To Örebro University

AIM: To develop a method for diagnosing left ventricular (LV) hypertrophy from cardiac perfusion ¹⁵O-water positron emission tomography (PET).

METHODS: We retrospectively pooled data from 139 subjects in four research cohorts. LV remodeling patterns ranged from normal to severe eccentric and concentric hypertrophy. ¹⁵O-water PET scans (n = 197) were performed with three different PET devices. A low-end scanner (66 scans) was used for method development, and remaining scans with newer devices for a blinded evaluation. Dynamic data were converted into parametric images of perfusable tissue fraction for semi-automatic delineation of the LV wall and calculation of LV mass (LVM) and septal wall thickness (WT). LVM and WT from PET were compared to cardiac magnetic resonance (CMR, n = 47) and WT to 2D-echocardiography (2DE, n = 36). PET accuracy was tested using linear regression, Bland-Altman plots, and ROC curves. Observer reproducibility were evaluated using intraclass correlation coefficients.

RESULTS: High correlations were found in the blinded analyses (r ≥ 0.87, P < 0.0001 for all). AUC for detecting increased LVM and WT (> 12 mm and > 15 mm) was ≥ 0.95 (P < 0.0001 for all). Reproducibility was excellent (ICC ≥ 0.93, P < 0.0001).

CONCLUSION: ¹⁵O-water PET might detect LV hypertrophy with high accuracy and precision.

Implantable cardioverter-defibrillator (ICD) treatment has expanded due to its effectiveness. However, there are concerns about complications, and use in the most elderly has been questioned. There is scarce data on qualitative aspects regarding experiences of living with an ICD among patients above the age of 80 years. The aim of this study was to explore octogenarians’ experience, knowledge, and attitude of living with an ICD. We used semi-structured interviews to collect data from 20 patients, aged 80–89 years (90% men). The data were then structured and analysed through deductive thematic analysis network approach using the ATLAS.ti v.8.4 software. The framework of the analysis was based on the Successful Aging Theory. Three main themes emerged regarding the patients’ experiences: Life goes on; Their Health, The Janus-Faced Device; Their attitudes, and Mind the gap; Their knowledge. None of the octogenarians regretted receiving their ICD, instead, they presented with feelings such as gratitude towards the device. However, a lack of knowledge about the devices was expressed, which can be a risk for potential complications, in turn causing suffering and unnecessary concerns. Overall, the ICD did not pose a threat towards successful ageing. It was mainly considered a life-saving device. However, the lack of knowledge might hinder informed choices close to death and contribute to ethical dilemmas when deactivation of the ICD is a reasonable option.

Pharmacists around the world are playing an active role in educating the public about COVID-19. First-year pharmacy students taking a healthcare course at Temple University in Philadelphia were asked to write papers based on the nature of a pharmacist’s contributions during the pandemic. 90% of the essays outlined the importance of community pharmacists, as they are the most accessible healthcare professional, providing immediate social interaction and drug expertise. They help minimize the need for hospital visits, limiting their time in public, therefore reducing their risk of becoming infected. For the pharmacies that have a drive-thru window, over-the-counter medications and other necessities can be sold to decrease the likelihood of transmission. Many students also proposed the opportunity for more leniency in prescribing power. Unless pharmacists are within a collaborative practice agreement, they cannot prescribe even maintenance medication. Due to the pandemic, it has become increasingly hard to reach the doctor or see them in person, as most offices have switched to telehealth. Clinical pharmacists operating out of hospitals have the opportunity to oversee proposed treatment options or experimental drugs, such as remdesivir. Retail pharmacies are emerging as key resources in this pandemic, and it is important that students see this as a vibrant and important form of pharmacy practice.

Sedan demokratins införande har frågan om monarkins avskaffande och övergång till republik aktualiserats regelbundet. Frågan är dock vilken form av republik som önskas mer preciserat. Vilken typ av presidentmakt önskas vid ett införande av republik? Detta kapitel undersöker vilka befogenheter som medborgarna önskar ge en president vid ett införande av republik. Analyserna visar att en stor andel saknar uppfattningar i frågan. Bland de svarande med uppfattningar finns det tre grupper. En grupp som endast vill ge presidenten representativa uppgifter, en annan grupp som också vill ge presidenten möjlighet att lämna förslag till riksdagen, och avslutningsvis en grupp som önskar ge presidenten mer omfattande befogenheter. Analyserna visar också att inställningen till presidentbefogenheter har samband, om än svaga, med inställning till införandet av republik, utbildningsnivå, politiskt intresse, demokratinöjdhet, vänster-höger-position och partisympatier. Sammantaget är det inget i analyserna som tyder på att det parlamentariska statsskicket skulle utmanas vid ett inrättande av republik.

