At the Primary Health Care Centre in Vännäs (VPHCC), northern Sweden, a development work was implemented in 1976-1980. The overall purpose was to enhance primary health care planning. In trying to improve health care delivery cooperation with community members was initiated and some organizational changes like a new appointment system, a new medical record and local care programs for some common diseases were introduced. Official statistics were also used for comparative purposes. The aims of the work were postulated (increased accessibility, higher continuity, more equitable distribution and enhanced cooperation) and suitable methods were designed. From postal surveys, chartreviews and administrative data (from hospitals, out-patient clinics and health centres) figures and information were collected. Accessibility was studied by waiting room time which was reduced and continuity, analyzed with a new concept - visit based provider continuity - was improved. The question of equitable distribution was studied by the consultation rates at different out-patient clinics. It seemed as if the local development work changed the patterns of utilization but some important issues were not decisively answered. Repeated postal surveys reflected the question of equitable distribution and the cooperation between the VPHCC and the community members. Positive responses were recorded in aspects like telephone accessibility and health care information. In a tracer study of diabetes the quality of care was studied. The local care program was actually implemented in the daily practice but the question of care quality needs further penetration. Within the frames of the development work new methods in the health care planning were introduced. Our work started from the prerequisits of the VPHCC and other health centres might find other ways of planning for care provision. On a general level, however, the structure of our work - defining aims, means and evaluation methods - can be used by others. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1986, härtill 6 uppsatser.</p> / digitalisering@umu

Thesis (PhD)-- Stellenbosch University, 2013. / ENGLISH ABSTRACT: A telemedicine service is a healthcare service (-medicine) that is delivered over a distance (tele-). The interest in the potential of telemedicine to increase the quality, accessibility, utilization, e ciency and e ectiveness of healthcare services is fuelled by the rapid development of information and communication technology (ICT) and connectivity. Despite this potential, the success rate of telemedicine services disappoints. Many mistakes in the implementation of telemedicine services are repeated over and over again and best practices are not captured and replicated. This study responds to the need for reference models for the assessment and optimization of telemedicine services in a consistent, systematic and systemic way. Maturity models are reference models that describe typical patterns in the development of organizational capabilities and depict a sequence of stages towards the desired state. Many reference models exist that are applicable to telemedicine services, but none of these provide guidance for the optimization of services, like a maturity model does. Many maturity models exist within a health systems context, but none of these can be applied "as is" to telemedicine services. In this study an iterative top-down design approach is followed to develop a Telemedicine Service Maturity Model (TMSMM). This model facilitates the assessment of a telemedicine service on micro, meso, and macrolevel along all the domains that comprise the telemedicine health system. Sets of capability statements are de ned, which follow each other in a cumulative manner, hence providing a maturation path towards the desired maturity state. These sets of capability statements provide yardsticks according to which quantitative values are allocated to an intangible concept, such as maturity. Once an individual service is assessed, further actions towards the optimization