ABSTRACT Background Water is an essential requirement for the survival and development of people. It is estimated that 435 million people get their drinking water from unprotected wells worldwide. Water scarcity and chemical or biological aspects in water have been revealed, which can negatively affect health. This study aims to explore individuals’ experiences in drinking water with non-public water, hence individual wells. A further aim of the study is to explore authorities’ perspectives for implementing safe drinking water (SDGs 6) in Swedish coastal and rural areas.     Method In this qualitative study, semi-structured interviews were implemented to explore the experiences of 17 individual well owners and 4 authorities in non-public water use in Sweden. A thematic analysis was conducted to analyse the collected data.     Findings There were three main findings in the study: Firstly, concerns about water scarcity and water quality, mostly from families with children. Secondly, there was a feeling of exclusion among individuals due to lack of support from authorities and thirdly, a gap between existing assessment guidelines and the practices of individuals in terms of follow-up and benchmarking of the National health guidelines.   Conclusion The experiences of the individual well owners in Stockholm had some concerns due to water quality, the understanding, and implementation of the guidelines to safe drinking water. The authorities also highlighted the need for sustainable strategies. It concluded that multi-disciplinary approaches, communication, and community participation are necessary for a sustainable water strategy. These must be addressed globally as climate change impacts water supply and has a massive effect on rural and coastal areas. / <p>_{<em>We never know the worth of water till the well is dry (Thomas Fuller)</em>}</p> / The project “Evaluation of individual wells and systems”

Philosophiae Doctor - PhD / In this thesis, I use gender and human rights approaches to examine and analyse the major causes of maternal mortality, which result from delay in seeking maternity care and failure to attend maternity care during pregnancy. A gender approach was used to identify and analyse inequalities that arise from belonging to one sex or from unequal power relations between sexes and how these impact on women accessing maternity care. The Human Rights approach was used to identify and analyse health system related factors that led women to delay seeking care and also failing to attend maternity care. A qualitative multiple case study methodology was followed with data analysed thematically. Findings were interpreted in the context of the International Bill of Rights, the South African Bill of Rights and International Human Rights treatises. Maternity women are unable to access maternity care because of their unmet gender equity needs, and because of maternity services that are not respecting, protecting and fulfilling their human right to access health care. A Gender-Human rights model of accessibility to quality maternity care is developed to assist health care providers in promoting availability of maternity services to health consumers. The model propositions are based on the major concepts which are: Gender equity, Women empowerment, Human rights to quality health care, Evidence Based Health Care, and Support during labour.

The main aim of this master’s thesis is the design of combined child stroller which will be accepted the demands and needs of the users, not only children but also their parrents. Outside the observance of general technical, structural and ergonimical parameters should be the base of design simplicity, originality and creativity, which should bereflected to all shape of parts of the stroller, but also in addressing the functional and structural elements. The aim is therefore also move the the design and function of children's strollers combined on the next level up.

he thesis deals with safe operation of ammonia refrigeration technologies on ice pools in the Czech Republic. This thesis focuses on the possibility of evaluation and risk operation management. The thesis starts with a summary of basic factors affecting safe operation on ice pools. This includes also possible ways how to realize the ammonia refrigeration technology including week and strong part of different access. The ice pool are splitted into tree groups based on a precondition for a safe operation. Next, there is done analysis of current legal and directive frame for safe operation of ice pools in the Czech Republic. There are also included a methods for evaluation and simulation of risk for ihabittants. There is named a metod STADION_01 dedicated to evaluate a capability of tested companies to manage operations risk. Practical experience with evaluation are included. The metod stress, that is important to keep long-lasting and pernament safe operation of ammonia refrigeration.