The concept of human-centredness is frequently used within strategies and expectations in the field of digitalisation. But what does it really mean, and what does putting humans at the centre entail? We aim to highlight different perspectives of these questions and reflect on the various components of human-centredness.

What does it mean for the public sector to be human-centric? There are many expectations in this area from international organisations, as well as from Nordic and Baltic countries, where initiatives are underway clearly aimed at achieving a human-centric public sector.

In this report, we reflect on the concept from three different dimensions: governance, public services and innovation. We consider how these dimensions are interconnected and the challenges involved. What role does politics play in promoting human-centric governance? How can and should priorities be set from a human-centric perspective? What are the limits and possibilities for public administration to work in a human-centric way? Our aim is not to provide ready made answers but to encourage questions and discussions – alongside decision makers, practitioners, researchers, and others with an interest in the topic.

This study concerns adult Codas, or hearing children of deaf¹, signing parents. They are of significant interest to language researchers as bimodal bilinguals who grew up in a multifaceted bicultural environment. The study is based on interviews with 12 Coda adults in Sweden (aged 18–50 years). The interviews were translated, transcribed, and coded for thematic analysis. The analysis draws on the theoretical concepts of social identity and investment proposed by Norton (Norton Peirce, B. (1995). Social identity, investment, and language learning. TESOL Quarterly, 1(29), 9–31 https://faculty.educ.ubc.ca/norton/Norton%201995%20p.pdf.). The main findings indicate that for these Codas, the everyday experience of bimodal bilingualism acts as a driving force in the formation of social identities, fostering linguistic, cultural, and social awareness, which, in turn, influences how individuals invest in their languages and cultures.

The chapter examines the process of integrating LegalTech and AI into the activities of the Ukrainian notariat in the context of digital transformation, war and post-war reconstruction. The author proves that the integration of LegalTech and AI into the activities of the Ukrainian notariat does not pose a threat to the traditional role of the notary, but, on the contrary, strengthens its function as a guarantor of legal certainty, authenticity and non-contentious justice. Based on a comparative analysis of the experience of Brazil, Mexico, Canada and Estonia, the author identifies models of electronic notaries that may be relevant to Ukrainian realities. The author also examines legislative initiatives in Ukraine, in particular the draft Law of Ukraine "On Amendments to Certain Legislative Acts of Ukraine on Improving the Regulation of Notarial Activities". The author emphasises the importance of ensuring cybersecurity, preserving notarial secrecy, regulatory definition of the boundaries of responsibility of notaries and technology providers, and the need to improve the digital literacy of notaries. The article emphasises that the Ukrainian experience is unique, since the digitalisation of the notariat sphere is taking place in the context of war, which requires a cautious and adaptive approach to the introduction of innovations to ensure sustainable economic circulation.

In this chapter, by taking the time–credit lag as a starting point, it is possible to analyze how the capitalistic moral economy that spread through the globalization of the cotton industry during the 19th century developed in a unique Swedish context. The argument relies on an illustrative case of a time–credit lag in the production chain that Rydboholm’s factories were a part of, uncovering the specific challenges the company faced when solving this lag, and how different arrangements, such as credit solutions, hierarchical dominance, and coercion, involved different social relations.

Sextortion är en form av korruption och könsbaserat våld. Det innebär att en person missbrukar sin maktposition för att få tillgång till en sexuell tjänst i utbyte mot en tjänst eller förmån som hen har möjlighet att bevilja eller undanhålla i kraft av sin position. Sextortion är en korrupt handling där valutan är sex, och en sexuell handling där utbytet, quid pro quo, medför en form av tvång. Ansvaret för sextortion ligger alltid hos den part som missbrukar sin position (förövaren), och utbytet bidrar till skam, rädsla och osynliggörande genom att offret framställs som ‘medskyldigt’. Sextortion är en kränkning av mänskliga rättigheter och ett missbruk av makt, och måste förstås i relation till de köns- och maktrelationer och -normer som utgör handlingens sammanhang.

