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The overall aim of this research project was to explore and describe the significance of assistive devices in daily life. The project involves two qualitative and two quantitative studies. Three of these studies were from the perspective of persons with stroke and one from the perspective of spouses of persons with stroke. A hermeneutic phenomenological lifeworld approach was used in the qualitative studies and data was obtained through conversational interviews with the two study groups, 22 persons with stroke and 12 spouses of persons with stroke, after the devices had been used for about a year. The results indicated that the lived experiences of assistive devices in respect of the different lifeworld existentials (lived body, lived space, lived time, lived human relation) are closely interconnected in both study groups. The lived body existential included aspects of habits, feelings and the incorporation, figuratively speaking, of the devices into their own bodies. Lived space concerned the gradual development of a new view of the environment and the devices’ role as a prerequisite for being able to live at home. The devices brought about a changed relation to lived time with respect to the temporal perspectives of past, present and future. To be able to take control of one’s own time was an important experience that the devices facilitated. Assistive devices were an integral part of the lived human relation between the couples in the study groups, as well as between the disabled persons/spouses and other people, including the health-care professionals. The devices contributed either to the maintenance or the change of social roles, but they sometimes also gave rise to the experience of being stigmatised. The results in the case of both study groups showed that the use of different devices is complex and often contradictory, especially when it comes to persons with stroke. Overall the persons’ experiences of the advantages of the devices overshadowed their experiences of the disadvantages. The quantitative studies included a pre- and post-assessment design. Thirty-two persons with disabilities after stroke were included. The impact of an outdoor powered wheelchair on activity and participation (IPPA, WHODAS II) and quality of life (PIADS, EQ-5D) was measured. Statistical analysis with mainly non-parametric tests was used to determine significant within-group and between-group changes after intervention. The conceptual framework ICF was used in one of the quantitative studies when classifying the participants’ stated problems. The results showed that the outdoor powered wheelchair is an essential device for persons with disabilities after stroke with regard to overcoming activity limitation and participation restrictions in everyday life. Furthermore it mostly has a positive impact on such users’ quality of life. However, it is also important to highlight the negative experiences of a few with regard to the use of powered wheelchairs. In sum, these results will enable prescribers to better understand the individual experiences of using assistive devices and the individuals’ and the families’ need for support in connection with the prescription of assistive devices, the particular example being powered wheelchairs.

Multiple proxies derived from the Lake Loitsana sediment sequence (NE Finland) are employed to determine the timing of deglaciation, characterise an early Holocene proglacial lake stage and reconstruct Holocene lake development. Local-scale processes causing shifts in biological assemblages are identified and the most likely Holocene mean July air temperature (Tjul) development is assessed. The study area was deglaciated shortly prior to 10 700 cal. a BP. The sediment record reflects four local events; the presence of a glacial lake, glacial lake drainage and formation of Lake Loitsana, changes in fluvial input due to progressive wetland expansion, and gradual lake infilling. The results suggest that local events have driven changes in biological assemblages through various processes, and that biotic proxies reflect changes in environmental parameters in a highly individual manner. Furthermore, biological assemblages can themselves act as important drivers, influencing the composition of other assemblages. It is suggested that future studies should consider macrophyte abundance and food-web interactions as equally important factors when assessing changes in biological assemblages. Quantitative Tjul reconstructions based on biotic proxies display contrasting trends. While Tjul reconstructions based on pollen found in the Loitsana sequence display relatively low early Holocene values, plant macrofossil and chironomid data reflect warm summer conditions also during the early Holocene, i.e. at the peak of summer insolation. The early Holocene Tjul recorded by terrestrial pollen are affected by local factors possibly combined with a delayed response of the terrestrial ecosystem compared to the aquatic one. This study emphasises the importance of using multiple proxies in palaeoenvironmental studies and shows that local factors have a potential to drive changes in biological assemblages that can affect transfer-function based temperature reconstructions. / <p>At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 1: Epub ahead of print. Paper 2: Accepted. Paper 3: Manuscript.</p>