博士（社会学） / 133p / 一橋大学

Bakgrund: Sjuksköterskor inom ambulansverksamheten utsätts för många olika situationer i arbetsmiljön som riskerar att påverka vårdandet av patienterna. De riskerar att utsättas för både fysiska och psykiska påfrestningar som i vissa fall kan medföra att den patientsäkra vården riskerar att äventyras. Syfte: Syftet med studien var att undersöka sjuksköterskans erfarenheter av hur arbetsmiljön kan påverka vårdandet inom ambulanssjukvården. Metod: Studien var en kvalitativ intervjustudie som byggde på semistrukturerade intervjuer. Det var 15 sjuksköterskors erfarenheter inom ambulansverksamheten som ligger till grund för resultatet. Intervjuerna analyserades genom en kvalitativ innehållsanalys med en manifest ansats. Resultat: Resultatet belyste att det finns ett flertal faktorer inom arbetsmiljön som enligt ambulanspersonalens erfarenhet påverkar vårdandet inom den prehospitala sjukvården. Analysen av intervjuerna resulterade i fem olika teman, Dygnet runt verksamhet, Otrygg arbetsmiljö, Mötet, Fysiskt arbete samt Kunskap. Dessa teman sammanfattar informanternas erfarenheter av hur arbetsmiljön riskerar att påverka vårdandet. Slutsats: Slutsatsen med studien visar att det är många faktorer med arbetsmiljön som påverkar vårdandet. Faktorer som ansågs viktiga var mötet med sina kollegor, patienter och anhöriga. Kunskap och kunskapsbrist togs upp som en viktig aspekt när det handlar om att det ska vara möjligt att utföra en patientsäker vård. Många upplevde de långa arbetspassen som slitsamma vilket i sin tur riskerar att påverka mötet med alla inblandade. Det som upplevdes som positivt var att i dagens ambulanssjukvård förfinas hjälpmedlen hela tiden vilket innebär mindre lyft vilket ses som positivt både för patienterna och ambulanspersonalen. / Background: Nurses in the ambulance business are exposed to many different situations in the work environment that risk affecting the care of the patients. They risk being subjected to both physical and mental stress, which in some cases can result in the risk of patient-safe care being compromised. Aim: The aim of the study was to investigate the nurse's experiences of how the work environment can affect the care in ambulance care. Method: The study was a qualitative interview study based on semi-structured interviews. It was 15 nurses' experiences in the ambulance business that form the basis for the result. The interviews were analyzed through a qualitative content analysis with a manifest approach. Result: The result highlighted that there are a number of factors in the work environment that, according to the experience of the ambulance staff, affect the care in prehospital care. The analysis of the interviews resulted in five different themes, Round the clock activities, Safe working environment, Meeting, Physical work and Knowledge. These themes summarize the informants' experiences of how the work environment risks affecting care. Conclusion: The conclusion of the study shows that there are many factors with the working environment that affect the care. Factors that were considered important were the meeting with their colleagues, patients and relatives. Knowledge and lack of knowledge were raised as an important aspect when it comes to whether it should be possible to perform patient-safe care. Many experienced the long work passes as tiring, which in turn risks affecting the meeting with everyone involved. What was perceived as positive was that in today's ambulance care, the aids are constantly refined which means less lifting which is seen as positive for both the patients and the ambulance staff.