This thesis addresses the question: How can a Digital Index Framework (DIF) provide an assessment of digitalisation of core processes in government agencies? It aims to understand how digitalisation can be assessed in the context of public administration and core processes. The research is grounded in the multi-disciplinary field of digital government and applies mixed methods: literature review, design science and case studies. The thesis finds that benchmarking digital government faces recurring criticism regarding how assessments are conducted and what they measure. By examining the design of a DIF, the thesis proposes design principles for assessing digitalisation, focusing on how digital technologies support administrative processes. This includes a process view highlighting interaction with society, internal case handling and data exchange. Examining digitalisation through a DIF highlights core processes and contributes to scholarly discussions on linking public administration with digitalisation. Focusing on core processes, the thesis presents a classification of eight types, which can support both assessing digitalisation and studying phenomena such as artificial intelligence and digital services. The thesis also contains results concerning the influences from the practical implementation of the DIF among practitioners in government agencies. The engagement with the DIF fostered skill development, deeper reflections on cross-government processes and led to policy learning and change.

Concerns about noise-induced hearing loss among young people are increasing as young people frequently engage in music listening for extended periods of time and/or at high sound levels. The aim of this thesis was to investigate associations between music listening and hearing health among young people. Study I is a systematic review investigating associations between hearing function and recreational noise (focus on music exposure) among 10 – 30 year olds. Study II is a qualitative study exploring the meaning of music in the daily life of participant’s (15 – 19 – year – olds) and how young people understand hearing-related risks. Study III is a cross-sectional study examining associations between measured headphone sound pressure levels (SPLs) with hearing thresholds and distortion product otoacoustic emissions (DPOAEs) among 10 – 20 year olds. Study IV is a cross-sectional study investigating how attitudes to noise/loud music and auditory symptoms (tinnitus, sound sensitivity etc.,) relate to hearing-and sound level measurements among 10 – 20 year olds. Study I showed that some previous research has found associations between music exposure with worse extended high-frequency (EHF) thresholds and reduced DPOAEs. However, consistent evidence of long-term effects remains limited, partly due to differing methods of exposure assessment across studies. Study II showed that music is an integral part of the participants’ daily life and valuable for emotional regulation. Despite an awareness of the potential risks, the benefits of music outweighed any concerns about hearing health. Study III showed that older participants (age ≥15 years) had some slightly elevated EHF thresholds and reduced DPOAEs, but no statistically significant associations were found between measured SPLs and hearing outcomes. Study IV showed that more positive attitudes to noise/loud music were significantly associated with higher measured SPLs and longer daily listening durations (self-reported). Most auditory symptoms were not associated with hearing-or sound level measurements, except greater need for auditory recovery, which was associated with reduced DPOAEs. The overall results point to the importance of prevention efforts as potentially risky music listening behaviors may indicate early auditory changes related to noise exposure.

This article aims to identify and shed light on areas of possibility and barriers for teachers who want to take on a critical approach to global justice issues (GJI). Fifteen upper secondary school teachers from four schools in Sweden participated in focus groups and discussions during a workshop on decolonial and critical approaches to teaching GJI to explore possibilities and challenges. Participants understand critical approaches as those that challenge mainstream perspectives and see this as both difficult and necessary. They express that there are plenty of opportunities and support to take such an approach in the existing curriculum but also note school-level challenges such as a crowded curriculum and assessment-focused culture. Participants find it difficult to engage the current generation of students in recognising and interrogating mainstream approaches and also in linking local and global responsibilities and concerns whereby GJIs can feel either “too close” or “too far away.” Yet, these teachers are highly motivated to take up the challenge and innovate their teaching accordingly. The research contributes to understanding the possibilities and potential foreclosures regarding how teachers approach GJIs in their classrooms. Overall, our research highlights the need to support, develop and sustain reflexive approaches.

