<p>MobileMe is a recently developed system for monitoring and recording physiological variables. It is wireless, and can therefore be suitable for field research, for example when measuring motion sickness symptoms.</p><p>The aim of this thesis was to conclude whether the MobileMe recording system was valid for research studies. A validation study, consisting of two parts and including 10 subjects, was performed. The first part was a laboratory study, where data from MobileMe and a reference equipment were compared. A field study was also performed, onboard a combat boat, to determine the equipment’s validity in uncontrolled environments. Furthermore, the field study included an investigation of motion sickness symptoms, and provided data for evaluation of motion sickness rating scales.</p><p>Statistical results from the laboratory study, and results from evaluation of data from the field study, showed that MobileMe was valid in both controlled and uncontrolled environments.</p>

Carbody tilting is today a mature and inexpensive technology that allows higher train speeds in horizontal curves, thus shortening travel time. This doctoral thesis considers several subjects important for improving the competitiveness of tilting trains compared to non-tilting ones. A technology review is provided as an introduction to tilting trains and the thesis then focuses on enhancing the benefits and strategies for less motion sickness. A tilting train may run about 15% faster in curves than a non-tilting one but the corresponding simulated running time benefit on two Swedish lines is about 10%. The main reason for the difference is that speeds are set on other grounds than cant deficiency at straight track, stations, bridges, etc. The possibility to further enhance tilting trains’ running speed is studied under identified speed limitations due to vehicle-track interaction such as crosswind requirements at high speed curving. About 9% running time may be gained on the Stockholm–Gothenburg (457 km) mainline in Sweden if cant deficiency, top speed, and tractive performance are improved compared with existing tilting trains. Non-tilting high-speed trains are not an option on this line due to the large number of 1,000 m curves. Tilting trains run a greater risk of causing motion sickness than non-tilting trains. Roll velocity and vertical acceleration are the two motion components that show the largest increase, but the amplitudes are lower than those used in laboratory tests that caused motion sickness. Scientists have tried to find models that can describe motion sickness based on one or more motion quantities. The vertical acceleration model shows the highest correlation to motion sickness on trains with active tilt. However, vertical acceleration has a strong correlation to several other motions, which precludes vertical acceleration being pointed out as the principal cause of motion sickness in tilting trains. Further enhanced speeds tend to increase carbody motions even more, which may result in a higher risk of motion sickness. However, means to counteract the increased risk of motion sickness are identified in the present work that can be combined for best effect. Improved tilt control can prevent unnecessary fluctuations in motion sickness related quantities perceived by the passengers. The improved tilt control can also manage the new proposed tilt algorithms for less risk of motion sickness, which constitute one of the main achievements in the present study. Local speed restrictions are another means of avoiding increased peak levels of motion sickness when increasing the overall speed. The improved tilt control and the proposed tilt algorithms have proven to be effective in on-track tests involving more than 100 test subjects. The new tilt algorithms gave carbody motions closer to non-tilting trains. Rather unexpectedly, however, the test case with the largest decrease in tilt gave a greater risk of motion sickness than the two test cases with less reduction in tilt. It is likely that even better results can be achieved by further optimization of the tilt algorithms; the non-linear relation between motions and motion sickness is of particular interest for further study. / QC 20110429

I denna uppsats behandlas ohälsans regionala utveckling och syftet är att analysera vad som påverkar den svenska ohälsan. Teori angående hushållens val mellan fritid och arbete används för att analysera resultaten från den empiriska undersökningen. Bakgrunden till denna uppsats bottnar i utvecklingen av ohälsotalen som har ökat med 5,1 dagar mellan åren 2000 och 2004. De empiriska resultaten påvisar att arbetslösheten har ett positivt samband med ohälsa och att kvinnor tenderar att vara mer sjuka än män. Vidare bekräftar resultaten att inkomsten har ett negativt samband med ohälsa och detta är även sant för stora företag. Följaktligen har små företag en positiv inverkan på ohälsotalen och en analys av kommuner belägna i den norra delen av Sverige påvisar ett högre ohälsotal än övriga kommuner. Vidare är individernas ålder en faktor som kan förklara utvecklingen av öhälsotalen. Dessa resultat bekräftar att arbetslöshet, kön, inkomst, företagsstorlek, ålder och kommuner belägna i den norra delen är faktorer som kan förklara ohälsotalens utveckling, men även andra faktorer är av betydelse. / This thesis examines the regional development of ill-health and the purpose is to analyse factors that tend to influence the Swedish ill-health. Theory of household choice between work and leisure is used when analysing the results of the empirical study. The background for this thesis is derived from the development of ill-health that has increased with 5.1 days between the years 2000 and 2004. The empirical findings show that unemployment has a positive relationship with ill-health and that women tend to be more ill than men. Furthermore, the results confirm that income has a negative relationship with ill-health and this is also true for large companies. Consequently, small companies have positive influence on ill-health and an analysis of the municipalities in the northern part of Sweden points out a higher number of ill-health than the other municipalities. Moreover, the individuals’ age is also a factor that can explain the development of ill-health. These findings confirm that unemployment, gender, income, size of company, age, and the municipalities in the north-ern part are factors that can explain the development of ill-health. However, other factors are important in the process as well.

