<p>Enthusiasm for uvulopalatopharyngoplasty (UPPP) in the treatment of mild-to-moderate obstructive sleep apnea syndrome (OSAS) has declined in recent years, partly because of a lower success rate over time and partly because of adverse effects. In more severe cases, the patients are generally treated with nasal continuous positive airway pressure (CPAP). However, many patients do not satisfactorily tolerate CPAP as a result of frequent side-effects. Consequently, there is a need for an alternative treatment. Reports on the beneficial effects of mandibular advancement appliances in the treatment of mild-to-moderate OSA exist in the form of short–term evaluations.</p><p>One of the aims of the present thesis was to compare treatment effects with a mandibular advancement appliance and UPPP in patients with OSA with follow-up after one and four years. Ninety-five male patients with confirmed mild-to-moderate OSA (apnea index, AI >5 and <25) were randomised to treatment with a dental appliance or UPPP. Sleep studies were performed before and one and four years after intervention. According to the criteria for normalisation (AI<5 and apnea hypopnea index, AHI<10), 78% of the patients in the dental appliance group and 51% of the patients in the UPPP group had normalised after one year (p<0.05). Still after four years of treatment, 63% of the patients in the dental appliance group and 33% of the patients in the UPPP group were normalised. The dental appliance group had a higher normalisation rate than the UPPP group, but the efficacy was partly invalidated by the compliance rate of 62%.</p><p>Quality of life assessments in the dimensions of vitality, contentment and sleep improved in both groups at the one-year follow-up after treatment. There was no difference between the groups in terms of vitality and sleep. The UPPP group, however, reported a higher degree of contentment than the dental appliance group, even though the somnographic values were superior in the latter group. </p><p>Another aim was to conduct a randomised study to test the hypothesis that severe OSA patients will benefit from more pronounced mandibular advancement (MA) compared with a shorter advancement. Eighty-six males with severe OSA (AI>20) were randomly allocated to either 75% or 50% MA for a six-month treatment period. Treatment with a more pronounced mandibular advancement yielded a 20% higher normalisation rate than a shorter advancement. A mean normalisation rate of 45% was found for patients in this category with few side-effects, good patient satisfaction and a compliance of 92% after 6 months. </p><p>The overall conclusion is that dental appliance treatment is effective in patients with mild to moderate OSA and even for patients with severe OSA. The efficacy in terms of normalisation in patients with mild to moderate OSA was higher after the dental appliance treatment with a 50% degree of advancement than after the UPPP treatment. However, severe OSA patients might benefit from more pronounced advancement (75%) compared with a shorter degree of advancement (50%). QOL improved significantly after both dental appliance and UPPP treatment. </p>

Enthusiasm for uvulopalatopharyngoplasty (UPPP) in the treatment of mild-to-moderate obstructive sleep apnea syndrome (OSAS) has declined in recent years, partly because of a lower success rate over time and partly because of adverse effects. In more severe cases, the patients are generally treated with nasal continuous positive airway pressure (CPAP). However, many patients do not satisfactorily tolerate CPAP as a result of frequent side-effects. Consequently, there is a need for an alternative treatment. Reports on the beneficial effects of mandibular advancement appliances in the treatment of mild-to-moderate OSA exist in the form of short–term evaluations. One of the aims of the present thesis was to compare treatment effects with a mandibular advancement appliance and UPPP in patients with OSA with follow-up after one and four years. Ninety-five male patients with confirmed mild-to-moderate OSA (apnea index, AI &gt;5 and &lt;25) were