This thesis explores students’ resistance to environmental and sustainability education (ESE) and how teachers can address resistance in their teaching. The thesis consists of four studies. The first is a study of tensions and resistance expressed on a youth internet forum. The study indicates that “sustainable development” appears economically, culturally, and socially conditioned for young people. The second and third studies are ethnographic and draw on theories of counterculture and resistance. Together, they offer a nuanced understanding of resistance, which is often inventive and meaningful while also carrying limitations. Resistance frequently gives rise to the laff — a liberating laugh that simultaneously entails something profoundly serious. The studies illuminate how students navigate prescribed requirements alongside cultural, social, and material conditions, where resistance may serve as an expression of distancing or feeling alienated by ESE. The students’ resistance exposes cracks in educational practice: environmental and sustainability education seeks to offer critical thinking and action competence, but it may, at the same time, be constrained by normative, social, and material conditions. The fourth study draws on teacher interviews and identifies three didactical strategies to address student resistance. A common aspect of these strategies is that they rely on the teachers’ didactic sensitivity, whereby teachers adopt a non-judgmental and pluralistic stance. The findings suggest that during fragile moments when resistance, meaningful content, and didactic sensitivity come together, the boundaries of pluralism become apparent and open to challenge.

Purpose: The purpose of this study is to identify what factors influence user satisfaction with vocational rehabilitation services among service users in a Swedish context.

Methods: In a randomized control trial, ordinal logistic regression was applied to a dataset of 631 completed questionnaires about the support provided in three different vocational rehabilitation programmes in Sweden—Supported Employment, Case Management and Regular Vocational Rehabilitation.

Results: The factors Person-centeredness, Trust in Support Persons, and Experience that the activities help with getting a job were significant factors of satisfaction among service users. The ordinal logistic regression model explained between 34.3% and 49.9% of the variance in the material, depending on the pseudo R2-measure used.

Conclusions: Service users who experience vocational support as person-centered, experienced trust in their support persons and that vocational rehabilitation activities help with getting a job are more satisfied with the vocational rehabilitation services than are other service users, independent of the vocational rehabilitation models used. Therefore, a person-centered approach is relevant to include in models’ development and service design of vocational rehabilitation.

Introduction: Time management skills are crucial in daily life—at home, to maintain employment, and in parenting—posing a challenge for people with impaired executive functioning. To improve time management skills, individual occupational therapy is commonly offered. The occupational therapy group intervention Let’s Get Organized (LGO) includes ten weekly sessions with a focus on time management skills; it has shown promising results but needs to be further evaluated. Aim: The overall aim of this thesis was to evaluate the time management group intervention LGO for people with ADHD, autism, or mental disorders regarding effectiveness, sustainability over time, and parenting perspectives. Method: LGO was evaluated in four studies with different designs: a multi-center, two-armed, randomized controlled trial including 75 participants who were randomized to LGO or individual occupational therapy (Study I); a single-group one-year follow-up study including 38 participants (Study II); a study including data from the participants in Study I who were parents (n = 28, Study III); and a qualitative interview study with parents after intervention (n = 15, Study IV). To analyze the data, non-parametric tests, a mixed-effects model, correlation testing, and inductive qualitative content analysis were used. Results: Time management skills improved in both groups (LGO and individual occupational therapy) with no difference between them (Study I). Additionally, organization and planning skills and emotional regulation improved after intervention in both groups (Study I). The improved time management skills achieved after LGO were sustained one year after intervention (Study II). Parents improved significantly in parental self-efficacy after time management interventions with no difference betweenthe type of intervention (Study III). Parents experienced more active parenting and better predictability in the whole family after participating in LGO (Study IV). Conclusion: Time management interventions improve time management skills; the improvement is sustained over the long term and moreover has a positive impact on parenting.

This study investigates how older adults in Residential Aged Care (RAC) perceive and navigate their sexuality. Employing a qualitative approach with semi-structured interviews, it examines older adults’ perceptions of sexuality while living in RAC, the barriers they encounter, and the ways they maintain or adapt their sexuality. Data were collected from 15 participants in Swedish RAC facilities. Nine identified as women and six as men, with a mean age of 87.3. The analysis identified three principal themes: The Sexual Script for Older Adults, Co-creating the Script, and Navigating the Script. These themes highlight how older adults articulate their sexuality, respond to institutional norms, and sometimes resist expectations. The findings suggest that sexuality remains a substantial aspect of life for many older adults, even when they face age-related stigma or institutional limitations. This study underscores the need for RAC to better support the sexuality of older adults and advocates for policies that recognize and facilitate their sexual autonomy and well-being.

Purpose: Organizational trust is often professed to be communication-based, yet organizational research rarely provides methodological frameworks exploring how orientations to trust are articulated in communication. This paper therefore aims to help unpack how positions on trust are articulated in qualitative, conversational data in away that can be useful for future qualitative research into organizational trust.

