Research Doctorate - Doctor of Philosophy (PhD) / In this dissertation, Van Davy makes a case for a cohesive system of schools which can serve the public — both the national interest and individual interests — while directly addressing the current national schooling system’s failure: * to replace, for the entire student cohort...high levels of student boredom with high interest and engaging curriculum and pedagogy; * to replace, for low SES and indigenous students...low levels of learning outcomes, low enrolment levels in senior schooling, and only brief experience of curriculum choice with a curriculum paradigm providing intrinsic value, understanding of pathways from disempowerment to empowerment, curriculum choice from the earliest years, and schooling outcomes which, over time, equal those of the national cohort of students * to replace a citizenry divided in its support for public, church-based, and exclusionary schools with a community united in its support for a socially agreed set of social purposes for schooling and a new curriculum paradigm, one half of which is generated by this set of social purposes * to address a major political issue: social cohesion The proposed new and cohesive system of schools is envisaged to meet the needs - both Common Good and Individual Good - of the citizenry. It will grow from an earlier and pre-requisite national social agreement around a set of political goals which together sketch a preferred future society - these political goals in the hands of education specialists will generate an "essential" curriculum as one of two elements in a new two-tiered curriculum to be followed from the earliest until the latest years of schooling. The second element, occupying the other half of the curriculum from the earliest to the latest years of schooling, will be an elective curriculum designed to encourage all students to pursue their own interests in as much depth as desired. Studies of sectarian studies will be included in the elective curriculum. Davy’s analysis ranges across a number of disciplines, fusing together a number of viewpoints: historical, political theory, educational performance, and educational theory. It searches Australia’s schooling outcomes, identifies low SES and Aboriginal outcomes as major areas of failure, and challenges a number of widely accepted schooling practices. In the process, Davy discovers OECD and ACER data, but little official interest or analysis, concerning widespread boredom amongst Australia’s students. He argues that, in respect of both low SES students and student boredom, system responsibilities such as the nature of Australia’s curriculum, could be just as implicated as concerns for “teacher quality.” Davy’s interest extends beyond the purely educational. He examines the purposes that public and non-public school authorities articulate, as well as reasons parents give for enrolling their children in schools. From this research Davy identifies several issues and suggests that very considerable “choice” in schooling could be found in a different curriculum paradigm, and that both public and non-public schools are deficient when measured against widely-accepted concerns for religious freedom, social cohesion, and fundamental democratic principles. For Davy, a major political issue confronting Australia is the national imperative of “social cohesion.” He searches Australia’s schooling history for evidence of any social agreement around the social purposes of schooling, including more recent attempts to formulate “essential" and “new basics” and “national” curriculum. He concludes that while many educators, and the OECD, refer to the need for a pre-requisite set of social purposes that outline a preferred future society, the politics of schooling has not permitted this to eventuate and, given the absence of this management fundamental, “it is not surprising that schooling systems are shaped by internal logics (ideologies, religions, personalities, internal politics, quest for advantage and/or privilege) rather than wider concerns for the shape of the globe’s and nation’s future, and the advancement of the twins: Common Good and Individual Good.” With these problems laid bare — low SES and indigenous outcomes, student boredom, and social cohesion — Davy addresses all three simultaneously. He draws confidence from contemporary political theorists proposing political processes which engage the public in a “deliberative democracy.” He constructs a surrogate “foundation of agreed principles” which, he deduces, the processes of deliberative democracy might lead the Australian people to construct, then outlines a step-by-step means by which these principles can generate an essential curriculum for all Australian children, while encouraging a full range of choice within an elective stream. The political processes of open collaboration throughout civil society which produces the social agreement may produce a new political context. This new, less adversarial and more trusting political context is seen to be fertile ground for the replacement of Australia’s fractured schooling system with a cohesive schooling system for the Australian public — an Australian schooling system — to be managed nationally.