Pour respecter les droits d'auteur, la version électronique de cette thèse a été dépouillée de certains documents visuels. La version intégrale de la thèse a été déposée à la Division de la gestion des documents et des archives. / Au cours de son histoire, la salle de cinéma s’est érigée à partir d’une politique d’épuration sensorielle, elle-même héritée d’une longue tradition, faisant de l’expérience spectatorielle cinématographique une expérience de contemplation purement audiovisuelle. Cependant, lorsqu’elle traverse une période de crise, tant économique qu’intermédiale, la salle de cinéma renoue avec un modèle attractionnel, polysensoriel et plus particulièrement tactile, lié au cinéma des origines et à ses premiers lieux de diffusion, mais réprimé lors de l’institutionnalisation du média et de sa stabilisation dans la salle consacrée. Aux États-Unis, c’est notamment le cas autour de 1930, au moment de l’arrivée du cinéma parlant et de la Grande Dépression, de même qu’au cours des années 1950, alors qu’une importante compétition intermédiale liée à l’arrivée de la télévision et couplée à des changements démographiques majeurs affecte les exploitants de salles. C’est de nouveau le cas depuis les années 2000, la déferlante numérique et les possibilités de visionnement à domicile arrachant de plus en plus de spectateurs aux salles. Cette thèse propose l’examen approfondi d’une période et d’un cas exemplaires. Elle analyse précisément le moment où les salles américaines connaissent une baisse de fréquentation majeure au cours des années 1950. Pendant cette période apparaissent plusieurs technologies audiovisuelles, mais également de nombreux gimmicks polysensoriels. Or, ces derniers ne sont qu’une version radicale et matérialisée d’idéaux attractionnels portés par les producteurs et l’industrie cinématographique de l’époque aux États-Unis, ce que démontre l’étude du gimmick tactile Percepto, développé en 1959 par le cinéaste William Castle pour accompagner son film The Tingler. Bien au-delà du simple gadget promotionnel, le dispositif Percepto fait vibrer les sièges et hurler les spectateurs, les sollicitant par une sensation physique directe censée prolonger l’univers du film à même la salle de cinéma. Cette expérience cinématographique singulière valorise en outre le caractère à la fois collectif et participatif du visionnement en salle. À la jonction de plusieurs champs théoriques, soit l’histoire culturelle des sens, l’archéologie des médias et les études de diffusion, cette thèse cherche à mettre au jour le rôle majeur des sens pourtant dits « mineurs », notamment celui du toucher, dans l’histoire de la salle de cinéma américaine, et à resituer la tactilité dans les origines attractionnelles du cinéma, en démontrant de quelle manière le corps du spectateur est, par le biais de stratégies polysensorielles, de nouveau inclus dans l’expérience du cinéma, alors qu’il en est traditionnellement exclu. Par ailleurs, elle vise à réinscrire les gimmicks au sein de l’historiographie du cinéma en général et de celle des salles en particulier, tout en faisant découvrir un dispositif cinématographique tactile jusqu’ici généralement méconnu et oublié par la recherche savante : Percepto. Pour ce faire, la thèse s’appuie sur plusieurs sources de première main et propose l’analyse des éléments suivants : le film The Tingler, le fonctionnement du gimmick, les publicités produites autour du dispositif, son apparition en salles, ainsi que sa réception critique et populaire. / Throughout its history, the movie theater has emerged from politics of sensory purification inherited from a long tradition, making the cinematographic spectatorial experience one of a purely audiovisual contemplation. When going through a period of crisis, be it economic or intermedial, the movie theater reconnects with an attractional, multi-sensory and mainly tactile model linked to the origins of cinema and to its first exhibition spaces, but repressed at the time of the institutionalization of the media and its stabilization in the dedicated theater. In the