Design/methodology/approach: The study contributes methodologically by introducing an untapped resource, appraisal analysis, and applying it to focus groups evaluating the pandemic response in Scandinavia.

Findings: The analysis suggests that the emphasis of previous research on rational justifications of trust, commonly via assessments of ability, integrity and benevolence, leaves unexplored stances on trust that are taken more straightforwardly with potential effects on power relations. The study draws attention to suchalternative ways of realizing trust/distrust, with the concepts of simple-assertive evaluation and prescriptive evaluation, which still empower (or oppose) organizations and leaders. In addition, the study disentangles some of the “messiness” of qualitative data by demonstrating how stances on organizational trust involve activity-, agent-, and results-centered evaluations, as well as mixed evaluations.

Originality/value: Through the suggested analytical framework, common challenges with qualitative data, involving ambiguities regarding power, agency and overall dilemma-ridden situations, can be dealt with better. It thereby offers methodological fine-tuning that enables a more exhaustive analysis of trust as acommunication-based process. 

BACKGROUND: Understanding the relationship between mental and physical health conditions is crucial for developing comprehensive healthcare strategies. The putative existence of a general disease factor (d-factor) that underlies the vulnerability to both physical and mental conditions could have important implications for our approach to health assessment and treatment.

OBJECTIVE: To investigate the presence and characteristics of a general d-factor in children and adolescents.

METHODS: This Swedish registry-based cross-sectional study included children and adolescents born between 1996 and 2003 with follow-up until 2013. We extracted data on 25 mental and physical health conditions according to the ICD-10 system. To determine the optimal dimensional structure of these conditions, several competing measurement models were tested, including correlated factors, one factor, various bifactor specifications and bifactor exploratory structural equation modelling (ESEM).

FINDINGS: The study cohort included 776 667 individuals (mean age 13.96 years, IQR=11.96-16.04; 51% male). The bifactor ESEM model, including a general d-factor and specific mental and physical health factors, provided the best fit to the data compared to alternative models (Comparative Fit Index=0.971, Tucker-Lewis Index=0.962, root mean square error of approximation=0.007 (0.007-0.007)). The d-factor accounted for substantial variance (ω_h=0.582, explained common variance (ECV)=0.498), while specific mental (ω_hs=0.377, ECV=0.373) and physical (ω_hs=0.423; ECV=0.130) factors also indicated additional significant unique contributions.

CONCLUSIONS: This study provided evidence for a multidimensional structure of health in children and adolescents, characterised by a general d-factor underlying both mental and physical conditions, alongside distinct domain-specific factors. These findings have important implications for clinical practice, providing evidence that suggests the need for more integrated approaches to health assessment and treatment that consider the interconnectedness of mental and physical health.

This chapter examines problematic issues concerning the application of EU law and the law of EU Member States in Ukraine and the law of Ukraine in EU Member States. The full-scale invasion of Ukraine by the Russian Federation has had many unprecedented consequences, including the migration of Ukrainian population to EU countries on an unprecedented scale. From the perspective of private international law, it is a matter of time before such migration will give rise to legal situations with a foreign element within the meaning of private international law, and the relevant rules will need to be applied. In recent years, the number of cases involving a foreign element has increased significantly in the judicial and notarial practice of Ukraine. This raises a number of questions that are classic for private international law: which court/notary has jurisdiction to hear the case? Which law is applicable in a specific situation? How are court decisions and authentic instruments originating in Ukraine or an EU country recognised and enforced? In addition, this chapter examines the existing provisions of Ukrainian law that provide preliminary answers to these questions, EU regulations and the case law of the Court of Justice of the European Union.

Background: The structure and organisation of Swedish municipal healthcare has been criticised for being fragmented and inefficient. Municipal chief nurses hold overall responsibility for patient safety within municipal healthcare, yet they lack authority over finances and staffing. Their role and responsibilities have not been examined in previous studies. The aim of this study was therefore to explore municipal chief nurses' experiences of obstacles and possibilities in decision-making to ensure patient safety in municipal healthcare.

Methods: A qualitative descriptive design was used. Data were collected through 15 individual semi-structured interviews with municipal chief nurses, and the results were analysed via qualitative content analysis.