Bakgrund: Arbetet på en akutmottagning beskrivs som stressfyllt och innebär hög arbetsbelastning för sjuksköterskorna. Sjukvården regleras av ett antal lagar för att säkerställa att vården håller god kvalitet och även arbetsmiljön för sjuksköterskorna regleras i lagar och föreskrifter. Det är sjuksköterskans kompetensområde och ansvar att bedriva säker vård och se till att patienter inte far illa i sjukvården. Att vara sjuksköterska på en akutmottagning är både ansvarsfullt och krävande. Därför behövs sammanställd kunskap om hur sjuksköterskorna upplever att deras arbetsmiljö påverkar patientsäkerheten. Syfte: Syftet var att beskriva arbetsrelaterad stress, hög arbetsbelastning och patientsäkerhet på en akutmottagning ur sjuksköterskans perspektiv. Syftet kompletteras av tre frågeställningar: Vilken upplevelse och uppfattning har sjuksköterskan om arbetsrelaterad stress? Vilken upplevelse och uppfattning har sjuksköterskan om hög arbetsbelastning? Vilken upplevelse och uppfattning har sjuksköterskan om hur arbetsrelaterad stress och hög arbetsbelastning påverkar patientsäkerheten? Metod: Arbetet har utformats som en litteraturöversikt. Artiklar har sökts i databaserna PubMed och Cinahl och kvalitetsgranskats med hjälp av färdiga mallar från Högskolan Dalarna. Artiklarna har analyserats efter att de lästs igenom och har sedan kategoriserats avseende likheter och skillnader. Utifrån dessa kategorier har huvudkategorier och underkategorier skapats som resultatet presenterats under. Författarna till litteraturöversikten har reflekterat över sin egna förförståelse och strävat efter ett objektivt förhållningssätt till resultatet. Resultat: Litteraturöversikten resulterade i tre huvudkategorier: (1) sjuksköterskans upplevelse och uppfattning av arbetsrelaterad stress, (2) sjuksköterskans upplevelse och uppfattning av hög arbetsbelastning och (3) sjuksköterskans upplevelse och uppfattning av påverkan på patientsäkerheten. Slutsats: Litteraturöversiktens resultat visade att sjuksköterskor upplevde arbetsrelaterad stress när arbetsbelastningen var hög. Personalbrist, stort antal patienter, tidsbrist och dålig kommunikation och bristande teamwork var bakomliggande faktorer för hög arbetsbelastning. Vid arbetsrelaterad stress och hög arbetsbelastning upplevde sjuksköterskorna att patientsäkerheten påverkades negativt. / Background: To work in an emergency department is described as stressful and means high workload for the staff, which leads to work related stress. The healthcare is controlled by laws to ensure that the quality of the care is good. It is in the nurses competence to manage a safe care and ensure that patients doesn´t get hurt. It is both demanding and the nurse has a responsibility when working in an emergency department. That’s why compiled knowledge is needed to find out nurses experience of how their work environment affects the patient safety. Aim: The aim of this literature review was to describe work related stress, high workload and patient safety in an emergency department from a nurses’ perspective. The aim divides in three issues: What experiences and perceptions do nurses have of work related stress? What experiences and perceptions do nurses have of high workload? What experiences and perceptions do nurses have of how work related stress and high workload impacts patient safety? Method: This essay has been designed as a literature review. Articles has been searched from two databases called PubMed and Cinahl and also it´s quality has been controlled by templates from Högskolan Dalarna. The articles is analysed by the writers of this essay reading through them and then categorized them by similarity and differences. From those categories main- and subcategories were formed under which the results is presented. The writers of this essay has reflected over their own understanding and therefore aimed for an objective approach of the result. Results: The literature review resulted in three main themes: (1) nurses experiences and perceptions of work related stress, (2) nurses experiences and perceptions of high workload and (3) nurses experiences and perceptions of impact on patient safety. Conclusion: The result of this literature review shows that nurses experienced work related stress in times of high workload. Shortages in staffing levels, a large number of patients, lack of time and poor communication and poor teamwork contributed to create and increase high workload. With work related stress and high workload nurses experienced that patient safety were impacted in a negative way.