of the service can be derived from these yardsticks. The multidimensional design of the TMSMM, as well as the fact that capability statements facilitate the consistent quanti cation of maturity, makes it possible to analyze the aggregated results of cohort of services. To accomplish this, principles of business intelligence and data warehouse design are applied together with online analytic processing (OLAP) procedures. The TMSMM addresses the previously unful lled need for a reference model to assess and optimize telemedicine services in a consistent, systematic and systemic way. This study spans several academic and professional domains and thereby contributes to the scienti c world of telemedicine and ehealth. / AFRIKAANSE OPSOMMING: 'n Telegeneeskunde diens is 'n gesondheidsdiens (-geneeskunde) wat oor 'n afstand gelewer word (tele-). Met die snelle ontwikkeling van inligtings-en kommunikasietegnologie hou telegeneeskunde die potensiaal in om die kwaliteit, toeganklikheid, benutting, doelmatigheid en doeltre endheid van gesondheidsdienste te verhoog. Ten spyte van hierdie potensiaal, stel die aantal onsuksesvolle telegeneeskunde dienste teleur. Heelwat foute in die implementering van telegeneeskundedienste word oor en oor gemaak, terwyl die beste praktyke nie vasgevang en herhaal word nie. Hierdie studie is onderneem in reaksie op die behoefte aan 'n verwysingsmodel vir die assessering en optimering van telegeneeskunde dienste op 'n konsekwente, sistematiese en sistemiese manier. Volwassenheidsmodelle is verwysingsmodelle wat tipiese patrone in die ontwikkeling van organisatoriese vermoeëns beskryf. Dit stip 'n aantal fases neer wat uiteindelik behoort te lei na die ideale organisatoriese toestand. Daar bestaan verskeie verwysingsmodelle wat van toepassing is op telegeneeskunde dienste, maar geeneen daarvan gee leiding met die oog op die optimering van die diens, soos in die geval van 'n volwassenheidsmodel nie. In hierdie studie word 'n iteratiewe van-bo-na-onder ontwerpsbenadering gevolg om 'n telegeneeskunde volwassenheidsmodel (TMSMM) te ontwikkel. Hierdie model fasiliteer die assessering van 'n telegeneeskunde diens op 'n mikro-, mesoen makrovlak en met betrekking to al die fasette waaruit 'n telegeneeskunde stelsel bestaan. 'n Aantal vermoeëstellings is gede nieer. Hierdie stellings volg op mekaar en akkumuleer om sodoende 'n volwassenheidspad na die verlangde toestand aan te dui. Hierdie vermoeëstellings verskaf maatstawwe waarvolgens kwantitiewe waardes toegeken kan word aan 'n ontasbare konsep, soos volwassenheid. Sodra 'n individuele diens geassesseer is, kan verdere aksies met die oog op die optimering van die diens afgelei word. Die multidimensionele ontwerp van die TMSMM, tesame met die feit dat die vermoeëstellings volwassenheid op 'n konsekwente manier kwanti seer, maak dit moontlik dat die data van 'n kohort dienste saamgevoeg kan word met die oog op analise. Beginsels van besigheidsintelligensie, datastoorontwerp asook aanlyn analitiese prosessering (OLAP) word hiervoor ingespan. Die TMSMM spreek tot die voorheen onvervulde behoefte aan 'n verwysingsmodel waarmee telegeneeskunde dienste geassesseer in geoptimeer word in 'n konsekwente, sistematiese en sistemiese manier. Hierdie studie strek oor verskeie akademiese en professionele domeine en lewer sodoende 'n bydrae tot die multidissiplinêre wetenskapswêreld van telegeeskunde en e-gesondheid.

Begreppet brukarsamverkan lyftes fram i Sverige i samband med WHO ́s Sundsvalls-konferens 1991 som ”essensen i det demokratiska folkhälsoarbetet”. Samverkan, där handikapp- och patientorganisationer är delaktiga i planering av hälso- och sjukvård har varit aktuellt i mer än 35 år, man utvecklade former för handikappråd redan 1970. Ändå finns det mycket lite empirisk forskning på området. Syftet med uppsatsen är att få en fördjupad kunskap om brukarsamverkan samt att erhålla ett vidare perspektiv genom att jämföra utvecklingen i Sverige med Storbritannien utifrån frågeställningarna: Vilka motiv finns för samverkan, vilka faktorer påverkar