Andelen äldre personer ökar i Sverige och världen vilket innebär att efterfrågan av vård ökar, men all vård behöver inte ske på sjukhus. Insatser som kan förhindra undvikbar slutenvård bör vara viktiga att arbeta fram dels ur ett hållbarhetsperspektiv, men även viktigt för att minska den påfrestning, förvirring och försämrad hälsostatus en sjukhusvistelse kan innebära för den äldre sköra patienten. Mobila närsjuksvårdsteam som utgår från sjukhusen är en relativt ny vårdform i Sverige och introducerades i Västra Götalandsregionen för ungefär 10 år sedan. Mobila närsjukvårdsteam gör insatser för sköra patienter med komplexa behov i hemmet och i teamen arbetar bland annat sjuksköterskor. Inom sjuksköterskans kompetensområde ingår att självständigt kunna ansvara för omvårdnad av patienter, inneha förmågan att se hela patientens livsvärld samt arbeta för en säker vård.  Syftet med den här studien är att belysa sjuksköterskans arbete med sköra patienter i mobila närsjukvårdsteam. Denna studie har genomförts som kvalitativ metod med induktiv ansats och bygger på intervjuer som datainsamlingsmetod. Vi har intervjuat sjuksköterskor verksamma på tre olika mobila närsjukvårdsteam. Resultatet av vår studie har visat att sjuksköterskan i mobila närsjukvårdsteam har en viktig roll då de utför avancerad vård i hemmet genom samverkan i team och med andra vårdaktörer. Sjuksköterskan har ett helhetsperspektiv med patienten i fokus och på så sätt kan andelen onödiga sjukhusinläggningar minska. Vår studie visar att snabb uppföljning i hemmet av sköra patienter som skrivs ut från sjukhus skapar trygghet samt minskar återinläggningar. Dessutom är rätt vård av sköra äldre patienter en organisatorisk fråga och vården behöver bedrivas av rätt kompetens. Sjuksköterskans arbete i mobila närsjukvårdsteam innebär att arbeta med hållbar utveckling genom att konsumtion av slutenvård minskar. / The proportion of older people is increasing in Sweden and the world, which means that the demand for care is increasing, but all care need not executed in hospitals. Efforts that can prevent avoidable outpatient care should be important to work on from a sustainability perspective, but also important to reduce the stress, confusion and deteriorating health status a hospital stay can cause for the older fragile patient. Mobile local health care teams executed from the local hospital are a relatively new form of care in Sweden. Mobile local health care teams were introduced in the Västra Götaland region about 10 years ago. Mobile local health care teams makes efforts for fragile patients with complex needs in their home.  The registered nurse’s expertise includes being able to independently be responsible for the care of patients, having the ability to see the entire patient's needs and working for patient's safety. The aim of this study is to illustrate the nurse's work with fragile older patients in mobile local health care teams. This study has been conducted as a qualitative method with an inductive approach and is based on interviews as a data collection method. We have interviewed nurses working on three different mobile local health care teams. The result has shown that the registered nurse in mobile local health care teams plays an important role as they carry out advanced care in the home through collaboration in teams and with other healthcare players. The registered nurse has a holistic perspective with the patient in focus, unnecessary hospitalizations and re-admission can be reduced. This study shows that fast follow-up in the home of fragile patients who are discharged from hospitals creates security and reduces re-admissions. In addition, proper care of fragile elderly patients is an organizational issue and care needs to be conducted by the right expertise. Registered nurse's work in mobile local health care teams means working with sustainable development by reducing the consumption of inpatient care.