<p>The general purpose of this dissertation is to evaluate KrAmi – a correctional program for young offenders – regarding socioeconomic profitability. Evaluating socioeconomic results enables us to examine and reflect upon the possibilities of applying socioeconomic models to social work. The basic data, from a long-term follow up study of 140 persons in two KrAmi programs, one Knuff program and two probation programs (treatment as usual), also allow systematic comparisons with more traditional evaluation models</p><p>The data have been presented in one research report and three articles.</p><p>The research report examines both the effects in an effect study and the socioeconomic results in a CBA (Cost-Benefit Analysis) and a CEA (Cost-Effectiveness analysis). The overall aim of the socioeconomic study was to examine the socioeconomic profitability of the programmes. We found a halving of expenditure for the KrAmi and Knuff groups and a 25 percent reduction for the two probation programmes compared to the cost one year before rehabilitation started.</p><p>The 15-year investment analysis (CBA) showed that expenditures decreased and benefits increased by about 2.5 million SEK per individual for the two KrAmi programmes and one non-custodial program, by 0.5-1.0 million SEK for the Knuff program and the other non-custodial program. For the KrAmi programs investment in rehabilitation pays off in 1-1.5 years, for probation in 2.5-4 years and for Knuff in 4 years after the intervention. The benefit-cost ratios were 17.8 - 12.7 for the two KrAmi programs and 5.1 - 5.8 for the two non-custodial programs. For the Knuff program the benefit-cost ratio was 13.2. KrAmi rates are higher for rehabilitation rate (pension points), rehabilitation rate compared to investment costs and benefit-cost ratio, pay-off time is the shortest.</p><p>The results of both the effect study and socio-economic study, which were presented in the first article, suggest that social improvements for the clients corresponded with socio-economic profitability. However, these findings should be interpreted with caution due to difficulties in comparing short-term data on effects from ASI interviews collected in one period with long-term data concerning socio-economic costs per day per client in a different period. The second article elaborated on these design issues and also examined whether approaching an evaluation from different perspectives and employing different research methods can increase understanding. The conclusion drawn was that it was essential to have knowledge on the dissimilarities in design and measures between the two studies to come to the correct interpretations. These interpretations led to new questions to illuminate the results of the evaluations.</p><p>In the third article the focus was the long-term follow up period. In this study the Knuff program was excluded from the study and the two KrAmi programs formed the program group and the two probation group formed the control group. The follow-up period was two years during which the socioeconomic costs decreased stepwise for both groups, probation groups more so than program groups. The deteriorations were 70-80% compared to the period before treatment. However rehabilitation to labour market was more successful for program groups than for control groups thanks to the greater socio-economic profitability for program groups.</p><p>The introductory part of this dissertation focuses on methodological difficulties, and a multivariate regression analysis (MRA) is presented which shows that pre-existing differences in the composition of the program groups and control groups were not responsible for the differences on the socio-economic results. Moreover the introductory section includes a research presentation and the rationale for socioeconomic evaluation.</p>

<p>The overall aim of this thesis was to expand the knowledge and understanding of the processes of breastfeeding and becoming a mother in mothers of preterm infants. </p><p>For this purpose, in-depth interviews were conducted with 25 mothers, whose very preterm infants had received care in seven neonatal units (NU) in Sweden, 1-12 months after discharge (I-II). In addition, prospective population-based register studies were performed of infants born 1993-2001; among 35 250 term and 2093 preterm infants (III), and a subpopulation of 225 very preterm infants (IV). Data were obtained from the Child Health Service registry of breastfeeding in Uppsala and Örebro, the Medical Birth Registry, and Statistics Sweden. </p><p>The experiences of mother-infant separation, institutional authority, emotional exhaustion and disregard of breastfeeding as a relational interplay, comprised major hindrances to mothers’ experiences of breastfeeding as reciprocal and of a secure mother-infant relation, during and after the discharge from an NU (I-II). All studied socioeconomic factors, i.e. lower educational level, receiving unemployment benefit or social welfare or having a low equivalent disposable income, were individually adversely associated with breastfeeding up to six months of infants’ postnatal age, but were not found more decisive for weaning in mothers of preterm infants compared to those of term infants (III). Preterm infants were breastfed for a shorter time than term infants (III), but a long breastfeeding duration was evident. In addition, gestational age and neonatal disorders were not associated with breastfeeding duration in very preterm infants (IV).</p><p>In conclusion, this thesis shows that improvements in the NU environment and the caring paradigm are called for. Furthermore, as socioeconomic status clearly has an impact on breastfeeding duration, increased equity in health care in accordance with the individuals’ needs must be sought, where resources are allocated to ensure fulfilment of needs in more vulnerable mothers and infants. </p>