Results: The data analysis yielded an overall theme: Navigating decision-making to ensure patient safety. This overall theme comprised three underlying categories: Unclear role and understanding of the assignment; Impact of organisational level on decision-making mandate; and Knowledge, competence, and experience in patient safety work.

Conclusion: There was a lack of clarity regarding the municipal chief nurses' assignments in the municipal healthcare organisation. The participants felt that their organisations had insufficient knowledge of healthcare, and it became evident that organisational placement and their own competence affected their decision-making regarding healthcare and patient safety. Some noted that the organisation's shortcomings could be advantageous, providing them with a scope for action. Consequently, the informants had to navigate in the system and find alternative ways to ensure patient safety.

Clinical trial registration: Not applicable.

This thesis aimed to explore the associations between subjective and objective exposures to airborne small particulate matter and its impact on respiratory symptoms, lung function, and respiratory diseases.

The first paper investigated whether Swedish soldiers exposed to desert environments had a higher prevalence of respiratory symptoms. The second paper examined the relationship between airborne particulate matter exposure in Mali and the risk of developing respiratory symptoms, lung function impairment, and airway inflammation, measured as FeNO. The third paper focused on occupational exposure to silica, wood, and paper dust and its associations with respiratory symptoms and lung function. The final paper assessed the effects of traffic and occupational exposure on self-reported respiratory symptoms, asthma, and chronic bronchitis in a multicenter Swedish population. Results indicated that soldiers in desert environments experienced a higher prevalence of wheezing and coughing, with a dose-response relationship showing that longer deployment times correlated with increased symptoms. FEV1 significantly decreased after exposure to desert storms, likely due to small particulate matter. Additionally, exposure to inhalable wood dust was linked to reduced lung function, while traffic and occupational exposures were independently associated with respiratory issues. The findings highlight the need for pollution reduction measures and thorough exposure histories when managing respiratory symptoms amongst patients.

Many individuals with autism suffer from psychiatric comorbidity or experience low life quality, followed by a need for psychological healthcare. However, traditional interventions may not be adapted enough to their needs. Internet-based formats have the potential to increase access to necessary healthcare. Within this project, we developed an internet-based intervention targeting a range of life areas often struggled with by individuals with autism. The overall aim of this thesis is to investigate the feasibility, effectiveness and experiences of - as well as the participants’ communicative patterns in - the internet-based intervention, and to explore the concept sense of coherence in autistic adults. Study I is a longitudinal RCT evaluating the effects of the internet-based intervention in the quality of life and psychiatric symptoms of the participants. Study II is a qualitative interview study exploring the participant experiences of the intervention. Study III is a mixed method study exploring the participant’s communicative behavior during the intervention, and their potential relation to clinical outcomes. Study IV is a cross-sectional study investigating the sense of coherence among autistic individuals and its relation to autistic traits and quality of life.The findings of the four studies that constitute this thesis enhance our understanding of how an internet-based intervention can be adapted, implemented, and evaluated for individuals with autism. Furthermore, they provide insight into communicative behaviors that may be beneficial for participants to engage in during such an intervention, as well as clarify the relationship between autistic traits and sense of coherence in adults with autism.

Microscopic colitis (MC), divided into lymphocytic colitis (LC) and collagenous colitis (CC), is an inflammatory bowel condition with an unknown cause that commonly afflicts older women. Unlike ulcerative colitis (UC) patients, MC patients have a decreased risk of developing colorectal cancer. The adaptive immune response in MC patients was investigated to elucidate the role of CD8+ T cells.

Luminex analyses were performed in patients with MC, UC and controls. Paper I measured immunomodulatory molecules such as immune checkpoints in serum and colonic biopsies. Paper II examined mediators produced by CD8+ T cells in addition to other chemokines and cytokines in colonic biopsies from MC and UC patients.

In paper I, soluble levels of IDO, PD-1, TIM-3, 4-1BB, CD27 and CD80 were decreased in MC compared to controls, whereas IL-2R∝ and 4-1BBL were increased. In biopsies, increased levels of CTLA-4, PD-1, PD-L1, PD-L2, 4-1BB, APRIL, BAFF and IL-2R∝ were detected whereas levels of TIM-3 and CD27 were decreased in MC patients compared to controls.

In paper II, colonic levels of granzyme B and CCL5 were higher in CC than UC, CCL4 and CD163 were increased at similar levels in CC and UC, and MMP-1, MMP-3 and TNF-RII levels were increased in CC and UC compared to controls. MC and UC patients had increased levels of 4-1BB and perforin. Gp130 and IL-6R∝ were decreased in MC compared to controls.