This thesis builds on previous work on an Institute of Roads FAST VUT dealing with modifications of road I/43 Brno – Svitavy. A conversion of the existing temporary three leg single lane roundabout to egg turbo roundabout with four legs, is proposed there, in accordance with local plan of Lipůvka. The intersection of road I/43 and II/379 can be characterized by large congestions in the morning peak hours during weekdays and afternoon peak hours on Saturday and Sunday. That is the reason for implementation of capacity assessment of designed turbo roundabout and comparison with current situation. Construction of fourth leg is motivated by the planned expansion of residential area and the development of industrial zone on the south-western outskirts of the village and rerouting of the county road II/379 out of built-up area as well. Road I/43 is an important thoroughfare north of Brno, so it is obvious effort to eliminate the bottlenecks on the route. The thesis also includes a theoretical introduction dealing with the design of turbo roundabouts abroad.

PhD (Psychology) / Department of Psychology / Background: South Africa has world’s highest prevalence of HIV-positive people with approximately 7.06 million HIV-positive people with 110 000 HIV- related deaths reported by Statistics South Africa in 2017. South Africa has expanded access to anti-retroviral therapy services, from urban centers to resource-constrained rural communities. The rate of loss, however, to follow-up for patients on anti-retroviral treatment continues to increase. Aim of the Study: The aim of this study was to determine patient and nurse perspectives on loss to follow up among HIV-positive patients in Sekhukhune District of Limpopo Province, South Africa. The findings of the study guided the development of a proposed strategy to decrease loss to follow up among HIV-positive patients. Method: A qualitative research design was used with non-probability purposive sampling and with probability systematic sampling. The sample of patients comprised 30 HIV-positive people classified as lost to follow-up from clinics with high prevalence rates of lost to follow-up patients. Eight nurses, four from clinics with high rates and four from clinics with low lost to follow-up rates comprised the sample of nurses. Semi-structured interviews were conducted using the study research questions as a guide. Eight interviews were conducted with nurse clinic managers and 30 with the patients. Content analysis was used to analyze the data. Results: The key themes that emerged from the study included patients’ and nurses` perspectives on factors contributing to loss to follow up among HIV- positive patients; and Patients’ and nurses’ perspectives on strategies that would address barriers to loss to follow up among HIV- positive patients. Sub-themes on patients’ and nurses’ perspectives on factors contributing to loss to follow up among HIV- positive patients included: Lack of understanding of anti-retroviral treatment; fearful to disclose HIV status; lack of confidentiality; negative side effects; use of traditional medicine; self-transfer from one clinic to another. Patients’ and nurses’ elicited the strategies that would assist patients to remain in care and to take antiretroviral treatment consistently. The strategies included: providing patients with health education; working as a team; implementing social support group programme; providing nurses with in-service education on ethics and ethos. Informed by various intervention models in HIV care: Information Motivational Behavioural model; Health Belief Model; Social Action Theory and Social Cognitive Theory; I proposed a strategy that may reduce the rate of non-adherence and loss to follow up among patients with HIV in Limpopo Province. / HWSETA

La valve aortique est une composante anatomique centrale du cœur, sujette à de hautes pressions. Les conséquences d’un dysfonctionnement sont graves, notamment l’insuffisance cardiaque qui elle-même peut causer plusieurs symptômes et un impact sur la qualité de vie. Pour prévenir cette complication, il est possible de remplacer la valve par une prothèse. Il en existe plusieurs types parmi lesquelles l’équipe chirurgicale et le patient peuvent choisir. Les dernières lignes directrices américaines n’ont pas de recommandations claires pour les patients entre 50 et 70 ans. Ces patients, âgés de 65 ans et moins et surnommés jeunes adultes dans notre étude, reçoivent de moins en moins de prothèses