randomised to treatment with a dental appliance or UPPP. Sleep studies were performed before and one and four years after intervention. According to the criteria for normalisation (AI&lt;5 and apnea hypopnea index, AHI&lt;10), 78% of the patients in the dental appliance group and 51% of the patients in the UPPP group had normalised after one year (p&lt;0.05). Still after four years of treatment, 63% of the patients in the dental appliance group and 33% of the patients in the UPPP group were normalised. The dental appliance group had a higher normalisation rate than the UPPP group, but the efficacy was partly invalidated by the compliance rate of 62%. Quality of life assessments in the dimensions of vitality, contentment and sleep improved in both groups at the one-year follow-up after treatment. There was no difference between the groups in terms of vitality and sleep. The UPPP group, however, reported a higher degree of contentment than the dental appliance group, even though the somnographic values were superior in the latter group. Another aim was to conduct a randomised study to test the hypothesis that severe OSA patients will benefit from more pronounced mandibular advancement (MA) compared with a shorter advancement. Eighty-six males with severe OSA (AI&gt;20) were randomly allocated to either 75% or 50% MA for a six-month treatment period. Treatment with a more pronounced mandibular advancement yielded a 20% higher normalisation rate than a shorter advancement. A mean normalisation rate of 45% was found for patients in this category with few side-effects, good patient satisfaction and a compliance of 92% after 6 months. The overall conclusion is that dental appliance treatment is effective in patients with mild to moderate OSA and even for patients with severe OSA. The efficacy in terms of normalisation in patients with mild to moderate OSA was higher after the dental appliance treatment with a 50% degree of advancement than after the UPPP treatment. However, severe OSA patients might benefit from more pronounced advancement (75%) compared with a shorter degree of advancement (50%). QOL improved significantly after both dental appliance and UPPP treatment.

Fear is an innate emotion and an adaptive response to provide protection from potential harm. When fear is excessive and out of proportion in relation to the confronted situation, it can lead to the development of an anxiety disorder. Many individuals feel anxious at some point, but not all experience clinical anxiety or meet the diagnostic criteria of an anxiety disorder. Still, anxiety disorders are the most prevalent form of psychiatric disorder in the general population. More often than not people suffering from one anxiety disorder also present other psychiatric conditions. As of today, cognitive and behavioural treatments have been tested and found to positively affect anxiety disorders, making them the treatment of choice. Nevertheless, many patients do not seek or receive adequate treatment. One common critique of the research trials from which the recommendations for treatments stem is the use of a single protocol targeting only one diagnosis. This is because many people suffer from comorbidities. Another problem connected to the recommendation that cognitive behavioural therapy (CBT) should be the treatment of choice for anxiety disorders is the lack of therapists with adequate training. One possible way of dealing both with the shortcoming of therapists and making CBT more accessible is the use of the Internet. Internet-based CBT (ICBT) has been tested in numerous trials during the last 15 years, showing positive outcomes for a large variety of disorders. Many ICBT trials also make use of a single protocol. Another way of dealing with comorbidities might be to tailor the treatment to let characteristics and preferences of the patient guide the design of the protocol. Little is known about possible effects of tailoring the ICBT, the effects of therapeutic relationships in ICBT, and the effectiveness and cost-effectiveness of these treatments. This thesis is based on three studies