These studies suggest the presence of an active immunological responsein MC involving CD8+ T cells and different disease mechanismsin MC and UC.

Våren 2024 fick handledare vid Örebro universitet och Region Örebro län i uppdrag att skapa en ny högskolepoänggivande kurs i klinisk handledning, som sedan startade under höstterminen 2024. Kursens målgrupp är kliniker inom vårdprofessioner som utbildar studenter på grund- och avancerad nivå vid Örebro universitet, eller utbildar ST-läkare.

Förutom att ge färdigheter och förmågor inom klinisk handledning så syftar kursen också till att stärka deltagarnas interprofessionella handledarskap. Exempel på pedagogiska verktyg som används i syfte att stärka det interprofessionella handledarskapet är:

Lärare från olika professioner samverkar med varandra under varje undervisningsmoment.Lärare från flera vårdprofessioner är representerade.Kursen utnyttjar kliniska erfarenheter inom respektive profession men undervisningen innehåll är generellt för klinisk handledning.Deltagare från olika professioner blandas i grupparbeten och i rummet.Vid bikupor lyfts erfarenheter från olika professioner fram och deltagarna besvarar frågor utifrån respektive profession.En vetenskaplig artikel om interprofessionell handledning inläses som förberedelse, med reflektioner kring hur deltagarna bäst kan samverka interprofessionellt.Den här postern visar hur vi lärare har använt olika verktyg för att lyfta fram visionen om att stärka ett interprofessionellt handledarskap utan att kompromissa med kursens övriga mål. Vi tror att interprofessionella aspekter på handledningsfrågor är särskilt viktiga när kurser ges med deltagare från olika vårdprofessioner och där en del av kursens pedagogik syftar till att reflektera kring och dela med sig av sina egna professionserfarenheter i handledarskapet.

Modern medicine relies on the access to effective antibiotics. They are not only necessary to treat infections but enable the invasive therapies and surgeries to which we are accustomed today. Hence, the significant rise of bacterial resistance towards antibiotics threatens to topple a large part of global health care. This thesis investigates the potential of two antimicrobial peptides (AMPs), namely the bacteriocin Plantaricin NC8 ∝β (PLNC8 ∝β), and a novel synthetic lipopeptide derived from PLNC8 β termed 6-C5-N, for the topical treatment of infected wounds. Through a series of studies, the effectiveness and broad-spectrum activity of both these AMPs in vitro is demonstrated, and their influence on human cells in regard to toxicity, inflammation and survival is evaluated. Both AMPs exhibit low cytotoxicity in vitro and modulate important cytokines and growth factors in relation to infection and wound healing. Furthermore, utilizing ex vivo and in vivo models, it is demonstrated that 6-C5-N is an interesting candidate for the topical treatment of infected wounds. Additionally, a possible explanation of the complex problem with bacterial resistance to AMPs is presented, by demonstrating how extracellular divalent cations can be utilized by gram negative bacteria as protection against positively charged antibacterial peptides. In conclusion, PLNC8 ∝β and its derivative lipopeptide 6-C5-N are promising candidates for topical treatment of infected tissues and could play a role in the struggle against the development of antimicrobial resistance.

Disasters strike worldwide and cause large-scale suffering. However, there is only limited knowledge on how to best prepare disaster responders, and no universal consensus on the core competences that disaster responders need or should be required to have. The aim of this thesis was to understand the competences used and needed by disaster responders.

This thesis is based on four studies: two using a qualitative design with content analysis (Study I) and reflexive thematic analysis (Study IV), one scoping review (Study II) and one cross-sectional study (Study III). The results showed that although disaster responders are a diverse group, the competences they require are based on a combination of technical skills, non-technical skills, previous experience and personal traits. Leadership skills, teamwork skills and communication seem to be the most important skills for disaster responders’ ability to act during a disaster response mission. Another important aspect of disaster response is mental preparedness. Although disaster specific technical skills should form the foundation of disaster training programs, there is a need for a greater focus on non-technical skills. When technical and non-technical skills are combined with desirable personal traits, mental preparedness, and previous experience as well as training tailored for the disaster responders and adequate for the task, this seems to provide the best context for creating competence among disaster responders.