och vilka former finns för samverkan och hur stämmer dessa med existerande teorier? Arbetet är upplagt i tre delar, en litteraturstudie med material från Storbritannien, en dokumentanalys av material från Stockholms läns landsting och en intervjuundersökning som gjordes 1999 med representanter för förvaltning, sjukhus och handikapporganisationer inom SLL. Resultatet visar att brukarsamverkan anses som något önskvärt i bägge länderna. Motiven beskrivs som fördjupad demokrati, en förbättring av vårdkvalité genom överföring av kunskap och erfarenhet från brukare till de som planerar och beslutar om vård. Ett tredje motiv skulle kunna vara att ”förankra” neddragningar och ge underlag till prioriteringar, något organisationerna inte vill delta i. Trots att samverkan i Sverige underlättas av folkrörelsetraditionen med många erkända organisationer, hindras effektiv samverkan av oklara definitioner, diffusa mål och orealistiska krav på organisationernas representanter. Aktiviteten stannar på en nivå som stämmer med begreppen ”konsultation” eller ”samråd / The concept of “user involvement”/collaboration in Sweden was described at WHO:s conference in Sundsvall 1991 as “the essense of a democratic health promotion approach”. User involvement in the form of handicap or patients ́ organizations participating in the planning of health care has been of interest for more than 35 years. Work had begun with user groups in Sweden as early as 1970, but there is very little empirical research in the area.The purpose of this dissertation is to further knowledge in the area of user involvement/ patient collaboration and to gain a wider perspective by comparing developments in Sweden with the United Kingdom. What are the motives behind user involvement? What factors influence user involvement? What forms exist and how do they compare with existing theory on collaboration? The dissertation is in 3 parts: A literature study based on material from the United Kingdom, an analysis of official documents from the Stockholm County Council and an interview study from 1999 with representatives from health care administration and patient organizations. Motives for user involvement/collaboration are improved democracy as well as improved quality by making use of the knowledge and experience of health care users. User involvement may also be a method for legitimizing reductions of resources and prioritizations, a practice which the handicap movement doesn ́t wish to be part of. Despite the extensive Swedish tradition of participation in organizations and interest groups, effective collaboration is hindered by unclear definitions, diffuse goals and unrealistic demands on the organizations ́ representatives. The resulting activity can most often be characterized as “consultation” rather than “collaboration / <p>ISBN 91-7997-130-X</p>

Förväntad effekt av vårdens elektroniska IT-system är ökad patientsäkerhet, vårdkvalitet och tillgänglighet. Ett första villkor för att kunna uppnå detta är att IT-systemet används. I denna studie granskas ett underutnyttjat IT-system, använt för informationsöverföring mellan olika huvudmän vid samordnad vård- och omsorgsplanering. Granskningen baseras på teorier om hur individers intention och vilja till att använda ett IT-system initieras eller upprätthålls genom omgivningens påverkan. Resultatet visar att IT-användare i den patientnära vården (mikrosystemet) saknar adekvat tekniskt, organisatoriskt (mesosystemet) och ledningsstöd (makrosystemet), vilket kan förklara underutnyttjandet. / Expected impact of electronic healthcare systems is increasing patient safety, care quality and availability. Using the system is essential to achieve this. This study explain the assimilation gap in an electronic healthcare system used in coordinated care planning by theories how individuals’ intentions and willingness to use electronic systems is affected by environmental influences. The result shows that the end users lack technical, organizational, and management support, which can explains the assimilation gap.