on two separate randomized controlled trials (RCTs) using the same set of modules accessible for the tailored protocol. Study I was an RCT investigating treatment effects up to two-year after completion, showing favourable outcomes of the treatment in a self-recruited sample at all measure points. Study II was a secondary analysis exploring possible relations between working alliance and treatment outcome for participants in the treatment group recruited for Study I indicating that working alliance predict outcome in this tailored treatment. The second RCT was an effectiveness trial (Study III) analysing treatment effects and cost-effectiveness of the treatment up to one year post treatment in a primary-care population. This study showed positive treatment effects both regarding symptom reduction and cost-effectiveness, and that effects were sustained at one year post treatment. Conclusions drawn from these studies are that individually tailored ICBT seems to be a feasible approach for patients with anxiety disorders regardless of comorbidities, and a responsible choice in terms of societal costs. / Rädsla är en medfödd känsla och en adaptiv respons för att skydda organismen från potentiell skada. När rädslan blir överdriven och oproportionerlig i relation till den konfronterade situationen, kan det leda till utvecklandet av ångestsyndrom. Många personer upplever någon gång ångest, men inte alla upplever klinisk ångest eller uppfyller de diagnostiska kriterierna för något ångestsyndrom. Trots detta är ångest det vanligaste psykiatriska tillståndet i befolkningen i stort och oftast uppfyller personer som lider av ett ångestsyndrom även andra  psykiatriska tillstånd. Till dags dato har både kognitiva och beteendeinriktade behandlingar testats och visat sig verksamma vid ångestproblem, vilket gjort dem till de behandlingar som rekommenderas för dessa tillstånd. Trots god effekt av behandling söker många patienter ändå inte hjälp, alternativt erhåller inte adekvat behandling. En vanlig kritik mot den forskning från vilka behandlingsrekommendationerna för ångestsyndrom stammar är att många använt en manual eller ett protokoll som riktar sig mot bara en diagnos. Detta på grund av den stora komorbiditeten. Ett annat problem kopplat till rekommendationerna att kognitiv beteendeterapi (KBT) ska vara förstahandsval vid behandling av ångest är bristen på behandlare med adekvat utbildning. Ett möjligt sätt att göra KBT mer tillgängligt är att använda Internet. Internet- förmedlad KBT (IKBT) har prövats i ett stort antal studier de senaste 15 åren dessa har visat positiva resultat vid ett stort antal psykiatriska tillstånd. Flertalet av dessa studier har dock använt ett enda behandlingsprotokoll. En annan möjlighet att hantera komorbiditet kan vara att skräddarsy behandlingen för att låta patientens egenskaper och preferenser vara med och styra utformningen av behandlingsprotokollet. Möjliga effekter av att skräddarsy IKBT är relativt lite undersökt, likaså effekterna av terapeutiska relationer i IKBT samt klinisk effektivitet och kostnadseffektiviteten för dessa behandlingar. Denna avhandling bygger på tre studier från två randomiserade kontrollerade studier med samma uppsättning av moduler tillgängliga för att skräddarsy behandlingsprotokollen. I Studie I undersöktes behandlingseffekter upp till två år efter avslutad behandling i en självrekryterad grupp patienter. Studie II var en sekundäranalys av behandlingsgruppen från Studie I där eventuella samband mellan arbetsallians och behandlingsresultat undersöktes. Den andra randomiserade kontrollerade studien var en prövning av huruvida denna behandling var effektiv för en klinisk population (Studie III) rekryterad via primärvården. Förutom behandlingseffekter undersöktes även kostnadseffektiviteten upp till ett år efter behandlingsavslut. De slutsatser som dras utifrån dessa studier är att skräddarsydd IKBT verkar vara en framkomlig väg för patienter med ångest oavsett komorbiditet, att arbetsalliansen kan vara en faktor som påverkar utfallet, samt att det är ett ansvarsfullt val vad gäller samhälleliga kostnader.