In Sweden and elsewhere there is evidence of poorer cancer survival for patients of low socioeconomic status (SES), and in some settings differences in treatment by SES have been shown. The aim of this thesis was to explore factors which influence cancer treatment decisions, such as knowledge reaped from clinical trials, patient-related factors, and physician-related factors. In a register study of colorectal cancer, all stages, patients were stratified for SES-factors. Differences were seen with regards to clinical investigation, surgical and oncological treatment and survival, with the highly educated group being favored. Survival was better for highly educated patients in stages I, II and III but not in stage IV. In a Scandinavian cohort of newly metastasized colorectal cancer patients, recruitment to clinical trials was studied. Patients entering clinical trials had better performance status and fewer cancer symptoms than those who were treated with chemotherapy outside of a clinical trial. Median survival was 21.3 months for trial-patients and 15.2 months for those treated with chemotherapy outside a  trial. Those not treated with chemotherapy had a median survival of just 2.1 months. Patients in clinical trials are highly selected and conclusions drawn from studies cannot be applied to all patients. In the same cohort, treatment and survival were stratified for education, smoking and indicators of social structure. Highly educated patients did not have a survival advantage. Patients who lived alone were offered less combination chemotherapy and surgery of metastases than other patients and had 4 months shorter survival than those who lived with a spouse or child. In a fourth study, 20 Swedish gastrointestinal oncologists were interviewed on which factors they considered when deciding on oncological treatment. Oncologists feared chemotherapy complications due to lack of social support, and ordered less combination chemotherapy for patients living alone. Highly educated patients were seen as well-read and demanding, and giving in to these patients’ requests for treatment was regarded as a way of pleasing patients and relatives and of avoiding conflict.

The general purpose of this dissertation is to evaluate KrAmi – a correctional program for young offenders – regarding socioeconomic profitability. Evaluating socioeconomic results enables us to examine and reflect upon the possibilities of applying socioeconomic models to social work. The basic data, from a long-term follow up study of 140 persons in two KrAmi programs, one Knuff program and two probation programs (treatment as usual), also allow systematic comparisons with more traditional evaluation models The data have been presented in one research report and three articles. The research report examines both the effects in an effect study and the socioeconomic results in a CBA (Cost-Benefit Analysis) and a CEA (Cost-Effectiveness analysis). The overall aim of the socioeconomic study was to examine the socioeconomic profitability of the programmes. We found a halving of expenditure for the KrAmi and Knuff groups and a 25 percent reduction for the two probation programmes compared to the cost one year before rehabilitation started. The 15-year investment analysis (CBA) showed that expenditures decreased and benefits increased by about 2.5 million SEK per individual for the two KrAmi programmes and one non-custodial program, by 0.5-1.0 million SEK for the Knuff program and the other non-custodial program. For the KrAmi programs investment in rehabilitation pays off in 1-1.5 years, for probation in 2.5-4 years and for Knuff in 4 years after the intervention. The benefit-cost ratios were 17.8 - 12.7 for the two KrAmi programs and 5.1 - 5.8 for the two non-custodial programs. For the Knuff program the benefit-cost ratio was 13.2. KrAmi rates are higher for rehabilitation rate (pension points), rehabilitation rate compared to investment costs and benefit-cost ratio, pay-off time is the shortest. The results of both the effect study and socio-economic study, which were presented in the first article, suggest that social improvements for the clients corresponded with socio-economic profitability. However, these findings should be interpreted with caution due to difficulties in comparing short-term data on effects from ASI interviews collected in one period with long-term data concerning socio-economic costs per day per client in a different period. The second article elaborated on these design issues and also examined whether approaching an evaluation from different perspectives and employing different research methods can increase understanding. The conclusion drawn was that it was essential to have knowledge on the dissimilarities in design and measures between the two studies to come to the correct interpretations. These interpretations led to new questions to illuminate the results of the evaluations. In the third article the focus was the long-term follow up period. In this study the Knuff program was excluded from the study and the two KrAmi programs formed the program group and the two probation group formed the control group. The follow-up period was two years during which the socioeconomic costs decreased stepwise for both groups, probation groups more so than program groups. The deteriorations were 70-80% compared to the period before treatment. However rehabilitation to labour market was more successful for program groups than for control groups thanks to the greater socio-economic profitability for program groups. The introductory part of this dissertation focuses on methodological difficulties, and a multivariate regression analysis (MRA) is presented which shows that pre-existing differences in the composition of the program groups and control groups were not responsible for the differences on the socio-economic results. Moreover the introductory section includes a research presentation and the rationale for socioeconomic evaluation.