The construction industry has been hesitant for a long time to apply new technologies. In property development, the industry relies heavily on employees bringing experience from one project to another. These employees learn to manage risks in connection with the acquisition of land, but when these people retire, the knowledge disappears. An AI-based decision-support system that takes the risks and the market into account when acquiring land can learn from each project and bring this knowledge into future projects. In facility management, artificial intelligence could increase the efficiency of the allocation of staff in the ongoing operations. The purpose of the study is to analyse how companies in the real estate industry can improve their decision-making with the help of AI in property development and property management. In this study, two case studies of two different players in the real estate industry have been performed. One player, Bygg-Fast, represents property development and the other player, VGR, represents facility management. The study is based on interviews, discussions, and collected data. By mapping and then quantifying the risks and market indicators that are input data in the process, a basis can be created. The data can be used for a model that lays the foundation for an AI-based decision support system that will help the property developer to make calculated decisions in the land acquisition process. By mapping what a flow through a property looks like, measuring points can be set out to analyse how long the activities take in the specific business. These measured values provide a collection of data that makes it easier to plan the activities conducted in the property. A more efficient flow can be achieved by visualizing the entire process so staff can be allocated to the right part of the flow. By being flexible and being able to re-plan the business quickly if planning is disrupted, a high level of efficiency can be achieved. This could be done by an AI-based decision support system that simulates alternative day plans. / Byggbranschen har länge varit tveksamt till att applicera nya tekniker. Inom fastighetsutveckling bygger branschen mycket på att anställda tar med sig erfarenheter från ett projekt till ett annat. Dessa anställda lär sig hantera risker i samband med förvärv av mark men när dessa personer slutar eller går i pension försvinner kunskapen. Ett AI baserat beslutssystem som tar risk och marknad i beaktning vid förvärv av mark kan lära sig av varje projekt och ta med dessa kunskaper till framtida projekt. Inom fastighetsförvaltning skulle artificiell intelligens kunna effektivisera allokerandet av personal i den pågående verksamheten. Syftet med studien är att analysera hur företag i fastighetsbranschen kan förbättra sitt beslutstagande med hjälp av AI i utveckling av fastigheter samt fastighetsförvaltning. I denna studien har två fallstudier av två olika aktörer i fastighetsbranschen utförts. Ena aktören, Bygg-Fast, representerar fastighetsutveckling och den andra aktören, VGR, representerar fastighetsförvaltning. Studien bygger på intervjuer, diskussioner och insamlade data. Genom att kartlägga och sedan kvantifiera de risker samt marknadsindikatorer som är indata i processen kan ett underlag skapas. Underlaget kan användas för en modell som lägger grunden för ett AI baserat beslutsstödsystem som ska hjälpa fastighetsutvecklaren med att ta kalkylerade beslut i mark förvärvsprocessen. Genom att kartlägga hur ett flöde genom en fastighet ser ut kan mätpunkter sättas ut för att analysera hur lång tid aktiviteterna tar i den specifika verksamheten. Dessa mätvärden ger en samlad data som gör det lättare att planera verksamheten som bedrivs i fastigheten. Ett effektivare flöde kan uppnås genom att visualisera hela processen så personal kan allokeras till rätt del av flödet. Genom att vara flexibel och kunna planera om verksamheten snabbt ifall planering störs kan en hög effektivitet nås. Detta skulle kunna göras av ett AI baserat beslutsstödsystem som simulerar alternativa dagsplaneringar.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Background: In 1999, The International Study of Asthma and Allergies in Childhood (ISAAC) Phase One reported the prevalence of eczema symptoms in 715,033 children from 154 centers in 56 countries by using standardized epidemiologic tools. Objective: To update the world map of eczema prevalence after 5 to 10 years (ISAAC Phase Three) and include additional data from over 100 new centers. Methods: Cross-sectional surveys using the ISAAC questionnaire on eczema symptoms were completed by adolescents 13 to 14 years old and by parents of children 6 to 7 years old. Current eczema was defined as an itchy flexural rash in the past 12 months and was considered severe eczema if associated with 1 or more nights per week of sleep disturbance. Results: For the age group 6 to 7 years, data on 385,853 participants from 143 centers in 60 countries showed that the prevalence of current eczema ranged from 0.9% in India to 22.5% in Ecuador, with new data showing high values in Asia and Latin America. For the age group 13 to 14 years, data on 663,256 participants from 230 centers in 96 countries showed prevalence values ranging from 0.2% in China to 24.6% in Columbia with the highest values in Africa and Latin America. Current eczema was lower for boys than girls (odds ratio, 0.94 and 0.72 at ages 6 to 7 years and 13 to 14 years, respectively). Conclusion:ISAAC Phase Three provides comprehensive global data on the prevalence of eczema symptoms that is essential for public health planning. New data reveal that eczema is a disease of developing as well as developed countries. / Revisión por pares