Les sources transitoires sont souvent associées aux phénomènes les plus violents de l’Univers, où l’accélération de hadrons peut avoir lieu. Parmi ces sources, les sursauts gamma, les noyaux actifs de galaxie ou encore les supernovae à effondrement de coeur sont des candidats prometteurs pour la production de rayons cosmiques et de neutrinos de haute énergie. Le télescope ANTARES, situé au fond de la Méditerranée, a pour but de détecter ces neutrinos, qui pourraient révéler la présence d’une source de rayons cosmiques. Cependant, pour augmenter la sensibilité aux sources transitoires, une méthode basée sur le suivi multi-longueur d’onde d’alertes neutrino a été développée au sein de la collaboration ANTARES. Ce programme, TAToO, permet de déclencher un réseau de télescopes optiques et l’instrument XRT du satellite Swift seulement quelques secondes après la détection d’un neutrino par ANTARES. Les télescopes commencent un programme d’observation de la région du ciel correspondante pour tenter de détecter une contrepartie optique ou X à l’évènement neutrino. Les travaux présentés dans cette thèse portent sur le développement et la mise en place d’un programme d’analyse d’images optiques, ainsi que sur l’analyse de données optiques et X obtenues lors des observations par les différents télescopes, pour identifier des sources transitoires rapides, telles que les émissions rémanentes de sursauts gamma, ou lentes, telles que les supernovae à effondrement de coeur. / Transient sources are often associated with the most violent phenomena in the Universe, where the acceleration of hadrons may occur. Such sources include gamma-ray bursts (GRBs), active galactic nuclei (AGN) or core-collapse supernovae (CCSNe), and are promising candidates for the production of high energy cosmic rays and neutrinos. The ANTARES telescope, located in the Mediterranean sea, aims at detecting these high energy neutrinos, which could reveal the presence of a cosmic ray accelerator. However, to enhance the sensitivity to transient sources, a method based on multi-wavelength follow-up of neutrino alerts has been developed within the ANTARES collaboration. This program, denoted as TAToO, triggers a network of robotic optical telescopes and the Swift-XRT with a delay of only few seconds after a neutrino detection. The telescopes start an observation program of the corresponding region of the sky in order to detect a possible electromagnetic counterpart to the neutrino event. The works presented in this thesis cover the development and implementation of an optical image analysis pipeline, as well as the analysis of optical and X-ray data to search for fast transient sources, such as GRB afterglows, and slowly varying transient sources, such as CCSNe.

Background: Prophylactic mastectomies in carriers of mutations in BRCA1 or BRCA2 are becoming increasingly more accepted. We investigated the outcome after prophylactic mastectomy, especially regarding satisfaction with the procedure, in a monocenter study. Methods: BRCA1/2 mutation carriers and non-carriers with elevated pedigree-based cancer risk were followed prospectively in a structured surveillance program between 2000 and 2017. A retrospective telephone survey was conducted among all patients with documented prophylactic mastectomy. Complications and satisfaction with the decision for prophylactic mastectomy were recorded. Results: 39 patients who opted for a prophylactic mastectomy (38 BRCA1/2 mutation carriers and 1 noncarrier) were interviewed. Mostly nipple-sparing mastectomy with reconstruction was performed (87%). Half of the patients (22/39; 56.4%) had a history of unilateral breast cancer. The median time since prophylactic mastectomy was 5.6 years. While 61.5% did not report any complications, flap loss was seen in 15% (3/20) and moderate limitations in everyday life were present in 20% (7/35). An improvement in quality of life was noticed by 82% after prophylactic mastectomy and no patient expressed regret with regard to the decision. Conclusions: Prophylactic mastectomy is a procedure with risk for long-term complications in some cases. Our results confirm high satisfaction with the decision and improved quality of life.

After repeated criticism of the social services about how they manage family care, the National Board of Health and Welfare decided to solve the problem by importing a model used in England (Integrated children's system). This was translated into Swedish conditions and named BBIC (Barns behov i centrum = Child’s needs at the center). Our study aims to investigate whether BBIC will contribute to more and more extensive follow-ups of children placed than before, with a focus on the child's best. This has been studied through qualitative interviews with six social workers who work with children investigations. The results indicate that follow-up is becoming more wide when BBIC is used, the social welfare worker needs to see the child several times to obtain all the information that BBIC documents require. The result also indicates that the social workers use different BBIC documents when they do follow-ups. There are also other parts of the follow-up in which social welfare workers work different, for example how often they visit the child between the statutory reassessments.

