Music, Theatre and Art.
    Att lära genom improvisation - en didaktisk studie i grundskolans musikundervisning2019Doctoral thesis, comprehensive summary (Other academic)
  • Public defence: 2020-01-17 09:00 Örebro universitet, Campus USÖ, hörsal C1, Örebro
    Holster, Savanne
    Örebro University, School of Medical Sciences.
    Faecal Microbiota Transfer in Irritable Bowel Syndrome and Collagenous Colitis: Clinical outcomes and host-microbe interactions2020Doctoral thesis, comprehensive summary (Other academic)