mécaniques, au profit de celles de type biologique. Ce mouvement semble fondé sur certaines études suggérant une survie comparable entre ces 2 alternatives. De plus, on déconseille souvent la valve mécanique car elle nécessite un traitement anticoagulant à vie. Or, peu d’études ont suivi à long terme ces patients plus jeunes en analysant l’impact sur la qualité de vie du traitement anticoagulant ainsi que le risque de saignement. Notre étude visait donc surtout à analyser l’incidence, la sévérité et l’impact de ces saignements majeurs et la qualité de vie suite à un remplacement de valve aortique chez ces patients. Après un suivi moyen de 11 ans, les résultats suggèrent un taux incident de saignement majeur de 0.8% par patient-année et la mortalité associée à ceux-ci est faible à 3.3%, soit 2 hémorragies intracrâniennes. En tout, 48 patients ont eu un saignement majeur (8.9%). D’un autre côté, l’impact sur la qualité de vie obtenu par un questionnaire spécifique aux valves est faible. En outre, seulement 10.5% des patients utilisaient l’automesure pour surveiller leur anticoagulation, suggérant beaucoup de place à l’amélioration à ce niveau. Cette étude permet donc de mieux orienter la prise de décision au moment de la chirurgie et mieux informer les patients. / The aortic valve is a central component of the heart, experiencing high strain. The consequences of any dysfunctions are usually important, notably heart failure, which in itself is associated with many symptoms and lower quality of life. To prevent this complication, it is possible to replace the valve with a prosthesis. There are many options for the surgeon’s team and the patient to choose from. The latest American guidelines do not have clear recommendations for patients aged between 50 and 70 years. These patients aged 65 years and less, categorized as non-elderly adults, are receiving less and less mechanical prosthesis in profit of the biological ones. This trend seems to be based in part on some studies suggesting comparable survival between these alternatives. Moreover, the mechanical valve is frequently not recommended because it necessitates a lifelong anticoagulant treatment. However, few studies have reported a long-term follow-up of these younger patients analyzing the impact on the quality of life and the risk of major bleeding. The goal of our study was to analyze the incidence, severity and impact of major bleedings and the quality of life after aortic valve replacement in these patients. After a mean follow-up of 11 years, results show a linearized rate of 0.8% per patient-year and the associated mortality is low at 3.3%, consisting of 2 intracranial hemorrhages. Overall, 48 patients experienced a major bleeding (8.9%). On the other hand, the impact on the quality of life measured with a valve-specific questionnaire is low. Also, only 10.5% of the patients were using self-management or self-medication to monitor their anticoagulation, suggesting a lot of room for improvement in this regard. This study helps better define long-term outcomes in this patient population in order to better inform patients about surgical options.

The purpose of the study was to identify factors associated with the HIV transmission rate in 18 to 24 month-old children enrolled in the PMTCT programme at two selected City of Tshwane clinics. Mother-to-child transmission of HIV during labour and breastfeeding accounts for 40% of all HIV infection in children. The prevention of mother-to-child transmission of HIV programme is one effective strategy to reduce the rate of HIV infection in children. The HIV transmission rate was low at six weeks of age but increases at 18 to 24 months of age due to several factors. The researcher selected a descriptive retrospective correlational research design. A structured questionnaire was used to collect data from 60 mothers of children aged 18 to 24 months on the PMTCT programme and a data-collection form to collect data from 152 clinic records of children of the same age on the programme. The study found that the PMTCT guidelines were not properly adhered to by the nurses and the respondents. Prophylactic treatment was not provided as required and mixed feeding was prominent. The uptake of HIV test at 18 to 24 months was low compared to at 6 weeks. The transmission rate was high at 18 to 24 months compared to at 6 weeks. No factors were associated with the transmission rate / Health Studies / M.A. (Public Health)

No description available.