Venous disease is a common vascular condition affecting the lower limbs and causes considerable morbidity in affected patients. National Health Service (NHS) treatment costs are substantial and there is a large demand for treatment much of which cannot be met. Roughly half a million people in the United Kingdom contact their general practitioner each year about varicose veins and associated clinical symptoms. In order to assign priorities and target interventions properly, authorities need to know which patients with venous disease will progress. Although many epidemiological studies have investigated the prevalence of venous disease, information on deterioration is scarce. The overall aim of this study is to determine the natural history of venous disease in the population and to identify lifestyle and clinical factors related to deterioration which might aid clinical decision making and health services policy. The specific objectives were to determine which risk factors were associated with deterioration of venous disease and venous reflux, and to ascertain the natural history of asymptomatic venous incompetence in terms of deteriorating to overt trunk varicose veins and chronic venous insufficiency. The study design was a population based cohort in the Edinburgh Vein Study which the survivors of the 1566 individuals aged 18 to 64 randomly sampled years from the general population at baseline underwent a 13-year follow-up examination. Details of the 1566 participants in the baseline study were sent to the Practitioner Services Division (PSD) of the NHS in Scotland who provided updated addresses and general practitioner registration details. Information collected on each subject at a follow-up clinic included lifestyle factors and medical history, height and weight measurement (by means of a questionnaire), clinical examination for classification of venous disease according to the Basle and CEAP systems, and duplex scanning to assess incompetence of venous valves in the deep and superficial systems of ten vein segments in each leg. Of the subjects from the baseline, 880 participated in the follow-up study, and 576 did not participate, providing a response rate of 60.4% of which 490 were female (55.7%) and 390 were male (44.3%). The study subjects were generally older and slightly more affluent than residents of the City of Edinburgh. For trunk varicose veins, the baseline prevalence was higher in males compared to females (p<0.01), but there was no difference in prevalence among subjects at the follow-up stage of the study (p=0.56). The overall rate of deterioration in trunk varicose veins was 3.55% per annum. More females than males deteriorated (p=0.04). Among subjects who showed deterioration in their trunk varicose veins, the commonest deterioration was from Basle Grade I (mild) at baseline to Grade II (moderate) at follow-up in both the right and left leg (28.1% and 32.9% respectively). Subjects older than 55 years of age (OR=1.59, 95% CI 1.01-2.51), who had a positive family history of varicose veins or venous ulcer (OR=1.92, 95% CI 1.20-3.07), and sat down at work for more than half the working day (OR=1.69, 95% CI 1.04-2.73) had increased risk of deteriorating trunk varicose veins. There was no significant difference between males and females in the prevalence of chronic venous insufficiency (CVI) among subjects at both the baseline and follow-up stage of the study (p=0.15 and 0.16 respectively). The rate of deterioration in CVI was 1.76% per annum. Similarly, among subjects who deteriorated, the commonest deterioration was from Grade I (mild) to Grade II (moderate) CEAP classification in both the right and left leg (42.4% and 45.5% respectively). The risk of worsening of CVI among those older than 55 was nearly three times more than those aged less than 55 (OR=2.85, 95% CI 1.18-6.87), and was still significant when adjusted for gender. The prevalence of telangiectasia was higher in females than in males in both the baseline and follow-up stages of the study (both p<0.01). The rate of deterioration in telangiectasia was 1.6% per annum. The commonest deterioration was from grade I (mild) at baseline to grade II (moderate) follow-up in the left and right leg (using the Basle Classification). Females subjects (OR=1.87, 95% CI 1.35-2.64), those older than 55 (OR=1.68, 95% CI 1.19-2.36), with a positive family history of venous disease (OR=1.60 