The overall aim of this thesis was to expand the knowledge and understanding of the processes of breastfeeding and becoming a mother in mothers of preterm infants. For this purpose, in-depth interviews were conducted with 25 mothers, whose very preterm infants had received care in seven neonatal units (NU) in Sweden, 1-12 months after discharge (I-II). In addition, prospective population-based register studies were performed of infants born 1993-2001; among 35 250 term and 2093 preterm infants (III), and a subpopulation of 225 very preterm infants (IV). Data were obtained from the Child Health Service registry of breastfeeding in Uppsala and Örebro, the Medical Birth Registry, and Statistics Sweden. The experiences of mother-infant separation, institutional authority, emotional exhaustion and disregard of breastfeeding as a relational interplay, comprised major hindrances to mothers’ experiences of breastfeeding as reciprocal and of a secure mother-infant relation, during and after the discharge from an NU (I-II). All studied socioeconomic factors, i.e. lower educational level, receiving unemployment benefit or social welfare or having a low equivalent disposable income, were individually adversely associated with breastfeeding up to six months of infants’ postnatal age, but were not found more decisive for weaning in mothers of preterm infants compared to those of term infants (III). Preterm infants were breastfed for a shorter time than term infants (III), but a long breastfeeding duration was evident. In addition, gestational age and neonatal disorders were not associated with breastfeeding duration in very preterm infants (IV). In conclusion, this thesis shows that improvements in the NU environment and the caring paradigm are called for. Furthermore, as socioeconomic status clearly has an impact on breastfeeding duration, increased equity in health care in accordance with the individuals’ needs must be sought, where resources are allocated to ensure fulfilment of needs in more vulnerable mothers and infants.

Stroke is one of the leading causes of death and disability in Sweden and in the Western world. Despite this, stroke with focus on elderly is a field where few studies have been conducted from a gender and socioeconomic perspective. The objectives in this thesis were to analyse from a gender, age and socioeconomic perspective how women were affected by stroke compared with men. The focus was on what it meant for elderly women and men to live with stroke and to explore various gender constructions among men and women. The study also included aspects such as incidence, medical treatment and case fatality after stroke. Both quantitative and qualitative methods were used. During a two-year period (15 October 2000–14 October 2002), uniform information was collected for all cases of first-ever and recurrent (&gt;28 days) stroke occurring in people of all ages living the region of Umeå, admitted to the University Hospital. Five different registers were used to achieve maximum coverage; the Riks-Stroke (RS) register, the Hospital Discharge Register (HDR), the Cause of Death Register, the northern Sweden WHO MONICA study, and one case-finding study in nursing homes and homes for elderly performed for this thesis. For the qualitative study a maximum variation sampling procedure was used to retrieve participants for in-depth interviews in a follow-up study. Nine women and seven men were interviewed about their experiences of treatment and care after suffering a stroke, as well as about their perceptions and experiences of help from others (health care personnel, relatives and home help personnel). The first-ever incidence of stroke was higher among low-educated than high educated men and women. Our study showed that there was an education-related age-dependent difference in stroke incidence, where elderly women had the highest incidence of stroke. The 28-day case fatality was shown to be associated with low educational level in patients above 75 years, after controlling for sex, risk factors and acute care variables. The elderly stroke patients experienced subordination in their contacts with health care personnel and the medical context. The participants used different ways to negotiate in the subordinate position, and some of these negotiations were interpreted as being gendered. We have also shown how the elderly stroke patients minimized their own needs of help, strove for independence and accepted help. The men and the women differed in their perceptions and experiences of help from others. Also, the participants expressed multiple types of needs. The elderly stroke patients’ perceptions and experiences of help from others must be studied in relation to their life circumstances and expectations from society. Further analyses of the patients’ perceptions and experiences of help from others were interpreted as being different examples of constructions of masculinities and femininities. Stroke with a focus on the elderly is a field where few studies have been conducted from a gender and socioeconomic perspective. With further community-based stroke incidence studies including elderly men and women and with the development of appropriately targeted interventions, the burden of stroke in the population could be reduced. More research is needed where both qualitative and quantitative methods are used, as this can provide a richer and perhaps more authentic description of the issue under investigation.