Bakgrund & problem: Controllerfunktionen är i litteraturen ett omtalat ämne och det finns delade meningar om vad funktionen bör innefatta och hur utvecklingen sett ut. Det saknas däremot studier som undersöker hur funktionen samspelar med ledningens behov samt huruvida det kan uppstå spänningar mellan funktion och behov. Det är relevant att studera eftersom vi vet att det förekommer en agent-principalrelation i offentlig sektor men inte huruvida det kan kopplas till controllern och ledningen. Det medför att det finns en kunskapslucka att fylla avseende balansgången mellan funktion och behov samt spänningar när dessa kolliderar. Syftet: Syftet med studien är att studera controllers funktion i relation till ledningens behov för att kunna ta reda på vilka spänningar som kan uppstå när funktion och behov inte samspelar för att kunna förstå hur controllers balanserar kraven utifrån ledningens behov. Metod: För genomförande av studien har en kvalitativ forskningsansats applicerats. För att besvara frågeställningarna och syftet med studien har en intervjustudie genomförts med tio olika controllers och sex individer från ledningen i totalt sju olika svenska myndigheter. Studien har genomförts med semistrukturerade intervjuer och är uppbyggd utifrån fyra huvudsakliga avsnitt: teoretisk referensram, empiriska data, analys och slutligen resultat & slutsats. Den teoretiska referensramen beskriver controllers funktion inom de fyra arbetsområdena: informationshantering, planering & uppföljning, riskhantering samt strategiskt beslutsfattande. Empiriska data har sammanställts genom en omfattande empirigenomgång med fokus på controllers uppfattning samt ledningen uppfattning utifrån controllers fyra arbetsområden. Syftet med avsnittet är att skapa förståelse för controllers och ledningens uppfattning. Vidare presenteras analysavsnittet som avser att beskriva hur begreppsparet, funktion och behov, samspelar med varandra samt att identifiera spänningar. Slutligen konkluderas studiens resultat i ett slutsatsavsnitt för att besvara frågeställningarna. Slutsats: Studien konkluderar att spänningar kan uppstå mellan controllerfunktionen och ledningens behov när begreppsparet inte matchar varandra. De främsta spänningarna som identifierats är: agent-pricnipalproblematik, egenintresse, informationsasymmetri samt olika uppfattningar om funktionens innebörd. Vidare kan slutsatsen dras att controllern balanserar funktion gentemot ledningen. Balansering görs främst genom tydlig kommunikation, frekvent dialog samt ömsesidiga förväntningar. / Background & problem: The controller function is a discussed topic in the literature and there are divided opinions about what the function should include and how the development has looked. However, there is a lack of studies that examine how the function interacts with the management's needs and whether tensions can arise between function and needs. It is relevant to study because we know that there is an agent-principal relation in the public sector but not whether it can be linked to the controller and management. This means that there is a knowledge gap to be filled regarding the balance between function and needs and tensions when these collide. Purpose: The purpose of this study is to study the controller's function in relation to management's needs to find out what tensions can arise when function and needs do not work together in order to understand how the controller balances the requirements based on management's needs. Method: For the implementation of the study, a qualitative research approach has been applied. To answer the research questions and the purpose of the study, an interview study has been carried out with ten different controllers and six individuals from management in seven different Swedish authorities. The interview study has been conducted with semi-structured interviews and is structured based on four main sections: Theoretical reference frame, empirical data, analysis and finally conclusion & results. The theoretical reference frame describes the controller's function within the four work areas: information management, planning & control, risk management and strategic decision-making. The empirical data has been compiled through an extensive empirical review with a focus on the controller's perception of the management in contrast based on the controller's four work areas. The purpose of the section is to create an understanding of the controller's and management's view. Furthermore, the analysis section is presented, which intends to describe how the pair of concepts: function and need, interact with each other and to identify tensions. Finally, the results of the study are concluded in a conclusion section to answer the research questions. Conclusion: The study concludes that tensions can arise between the controller function and management's needs when the pair of concepts do not match each other. The main tensions identified are agent-principal problem, self-interest, information asymmetry and different perceptions of the function's meaning. Furthermore, the conclusion can be drawn that the controller balances its function against management needs. Balancing is mainly done through clear communication, frequent dialogue, and mutual expectations.