95% CI 1.14-2.24) were associated with an increased risk of deterioration from telangiectasia compared to male subjects under 55 years of age and with no family history of the disease. The risk of telangiectasia deterioration was more than twice as high in subjects with venous reflux in the greater saphenous vein (origin) (OR=2.34, 95% CI 1.53-3.57), the greater saphenous vein (lower third of the thigh) (OR=2.28, 95% CI 1.59-3.27) and in the small saphenous vein (1.89, 95% CI 1.06-3.36) compared to those with no segments affected. The age and gender adjusted risk was also more than twice as high in subjects with venous reflux in two segments of the superficial system compared to subjects with no venous reflux in any segment (OR=2.06, 95% CI 1.23-3.44), and almost four times as high in subjects with reflux in more than three segments of the superficial system (OR=3.97, 95% CI 2.16-7.31) compared to subjects with no segments affected. On duplex scanning, the prevalence of reflux was higher in females than in males in the superficial system at baseline and follow-up stages of the study (p<0.01 respectively). In the deep system, the prevalence was higher in males than females at the baseline stage (p<0.01) with no significant difference at the follow-up stage (p=0.85). The rate of deterioration in venous reflux was 1.28% per annum. Most subjects deteriorated from one to two vein segments affected in the leg, the majority of which had reflux in the greater saphenous vein (thigh) at baseline and developed reflux in the greater saphenous vein (origin) at follow-up. Subjects more than 55 years of age had significantly more deterioration than those aged less than 55 (p<0.01). Obese or overweight subjects (OR=1.59, 95% CI 1.32-3.67), those aged more than 55 (OR=2.20, 95% CI 1.32-3.67), with a family history of varicose veins (among female subjects only, OR=2.55, 95% CI 1.16-5.56), and who sat down at work more than half the working time (among male subjects only) (OR=2.26, 95%CI 0.97-5.23) had increased risk of showing deterioration in reflux in any leg and in any vein segment from baseline to follow-up. Subjects with venous reflux at baseline were over two and half times more likely to show deterioration in trunk varicose veins compared to those with no reflux (OR=2.69, 95%CI 1.44-5.01), and four times more likely to deteriorate in either trunk varicose veins or chronic venous insufficiency (OR=4.20, 95% CI 2.42-7.29). Subjects with venous reflux at baseline were twice as likely to develop new trunk varicose veins (OR=2.08, 95%CI 1.25-3.46), and 1.78 times more likely to develop either trunk varicose veins or chronic venous insufficiency (OR=1.78, 95%CI 1.12-2.80). Age and gender adjusted risk of trunk varicose veins increased more than fourfold among subjects with venous reflux in the greater saphenous veins (OR=4.04, 95% CI 2.36-6.92), and more than threefold in the greater saphenous vein (lower third of the thigh) (OR=3.13, 95% CI 1.85-5.27) and the small saphenous vein (OR=3.17, 95% CI 1.55-6.48). Subjects with venous reflux in two or more than three vein segments in the superficial system were more than five times more likely to deteriorate from trunk varicose veins (OR=5.39, 95% CI 2.64-10.99 and OR=5.96, 95% CI 2.71-13.10 respectively). The Edinburgh Vein Study follow-up identified factors linked to deterioration of trunk varicose veins and CVI. The findings of this follow-up study have important implications in decision making in NHS and a prognostic tool could be produced to assist clinicians in deciding who should receive treatment or maintained under surveillance. Increasing age, and family history will likely lead to worsening of trunk varicose veins and CVI. The findings also confirm the association between asymptomatic and symptomatic venous valvular incompetence with worsening and developing new cases of venous disease. Such information will be essential for policy makers facing difficult decisions over prioritisation of services in the future. Further research might include trials of surgical and non-surgical interventions designed to limit deterioration in high risk individuals and enable surgeons to target interventions appropriately. Larger prognostic studies of many factors, including genotype, might be conducted to link progression of venous disease, and to provide further information on high risk individuals who might benefit from treatment.