It has been argued, albeit with some degree of success, that the challenges facing the 21st century Canadian classroom are highly complex. A troubled economy riddled with cutbacks to the education system, ongoing enrolment decline and challenges in embracing a growth in the diversity of students are among the changes that have made classrooms increasingly difficult to navigate. Though the last assertion may be true, disciplinary policies and the tools used to address unwanted student behaviour have remained relatively unchanged within the education system. Using Critical Race Theory, the author examines the implications of school suspension and expulsion programs on students and provides an analysis of current literature on alternative disciplinary methods in public schools. Findings suggest that a mixture of strategies within various disciplinary programs can benefit some students, but more work must be done to address socioeconomic disparities plaguing the majority of students found in these programs.

It has been argued, albeit with some degree of success, that the challenges facing the 21st century Canadian classroom are highly complex. A troubled economy riddled with cutbacks to the education system, ongoing enrolment decline and challenges in embracing a growth in the diversity of students are among the changes that have made classrooms increasingly difficult to navigate. Though the last assertion may be true, disciplinary policies and the tools used to address unwanted student behaviour have remained relatively unchanged within the education system. Using Critical Race Theory, the author examines the implications of school suspension and expulsion programs on students and provides an analysis of current literature on alternative disciplinary methods in public schools. Findings suggest that a mixture of strategies within various disciplinary programs can benefit some students, but more work must be done to address socioeconomic disparities plaguing the majority of students found in these programs.

Family quality of life (FQOL) refers to the degree to which families of individuals with disabilities are able to meet their basic needs, enjoy time together, and pursue leisure interests and activities (Park et al., 2003). Researchers have identified barriers that families of individuals with disabilities encounter as they pursue a life of quality including elevated parental stress (Hauser-Cram, Warfield, Shonkoff, & Kraus, 2001), low socioeconomic status (SES) (Park, Turnbull, & Turnbull, 2002) and inadequate social service support (Soresi, Nota, & Ferrari, 2007). This study utilized data collected from a sample of parents (N = 389) of children receiving special education services from preschool through fifth grade to determine parental stress levels, satisfaction with social service supports and FQOL. Instruments included a demographic questionnaire, Parental Stress Scale (PSS; Berry & Jones, 1995), Client Satisfaction Questionnaire-8 (CSQ-8; Larsen, Attkisson, Hargreaves, & Nguyen, 1979) and Family Quality of Life Survey (FQOLS; Turnbull et al., 2004). A MANCOVA analysis failed to reflect significant differences between parental stress levels and FQOL based on child disability type. Point biserial correlations did not reveal significant relationships between children’s free or reduced lunch (FRL) status, parental stress, satisfaction with social services, and FQOL. Initial linear regression analysis indicated that parental stress was a significant predictor of FQOL (p < .001) while satisfaction with social services approached significance (p = .057). However, a subsequent linear regression analysis that included the interaction between satisfaction with social services and parental stress failed to support a moderation effect between satisfaction with social services and parental stress in the prediction of FQOL (p = .142). The examination of parental stress and FQOL within a school-based setting was a unique contribution to the literature that focuses primarily on FQOL and families of children with disabilities within clinical, medical and mental health settings. Limitations of this study, future research directions, and implications for school-based mental health providers are presented.