The manufacturing industry is accountable for a significant amount of carbon emissions released, and manufacturers experience pressure from stakeholders to address the sustainability issues and contribute to the UN Sustainable Development Goals. However, the lack of verified frameworks to achieve a sustainable supply chain makes it difficult to revisit their supply chain strategies. This study benchmarks how manufacturing companies in Sweden achieve sustainability in their supply chains by examining the a priori and post-implementation factors required, as well as how the sustainability initiatives are structured. The study is a multiple case study, which started with a literature review to gain a relevant understanding of the research problem. Semi-structured interviews were held with seven case companies in different sectors in the manufacturing industry and with two environmental consultants. The findings prove that manufacturing companies achieve sustainability in their supply chains by combining a priori and post-implementation factors with aspects regarding the structure of the initiatives. Top management commitment and management providing the necessary means to drive the initiative are crucial a priori factors. Moreover, the findings demonstrate to define ownership of the tasks in the initiative and that top management should integrate sustainability in the business model and have a budget for sustainability initiatives. Prioritizing the activities with the largest value creation is important, where a materiality analysis facilitates. Training employees and management on sustainability, and encouraging the employees to find green improvements are necessary. Post implementation, adopting a circular process is critical, while also ensuring sufficient resources throughout the initiatives. Moreover, the findings highlight strict governance with clearly defined ownership over time, the more decentralized the better. A cross-functional organization is advantageous for achieving the above-mentioned factors. The reason for pursuing an initiative must be defined to enable clear goals. Backcasting and a materiality analysis are useful tools to create measurable goals accordingly, and the goals should be scientifically approved by the Science Based Target initiative. In the execution, using previous experiences on internal and external platforms aid the case companies with their goal conflict prioritization. Lastly, frequent follow ups are critical, where the follow-up process should follow international standards. It is necessary to have a defined process for follow ups and have traceable follow ups to view the progress. / Tillverkningsindustrin står för en betydande mängd av världens koldioxidutsläpp, och tillverkningsbolag blir alltmer pressade av intressenter att ta itu med hållbarhetsfrågorna och bidra till FN:s globala mål för hållbar utveckling. Bristen på verifierade ramverk för att uppnå en hållbar försörjningskedja försvårar för företag att se över deras hållbarhetsstrategier. Denna benchmarkingstudie om hur tillverkningsföretag i Sverige uppnår hållbarhet i sina försörjningskedjor undersöker de faktorer som krävs innan och efter en implementering av ett hållbarhetsinitiativ, samt hur initiativen är strukturerade. Fallstudien började med en litteraturundersökning för att få relevant förståelse och kunskap om forskningsproblemet. Semistrukturerade intervjuer genomfördes med sju fallföretag inom olika sektorer i tillverkningsindustrin och med två miljökonsulter. Resultaten visar att tillverkningsföretag uppnår hållbarhet genom att kombinera kritiska faktorer innan och efter utförandet, samt att följa aspekter som rör initiativens struktur. Engagemang från högsta ledningen som ger nödvändiga medel för att driva initiativet är avgörande innan implementeringen. Dessutom visar resultaten att fallföretagen och högsta ledningen bör integrera hållbarhet i affärsmodellen och ha en budget för hållbarhetsinitiativ. Att prioritera aktiviteter med störst värdeskapande är viktigt, där en väsentlighetsanalys underlättar. Det är nödvändigt att utbilda medarbetarna och ledningen inom hållbarhet och uppmuntra de anställda att hitta miljöförbättringar. Efter implementeringen är det avgörande att arbeta i en cirkulär process, samtidigt som det säkerställs tillräckligt med resurser genom hela initiativet. Dessutom visar resultaten att en strikt styrning med tydligt definierat ägarskap över tid är essentiellt, och ju mer decentraliserat desto bättre. En tvärfunktionell organisation är fördelaktig för att uppnå ovan nämnda faktorer. Anledningen till att driva ett initiativ måste definieras för att möjliggöra tydliga mål. Backcasting och väsentlighetsanalyser är användbara verktyg för att skapa mätbara mål utifrån, samt att målen bör vara vetenskapligt godkända i enlighet med Science Based Target initiative. Under genomförandet anser fallföretagen att det är viktigt att beakta tidigare erfarenheter av att driva hållbarhetsinitiativ, då det underlättar målkonfliktprioriteringen. Slutligen är frekventa uppföljningar kritiska, där uppföljningsprocessen bör följa en internationell standard. Det är även nödvändigt att ha en definierad och spårbar process för uppföljningen för att tydligt se framstegen.