There is no common understanding on what constitutes good sick-listing, a frequent and problematic task for many physicians, especially general practitioners (GPs) and orthopaedic surgeons. Aiming to achieve a deeper understanding of sick-listing practices, 19 GPs (I, III) and 18 orthopaedic surgeons (II) in four counties were interviewed, and data analysed qualitatively for views on good sickness certification and barriers to desired practice. Data from a survey of all 7665 physicians in two counties on emotionally straining problems in sickness certification (IV) was analysed quantitatively. Some GPs exposed narrow views of sick-listing, where their responsibility was limited to issuing a certificate, while GPs with the most inclusive view had a perspective of the patient’s total life-situation and aimed to help patients shoulder their own responsibility (I). The orthopaedic surgeons´ perceptions of good sick-listing were mainly related to their views on their role in the health-care system. Some perceived their responsibility as confined to the orthopaedic clinic only, while others had the ultimate goal of helping the patient to become well functioning in life with regained work capacity – by means of surgery and proper management of sick-listing (II). Difficulty handling conflicting opinions was a barrier to good sickness certification for GPs (III), and problematic for about 50% of all physicians and about 80% of GPs (IV). Orthopaedic surgeons’ handling of such situations varied from being directed by the patient, via compromising, to being directed by professional judgement (II). Other barriers included poor stakeholder collaboration (III). GPs with a workplace-policy on sickness certification reported fewer conflicts and less worry of getting reported to the disciplinary board in relation to sick-listing (IV). Understanding physicians’ underlying views on and barriers to practicing “good sick-listing” can inform efforts to change physician practice. Communications skills training in handling sick-listing situations with conflicting opinions is recommended.

The presented studies were performed to investigate the effects of motion sickness (MS) on human autonomic and behavioural thermoregulatory mechanisms during cold stress and in a thermoneutral environment. The roles of histaminergic and cholinergic neuron systems in autonomic thermoregulation and MS-dependent dysfunction of autonomic thermoregulation were studied using a histamine-receptor blocker, dimenhydrinate (DMH), and a muscarine-receptor blocker, scopolamine (Scop). In addition, the effects of these substances on MS-induced nausea and perceptual thermoregulatory responses were studied. MS was found to lower core temperature, during cold stress by attenuation of cold-induced vasoconstriction and decreased shivering thermogenesis, and in a thermoneutral environment by inducing sweating and vasodilatation. The increased core cooling during cold stress was counteracted by DMH but not by Scop. In a thermoneutral environment, the temperature was perceived as uncomfortably warm during and after the MS provocation despite decreases in both core and skin temperature. No such effect was seen during cold-water immersion. Both pharmacologic substances had per se different effects on autonomic thermoregulatory responses during cold stress. Scop decreased heat preservation, but did not affect core cooling, while DMH reduced the rate of core cooling through increased shivering thermogenesis. Both DMH and Scop per se decreased thermal discomfort during cold-water immersion.Findings support the notion of modulating roles of histamine (H) and acetylcholine (Ach) in autonomic thermoregulation and during MS. MS activates cholinergic and histaminergic pathways, thereby increasing the levels of H and Ach in several neuro-anatomical structures. As a secondary effect, MS also elevates blood levels of several neuropeptides, which in turn would influence central and/or peripheral thermoregulatory responses.In conclusion, MS may predispose to hypothermia, by impairment of autonomic thermoregulation in both cold and thermoneutral environments and by modulation of behavioural thermoregulatory input signals. This might have significant implications for survival in maritime accidents. / <p>Medicine doktorsexamen</p>

MobileMe is a recently developed system for monitoring and recording physiological variables. It is wireless, and can therefore be suitable for field research, for example when measuring motion sickness symptoms. The aim of this thesis was to conclude whether the MobileMe recording system was valid for research studies. A validation study, consisting of two parts and including 10 subjects, was performed. The first part was a laboratory study, where data from MobileMe and a reference equipment were compared. A field study was also performed, onboard a combat boat, to determine the equipment’s validity in uncontrolled environments. Furthermore, the field study included an investigation of motion sickness symptoms, and provided data for evaluation of motion sickness rating scales. Statistical results from the laboratory study, and results from evaluation of data from the field study, showed that MobileMe was valid in both controlled and uncontrolled environments.