I denna studie undersöks och analyseras kopplingen mellan yrkesutbildningens mål och APL för att få en rättssäker och likvärdig betygsättning. Jag har undersökt sex yrkeslärare inom gymnasial yrkesutbildning på handels- och administrationsprogram om deras bedömningspraktik i samband med det arbetsplatsförlagda lärandet (APL). Jag har även undersökt åtta elever på handels- och administrationsprogrammet om hur de uppfattar kursmål/bedömningar /uppföljning under sin APL-period. Datainsamlingen har skett genom kvantitativa enkät-undersökningar. Det insamlade materialet sammanställdes och därefter analyserades data i förhållande till studiens frågeställningar. Den teoretiska utgångspunkten fokuserar på bedömningspraktiken, uppföljning/återkoppling samt kommunikationens betydelse för lärandet och bedömning. Tidigare forskning visar att en tydlig bedömningspraktik är mycket viktig för att få en så bra koppling mellan skolans mål och APL-platsen som möjligt. Resultatet visar att de flesta har en väl fungerande bedömningspraktik. Flera yrkeslärare säger dock att tiden är det största hindret för rättssäker och likvärdig betygssättning. Rektorn har i detta sammanhang en central roll i att organisera verksamheten så att förutsättningar ges för detta arbete. / This stydy investigates and analyses the connection between the vocational educations aim and APL to get an assured and equivalent assessment. I have surveyed six vocational education teachers within secondary vocational education in business and administration programme about their assessment practice in connection with the workplace-based learning (APL). I have moreover surveyed eigth students in business and administration programme about how they perceived the course objective/ assessment/ monitoring during their APL-period. The data collection has been carried out in the form of quantitative questionnaires. The gathered data got compiled and subsequently analysed in relation to the studies question formulations. The theoretical premiss focuses on the assessment practice, monitoring/ feedback and the communications significance for the learning and assessment. Prior research shows a clear assessment practice is quite important to get as good of a connection between the schools aim and the APL-place as possible. The result shows that most have a well functioning assessment practice. Several vocational education teachers says however that time is the biggest hindrance for an assured assessment practice. The principal has in this contexture a central role in organizing the schools activity so that the basis is given for this work.

Syftet med examensarbetet är att skapa en handlingsplan för uppföljning av åtgärder i händelse av olycksfall, tillbud och observationer i avvikelsehanteringssystem (TIA-systemet)på en enhet på Scania i Södertälje. Frågeställningarnaär(1) Vad ska följas upp, (2) När kan uppföljning ske och (3) Hur kan uppföljning ske. Teorier om SMART:a mål, kartläggning av krav och målsättning, MoSCoW, product breakdown structure, ISO 9001, systematisk arbetsmiljö och hörnstensmodellen har legat till grund för studien. Metoden utgörs av aktionsforskning,fallstudie med kvalitativa data och abduktion. Datainsamlingen har bestått av intervjuer och enkät. Verktyg för datasortering är GAP-modellen, SWOT-analys, histogram och träddiagram. Resultatet visar på att inget standardiserat arbetssätt finns för en långsiktig uppföljning där mätning av effekter och mål endast sker ibland.Samtidigt finns en meningsskillnad angåendehuruvida uppföljning sker över huvud taget. Vid de fall uppföljning sker används en databas för att spara information ibland. Slutsatsen är att (1) det som ska följas upp är mål för åtgärder där det finns en bestämd metod för mätning och uppföljningsrutin. Information ska dokumenteras i databas och ledningen ska prioritera att uppföljning sker. (2) uppföljning ska ske efter behov, inga kända bestämmelser finns om när uppföljning borde ske.När uppföljning ska ske bestäms i åtgärdsplaneringen. (3) Uppföljning ska ske enligt handlingsplan (bilaga 4), det vill säga bestäm mål och indikationer, bestäm när och hur indikatorer ska följas upp samt dokumentera uppföljning i en databas. / The purpose of the thesis project is to create an action plan for monitoring measures in a deviation management systems (the TIA-system). The research questions are (1) What should be followed up, (2) When should a follow-up take place and (3) How can a follow-up occur. Smart goals, mapping of requirements and objectives, MoSCoW, product breakdown structure, ISO 9001, systematic work environment and the cornerstone model are theories the thesis is built upon. Action research and qualitative study have designed the method whereby data collection has consisted of interviews and questionnaires. Data sorting tools are the GAP model, SWOT analysis, histogram and tree chart. The result founds that there is no standardized way of working with a long-term follow-up, where measurement of effects and goals only occurs occasionally. Furthermore, there is an obscurity about whether follow-ups are carried out at all. In cases where a follow-up occurs, a database is occasionally used to save information. The conclusion is that (1) a follow-up should include goals for measures where there is a definite method for measurement and follow-up routine. Information must be documented in the database and the management must prioritize that a follow-up takes place at all time. (2) a follow-up should be carried out depending on the measures, there is not any known theories about when follow-ups should take place. Although, the timeline for when a follow-up should be done must be determined in the action plan. (3) A follow-up shall take place according to the action plan (Appendix 4), that is, determine goals and indications, determine when and how indicators should be followed up and document information from a follow- up in a database.