United States, this is notably the case around 1930 with the arrival of talking pictures and the Great Depression, as well as during the 1950s when significant intermedial competition resulting from the advent of television, coupled with major demographic shifts, affects theater exhibition. This has also been the case since the early 2000s, when the digital surge and the possibilities of home viewing have torn more and more spectators away from theaters. This thesis offers an in-depth examination of an exemplary period and case. It analyzes precisely when American theaters experienced a major drop in attendance during the 1950s. During this period, several audiovisual technologies appeared, along with many multi-sensory gimmicks. However, the latter are only a radical and materialized version of ideals of attractions carried by the producers and the film industry of the time in the United States, as demonstrated by the study of the Percepto tactile gimmick, developed in 1959 by filmmaker William Castle to complement his film The Tingler. Far beyond a simple promotional gadget, the Percepto device makes the seats vibrate and the audience scream, addressing the spectators with a direct physical sensation supposed to extend the fictional world of the film right into the theater. This unique cinematographic experience also underlines both the collective and participatory qualities of theatrical viewing. At the junction of several theoretical fields, namely the cultural history of the senses, media archeology and exhibition studies, this thesis seeks to bring to light the major role of the so-called “minor” senses, in particular that of the touch, in the history of the American cinema, and to restore tactility in relation to the attractional origins of cinema, by demonstrating how the spectator's body is, through multisensory strategies, included again in the experience of cinema although it is traditionally excluded. In addition, it aims to re-establish gimmicks within the historiography of cinema as a whole and that of movie theaters in particular while revealing a tactile cinematographic device largely unknown and forgotten by scholarly research to this day: Percepto. To achieve this, the thesis offers the analysis of the following aspects, based on several primary sources: the film The Tingler, the functioning of the gimmick, the advertisements produced around the device, its theatrical release and exploitation as well as its critical and popular reception.

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During recent decades, lumbar spinal stenosis (LSS) has become the most common indication for spine surgery, a change that coincides with a higher worldwide prevalence of overweight and obesity. Thus, surgical treatment of LSS in the overweight and obese population is common and increasing in scope. The overall aim of this thesis was to investigate whether body mass index (BMI) is related to the development of LSS, and whether BMI is linked to outcome after surgery for LSS. We further evaluated whether there are specific experiences of LSS from a patient perspective. Data were obtained for all patients registered in the Swedish Spine Register who had undergone surgery for LSS between January 1, 2006 and June 30, 2008. After adjusting for differences in baseline characteristics, patients with obesity showed both poorer results after surgery and a higher rate of dissatisfaction than patients with normal weight (odds ratio 1.73; 95% confidence interval, CI, 1.36-2.19). Furthermore, patients with obesity in the cohort reported modest weight loss at follow-up (2.0 kg; 95% CI, 1.5-2.4), and only 8% reported a clinical important weight loss 2 years after surgery. Our analysis of 389,132 construction workers, showed that overweight (incidence rate ratio, IRR 1.68; 95% CI, 1.54-1.83) and obesity (IRR 2.18; 95% CI, 1.87-2.53) were associated with an increased future risk in developing LSS when compared with patients with normal weight. To gain insight into the patients' perspective of LSS, we performed interviews with 18 patients who were on a waiting list for LSS surgery. The transcripts, analyzed with content analysis, revealed that living with LSS is a physical, mental and social challenge in which resources to cope with the condition are of major importance. In summary, obesity is associated with poorer results after surgery, and patients with obesity report modest weight loss during follow-up. In addition, obesity is associated with an increased risk to develop LSS. Our findings revealed that being a patient with LSS, naturally involves considerable suffering and pain, but it also implies being a person with his or her own resources who is able to cope with these adverse conditions.