Sjukfrånvaron i Sverige ökade kraftigt i slutet av 1990-talet och drabbade även högre utbildade personer som tidigare inte varit sjukskrivna. Många människor tillbringar större delen av livet på att arbeta och arbetsmiljön påverkar medarbetarna på olika sätt, där ledarskapet är en faktor som påverkar hälsan. Arbetsplatsen anses därför vara en av de hälsofrämjande arenor där insatser för att förbättra hälsan kan genomföras. Att ledarskapet påverkar medarbetarnas hälsa anses vara en självklarhet, men det finns inte så mycket forskning inom området. Syftet med studien var att undersöka hur medarbetare på en arbetsplats med låg sjukfrånvaro upplever att ledarskap bidrar till hälsa på arbetsplatsen. Studien är av kvalitativ ansats där data samlades in genom telefonintervjuer med fem personer. Arbetsplatsen som studeras har en låg sjukfrånvaro och har sin verksamhet inom ett landsting i Sverige. Resultatet visar bland annat att en bra ledare ska finnas tillgänglig, vara stöttande och tydlig. En ledare som bidrar till hälsa litar på sin personal, hjälper till att prioritera arbetsuppgifter, är lyhörd och omtänksam. En av de slutsatser som kunde fattas utifrån resultatet är att det som kännetecknar ett bra ledarskap även är det som bidrar till medarbetarnas hälsa. / Sickness absence in Sweden increased sharply in the late 20th century and hit the higher educated persons who have not previously been on sick leave. Many people spend most of their lives at work and the work environment affects employees in different ways, where the leadership is a factor affecting the health of the individual. The workplace is therefore considered to be one venue where health promotion interventions to improve health can be implemented. That leadership affects employee health is considered given, but there is not much research in this area. The aim of the study was to examine how employees in a workplace with low levels of sickness absence feel that leadership contributes to health in the workplace. The study was based on a qualitative approach where data was collected through telephone interviews with five persons. The workplace that is being studied has a low absenteeism and is based out of a county council in Sweden. The results show that a good leader should be available, be supportive and clear. A leader who contributes to the health trust their staff, helping to prioritize, is sensitive and caring. A conclusion that can be drawn about the results is that contributing to employee health is the same as good leadership.

African sleeping sickness is a parasitic infection spread by the protozoan parasite Trypanosoma brucei, and drugs used today are toxic and painful. Galactose metabolism is essential for the survival of T. brucei and without a functional UDP galactose 4’ epimerase (GalE) galactose starvation occurs and cell death will follow. In this Master thesis project two assays observing binding of small molecules to TbGalE has been investigated in attempt to establish an assay that in the future could be used for screening for drugs. TbGalE was biotinylated through the Pinpoint Xa vector and expressed in E. coli cells. The protein was successfully immobilized to a Streptavidin chip for Surface Plasmon Resonance experiments and the binding of the substrates UDP-galactose and UDP-glucose was observed. Unfortunately, the assay was not optimal for screening due to low signal response. However, the established protocol for expressing biotinylated proteins that bind to Streptavidin surfaces could be used in further experiments with TbGalE and other drug targets for African sleeping sickness. The fluorescent sugar nucleotide analogue UDPAmNS, which is a known inhibitor for E. coli GalE, was synthesised and purified and then used to establish a displacement assay. IC50 of UDPAmNS against TbGalE was determined and a synergic effect in fluorescence between the protein and the inhibitor was proven. Further, evidence for a reduction in fluorescence by displacing UDPAmNS with UDP was obtained. This reduction in fluorescence was also shown by a predicted cofactor inhibitor. The IC50 against TbGalE for this compound was determined before the displacement assay, which showed that the cofactor inhibitor, at least partly, binds to the active site of TbGalE. The UDPAmNS displacement assay could have the potential of becoming a robust screening assay for TbGalE, in the effort to find a better drug for African sleeping sickness.

The purpose of this thesis is to find out the reasons and perhaps some answers to the problem as we see it, the sickness benefit expiration of those who experience this. By this said we have also taken into account the different laws and adjustments in the long-term sickness benefit, but also major reformation of the security net in the Swedish society. The efficiency of the law on passive long-term sickness absence was added in July 2008, but was later in January 2010 supplemented. The purpose of this law wasn’t only to reduce the long-term sickness absence but also to reduce exclusion. These changes had also been highlighted by the media that people were actually being excluded from the society. It creates marginalization. The aim of this study is to highlight individuals' feelings about the whole performing hedge process. The survey was conducted through semi-structured interviews where we wanted a deeper knowledge of the interviewee’s experiences. In order to give the interviewee the opportunity and possibility to form their own mind and own reflections and express their own thoughts, the questions were open for answers. This allowed us to ask supplementary questions. After collecting the empirical data we did a breakdown in the following three themes: the experiences of the sickness absence, the experiences by the response of the concerned authorities. The theories chosen in this study are stigma, social exclusion, sense of coherence (SOC) and sick role. The economic exclusion creates social exclusion where as the sense of shame among the interviewee’s increase. By this said, the interviewee’s are not able to participate actively in the social activities to the same extent, but also they cannot provide for themselves. This can obviously lead to increased risk for mental illness. In our analysis we aim to discuss our issues based on the experiences for the interviewees’.