BACKGROUND: Many women of reproductive age are employed in industries involving exposure to organic solvents. Animal toxicological studies and human case reports demonstrate that exposure to organic solvents can cause neuropsychological deficits in exposed offspring; however, there is limited data from prospective controlled human studies. OBJECTIVE: To compare neuropsychological functioning between children whose mothers were occupationally exposed to organic solvents during pregnancy with a non-exposed matched comparison group. METHODS: Participants were 48 women who had previously contacted the Motherisk Program in Toronto, Canada during pregnancy regarding occupational exposure to organic solvents and a matched comparison group of women with no known exposure to teratogens during pregnancy. Children (18 months to 8 years 11 months at time of study) were compared in areas of cognitive, language, motor, and behavioral functioning. RESULTS: Children whose mothers were exposed to organic solvents during pregnancy displayed a lower level of functioning when compared with their matched peers in areas of cognitive, language, motor, and behavioral domains. Although the scores on measures of behavioral functioning were not in the clinical range, the mothers of exposed children reported more challenging behavioral problems. In order to determine whether exposure predicted neuropsychological outcomes above and beyond maternal intellectual functioning, hierarchical regressions were run with maternal IQ and maternal education at Step 1and exposure status added at Step 2. In utero exposure to organic solvents predicted lower sores on global measures of Verbal IQ, receptive and expressive language scales above and beyond maternal intellectual functioning. Factors associated with higher levels of exposure (detecting odor, longer duration and total number of toxicity symptoms) was associated with poorer outcome on behavioral and motor functioning tests. CONCLUSION: Despite the fact that the exposed mothers experienced minimal symptoms of toxicity, detrimental effects were still evident in their offspring. Current safety standards for exposure were designed for adults and need to be reevaluated. Further studies addressing exposure to specific organic solvents, dose, and gestational timing of exposure are warranted.

BACKGROUND: Many women of reproductive age are employed in industries involving exposure to organic solvents. Animal toxicological studies and human case reports demonstrate that exposure to organic solvents can cause neuropsychological deficits in exposed offspring; however, there is limited data from prospective controlled human studies. OBJECTIVE: To compare neuropsychological functioning between children whose mothers were occupationally exposed to organic solvents during pregnancy with a non-exposed matched comparison group. METHODS: Participants were 48 women who had previously contacted the Motherisk Program in Toronto, Canada during pregnancy regarding occupational exposure to organic solvents and a matched comparison group of women with no known exposure to teratogens during pregnancy. Children (18 months to 8 years 11 months at time of study) were compared in areas of cognitive, language, motor, and behavioral functioning. RESULTS: Children whose mothers were exposed to organic solvents during pregnancy displayed a lower level of functioning when compared with their matched peers in areas of cognitive, language, motor, and behavioral domains. Although the scores on measures of behavioral functioning were not in the clinical range, the mothers of exposed children reported more challenging behavioral problems. In order to determine whether exposure predicted neuropsychological outcomes above and beyond maternal intellectual functioning, hierarchical regressions were run with maternal IQ and maternal education at Step 1and exposure status added at Step 2. In utero exposure to organic solvents predicted lower sores on global measures of Verbal IQ, receptive and expressive language scales above and beyond maternal intellectual functioning. Factors associated with higher levels of exposure (detecting odor, longer duration and total number of toxicity symptoms) was associated with poorer outcome on behavioral and motor functioning tests. CONCLUSION: Despite the fact that the exposed mothers experienced minimal symptoms of toxicity, detrimental effects were still evident in their offspring. Current safety standards for exposure were designed for adults and need to be reevaluated. Further studies addressing exposure to specific organic solvents, dose, and gestational timing of exposure are warranted.