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Background InVietnam, the proportion of people aged 60 and above has increased rapidly in recent decades. The majority live in rural areas where socioeconomic status is more disadvantaged than in urban areas.Vietnam’s economic status is improving but disparities in income and living conditions are widening between groups and regions. A consistent and emerging danger of communicable diseases and an increase of non-communicable diseases exist concurrently. The emigration of young people and the impact of other socioeconomic changes leave more elderly on their own and with less family support. Introduction of user fees and development of a private sector improve the coverage and quality of health care but increase household health expenditures and inequalities in health care. Life expectancy at birth has increased, but not much is known about changes during old age. There is a lack of evidence, particularly in rural settings, about health-related quality of life (HRQoL) among older people within the context of socioeconomic changes and health-sector reform. Knowledge of long-term elderly care needs in the community and the relevant models are still limited. To provide evidence for developing new policies and models of care, this thesis aimed to assess general health status, health care needs, and perspectives on future health care options for community-dwelling older people. Methods An abridged life table was used to estimate cohort life expectancies at old age from longitudinal data collected by FilaBavi DSS during 1999-2006. This covered 7,668 people aged 60 and above with 43,272 person-years. A 2007 cross-sectional survey was conducted among people aged 60 and over living in 2,240 households that were randomly selected from the FilaBavi DSS. Interviews used a structured questionnaire to assess HRQoL, daily care needs, and willingness to use and to pay for models of care. Participant and household socioeconomic characteristics were extracted from the 2007 DSS re-census. Differences in life expectancy are examined by socioeconomic factors. The EQ-5D index is calculated based on the time trade-off tariff. Distributions of study subjects by study variables are described with 95% confidence intervals. Multivariate analyses are performed to identify socioeconomic determinants of HRQoL, need of support, ADL index, and willingness to use and pay for models of care. In addition, four focus group discussions with the elderly, their household members, and community association representatives were conducted to explore perspectives on the use of services by applying content analysis. Results Life expectancy at age 60 increased by approximately one year from 1999-2002 to 2003-2006, but tended to decrease in the most vulnerable groups. There is a wide gap in life expectancy by poverty status and living arrangement. The sex gap in life expectancy is consistent across all socioeconomic groups and is wider among the more disadvantaged populations.  The EQ-5D index at old age is 0.876. Younger age groups, position as household head, working, literacy, and belonging to better wealth quintiles are determinants of higher HRQoL. Ageing has a primary influence on HRQoL that is mainly due to reduction in physical (rather than mental) functions. Being a household head and working at old age are advantageous for attaining better HRQoL in physical rather than psychological terms. Economic conditions affect HRQoL through sensory rather than physical functions. Long-term living conditions are more likely to affect HRQoL than short-term economic conditions. Dependence in instrumental or intellectual activities of daily living (ADLs) is more common than in basic ADLs. People who need complete help are fewer than those who need some help in almost all ADLs. Over two-fifths of people who needed help received enough support in all ADL dimensions. Children and grand-children are confirmed to be the main caregivers. Presence of chronic illness, age groups, sex, educational level, marital status, household membership, working status, household size, living arrangement, residential area, household wealth, and poverty status are determinants of the need for care. Use of mobile teams is the most requested service; the fewest respondents intend to use a nursing centre. Households expect to use services for their elderly to a greater extent than did the elderly themselves. Willingness to use services decreases when potential fees increase. The proportion of respondents who require free services is 2 to 3 times higher than those willing to pay full cost. Households are willing to pay more for day care and nursing centres than are the elderly. The elderly are more willing to pay for mobile teams than are their households. ADL index, age group, sex, literacy, marital status, living arrangement, head of household status, living area, working status, poverty and household wealth are factors related to willingness to use services.   Conclusions                                                                                         There is a trend of increasing life expectancy at older ages in ruralVietnam. Inequalities in life expectancy exist between socioeconomic groups. HRQoL at old age is at a high level, but varies substantially according to socioeconomic factors. An unmet need of daily care for older people remains. Family is the main source of support for care. Need for care is in more demand among disadvantaged groups.  Development of a social network for community-based long-term elderly care is needed. The network should focus on instrumental and intellectual ADLs rather than basic ADLs. Home-based care is more essential than institutionalized care. Community-based elderly care will be used and partly paid for if it is provided by the government or associations. The determinants of elderly health and care needs should be addressed by appropriate social and health policies with greater targeting of the poorest and most disadvantaged groups. Building capacity for health professionals and informal caregivers, as well as support for the most vulnerable elderly groups, is essential for providing and assessing the services. / Aging and Living Conditions Program / Vietnam-Sweden Collaborative Program in Health, SIDA/Sarec