Bakgrund: Visselblåsarsystem införs nu för företag inom EU. EU ser ett behov för ett ökat skydd för visselblåsare och EU kommissionen fastslog 16e april 2019 ett direktiv som innebär att säkra kanaler för rapportering av visselblåsarärenden skall finnas för alla företag med fler än 50 anställda. Att minimera risker för ekonomiska oegentligheter är en nyckelfråga för företag och som visselblåsarsystem förväntas bidra till. Mutor, bokföringsbrott och bedrägerier kan påverka trovärdigheten i företagens redovisning och om brott förekommer och uppdagas kan företagets existens stå på spel. Allvarliga konsekvenser kan vara att investerare och aktieägare förlorar insatt kapital och anställda kan förlora sina arbeten. Intern styrning och kontroll påverkar företagets arbete för att uppfylla målen för effektivitet och produktivitet i verksamheten, tillförlitlig finansiell rapportering samt efterlevnad av tillämpliga lagar och regler. En aspekt som bidrar till ett säkrare kontrollarbete är när medarbetare och andra intressenter tryggt kan larma vid misstanke om ekonomisk brottslighet och andra oegentligheter. Syfte: Denna rapport syftar till att beskriva om införandet av ett visselblåsarsystem kan bidra till att minimera risker för ekonomisk brottslighet och bidra i företagets arbete med intern styrning och kontroll. Metod: Det empiriska materialet som har samlats in i studien har gjorts med en kvalitativ metod och 10 personer har intervjuats med semistrukturerade intervjuer. Informanterna har kunskap kring visselblåsning och förebyggande av ekonomisk brottslighet. Analys och Slutsats: Analysen pekar på att ett visselblåsarsystem kan bidra till företagets arbete med intern styrning och kontroll och till en korrekt redovisning och säkrare rapportering av företagets resultat, framförallt förebyggande genom att upptäcka oegentligheter i ett tidigt skede. Flertalet informanter belyste även vikten av företagskultur och dess påverkan på visselblåsarsystemets effektivitet. / Background: Whistleblowing systems are now being introduced within EU on a broad scale. April 16th, 2019 the European Parliament approved an EU Whistleblower Protection Directive. The new law must be transformed to national law by the member states, and legal entities with 50 employees or more must get ready to comply with the new law. Minimizing risks of financial irregularities is a key issue for companies and where a whistleblower system is expected to contribute. Bribes, accounting offenses and fraud can affect the credibility of corporate accounts and if a crime is discovered, the company's existence could be at stake. Serious consequences may be that investors and shareholders lose their capital and employees can lose their jobs. Internal control systems are present to fulfill the goals for efficiency and productivity in the business, reliable financial reporting and compliance with applicable laws and regulations. Models for internal control prescribes that employees and other stakeholders must be able to safely warn about suspicion of financial crime. Purpose: In this report we analyze if the introduction of a whistleblower system can help to minimize the risks of financial crime and contribute to the company's work with internal control. Method: The empirical material used in the study has been collected with a qualitative method and 10 people have been interviewed with semi-structured interviews. The respondents work in various ways close to whistleblowing with knowledge about prevention of economic crime. Analysis and Conclusion: The analysis indicates that a whistleblower system can contribute to the company's work with internal control and to a correct accounting and safer reporting of the company's results, especially in a preventive stage. Most respondents also highlighted the importance of corporate culture and its impact on the whistleblower system's efficiency.