Syfte: Syftet med denna studie var att kartlägga långtidssjukskrivnas hälsa före och efter avslutad intervention samt studera vilka faktorer som hindrat alternativt främjat återgång i arbete hos individer med tidsbegränsad sjukersättning. Metod: Studien baseras på data från EU-projektet ”SAMKLANG” som är en longitudinell interventionsstudie. Data har samlats in på 59 långtidssjukskrivna deltagare via enkäter både före projektstart och ett år efter och dels har data samlats in kvalitativt genom semistrukturerade intervjuer med 13 deltagare efter det att projektet avslutats. Intervjudeltagarna var indelade i två grupper (de som hade återgått i arbete/studier och de som fortfarande var sjukskrivna). Interventionen bygger på både behandling och samverkan mellan organisationer som är involverade i rehabilitering av personer som har ett år kvar av sin tid i sjukersättning. Resultatet från enkäterna analyserades fram via ANOVA upprepad mätning och data från intervjuerna analyserades via innehållsanalys. Resultat: Huvudresultaten från den kvantitativa delstudien visade att det inte fanns någon skillnad mellan de som efter ett år återgått i arbete/studier, arbetsträning alternativt de som fortfarande var sjukskrivna gällande kön, ålder eller utbildningsnivå. Den självskattade depressions- och ångestnivån minskade och självskattad hälsa och inre kontroll ökade signifikant över tid för den grupp som kommit ut i arbete efter projektet jämfört med de två andra grupperna. Den kvalitativa analysen av intervjuerna identifierade följande tema som stödjande faktorer för arbetsåtergång: att besitta egen drivkraft, ha en insikt om arbetets mervärde och att hitta en balans mellan krav- kontroll-stöd. Det tema som beskriver hur myndigheter kan hjälpa och stödja långtidssjukskrivna tillbaks i arbete är: trygghet med mer vårdkompetens och att synliggöra individuella behov. Slutsats: Att återgå i arbete för en tidigare långtidssjukskriven person kopplas till bättre självrapporterad hälsa med mindre depression och ångestbesvär, en starkare känsla av inre kontroll och en högre tilltro till egen förmåga jämfört med om personer fortfarande är sjukskrivna. Framgångsfaktorer för arbetsåtergång är balans mellan krav, kontroll och stöd för individen och en egen motivation att återgå i arbete. För att underlätta arbetsåtergång hos långtidssjukskrivna bör myndigheter och inblandade parter samverka med vård, erbjuda trygghet och synliggöra varje enskild individs behov av rehabilitering. / Aim: The aim of this study was to investigate long term sickness absentees’ health status before and after an intervention. Furthermore, to gain deeper understanding of factors related to promoting and preventing return to work for people with limited sick leave compensation. Method: The study is based on data from the EU-funded project ”SAMKLANG” which is a longitudinal intervention study. Data has been collected from 59 long term absentees though questionnaires conducted before and one year after the start of the project. Data has also been collected through semi structured interviews from 13 participants after the end of the project. They were divided into two groups (those who had returned to work/studies or had an internship and those who still were sickness absent). The intervention is based on treatment as well as cooperation between organizations involved in a rehabilitation process for people with one year of sick leave compensation remaining. The results from the surveys were analyzed with ANOVA for repeated measures and data from the interviews were analyzed using content analysis. Result: The main result from the quantitative part of this study showed no significant difference in return to work between those who had returned to work or studies, been on internships and those who still were sickness absent based on sex, age and education. The amount of self-rated depression and anxiety levels were reduced and the self-rated health and internal control were significant induced over time for the group who returned to work after the project compared to the other two groups. From the qualitative analyze of the interviews following theme was identified as supporting factors for returning to work: having own motivation, realized the positive in having a job and to have balance between demand-control-support. The theme that describes how the authority can help and support people with long term sickness absence back to work is: security with more competence in healthcare and make individual needs visible. Conclusion: Return to work for a former long term sickness absence is associated with better self-rated health with less depression and anxiety, a stronger feeling of internal control and a higher self-efficacy compared to if persons still were sickness absent. Factors for success in return to work is balance between demand-control-support for the individual and an own motivation to return to work. The authority can facilitate return to work among people with long term sickness absence by interact more with health-care services, offer security and make every individuals need for rehabilitation visible.