This thesis investigates the utilisation of maternal health care in Zambia, where despite being a signatory to the Safe Motherhood Initiative and Millennium Development Goals, which are aimed at improving maternal health, indicators of maternal health continue to perform poorly. The need to understand crucial factors in improving maternal health motivated the current research, especially since there is a dearth of literature in this area in Zambia. The thesis focuses on two aspects of maternal health care: antenatal care (ANC) and facility-based deliveries, to answer two broad questions. Firstly, what factors determine the use of ANC in Zambia? Secondly, to what extent has the abolition of user fees affected facility-based deliveries? An assessment of the factors, which explain the utilisation of ANC in Zambia, using three sets of comparable datasets reveals that, while there are differences in the factors explaining the decision to use ANC and the frequency of visits over time, the decision to seek ANC and the frequency of use is low among the poor and less educated, and there are marked regional differences in utilisation. The most appropriate econometric specification for antenatal visits, according to different performance indicators, was the two-part model, which differs from recent research favouring more complex methodologies. The analysis is further extended through the inclusion of supply-side factors and the examination of individual and community level factors associated with inadequate and non-use of ANC, following the adoption of the focused ANC approach in Zambia. To incorporate the supply side factors, the 2007 Zambia Demographic and Health Survey was linked to administrative and health facility census data using geo-referenced data. To assess the factors associated with (1) the inadequate use of ANC (defined as three or less visits), and (2) the non-use of ANC in the first trimester of pregnancy, we specify two multilevel logistic models. At the individual level, the woman’s employment status, quality of ANC received and the husband’s educational attainment are negatively associated, while parity, the household childcare burden and wealth are positively associated with inadequate utilisation of ANC. Both individual and community level characteristics influence inadequate use and non-use of ANC in the first trimester; however, community level factors are relatively stronger in rural areas. Although ANC is an important facet of maternal care, it occurs before delivery, but does not necessarily provide much information with respect to delivery decisions. Therefore, the thesis investigates delivery decisions, as well, in particular, the effect of user fee removal in rural areas of Zambia on facility-based deliveries. To account for regional differences, we employ a Seemingly Unrelated Regression model incorporating an Interrupted Time Series design. The analysis uses quarterly longitudinal data covering 2003q1-2008q4. When unobserved heterogeneity, spatial dependence and quantitative supply-side factors are controlled for, user fee removal is found to immediately increase aggregate facility-based deliveries, although the national trend was unaffected. Drug availability and the presence of traditional birth attendants also influence facility-based deliveries at the national level, such that, in the short-term, strengthening and improving community-based interventions could increase facility-based deliveries. However, there is significant variation and spatial dependence masked in the aggregate analysis. The results highlight the importance of service quality in promoting facility-based deliveries, and also suggest that social and cultural factors, especially in rural areas, influence the use of health facilities for delivery. These factors are not easily addressed, through an adjustment to the cost of delivery in health facilities. Additionally, we analyse the effect of user fee abolition on the location of childbirth, focussing on deliveries that occur in public health facilities using household survey data. To elicit the causal relationship, we exploit the relative change in fees across health districts within a difference-in-differences framework. Surprisingly, although reductions in home deliveries were observed, as expected, reductions in public health facility-based deliveries were also uncovered, along with increases in deliveries at private health facilities. However, these findings were statistically insignificant; suggesting that the abolition of user fees had little, if any, impact on the choice of location for childbirth. The statistically insignificant, but unexpected, causal effects further suggest that the removal of user fees have unintended consequences, possibly the transference of facility costs to the client, which would deter the utilisation of delivery services. Therefore, abolishing user fees, alone, may not be sufficient to affect changes in outcomes; instead, other efforts, such as improving service quality, could have a greater impact. / Thesis (PhD)--University of Pretoria, 2013. / gm2014 / Economics / unrestricted

Bakgrund: Inom dagens slutenvård möter legitimerade sjuksköterskor en ökad arbetsbelastning samtidigt som sjuksköterskor förväntas utföra god och säker vård gentemot patienter. Situationen kan resultera i att vårdskador uppstår och patientsäkerheten äventyras.  Syfte: Syftet var att belysa de faktorer som har betydelse för patientsäkerheten inom slutenvården utifrån sjuksköterskors perspektiv. Metod: Litteraturöversikt baserat på 20 artiklar med både kvalitativ och kvantitativ ansats. Resultat: Faktorer som påverkade patientsäkerheten identifierades som ogynnsam Arbetsmiljö, vårdpersonalens Kompetens, Kommunikation, Samarbete inom vårdlaget och Patientsäkerhetskulturen på avdelningen. Slutsats: Det är av vikt att identifiera arbetsrelaterade faktorer för att skapa en bättre arbetsmiljö och förebygga uppkomsten av vårdskador vilket leder till en förbättrad patientsäkerhet och en säker vård. / Background: Registered nurses of today in the inpatient care face increased workload concurrently when nurses are expected to deliver good and safe care for patients. The situation of today´s health care may result in patient safety events and jeopardizing patient safety. Aim: The aim of this study was to describe factors in inpatient care that can have an impact on patient safety. Method: A literature review including 20 articles with both qualitative and quantitative approach was performed. Results: Factors that have an impact on patient safety were identified as unfavorable Work environment, Healthcare workers competence, Communication, Cooperation within the task force and the patient safety culture in the department. Conclusion: It is important to identify work-related factors in order to create a better work environment and prevent patient safety events which leads to improved patient safety and safe care.

The popularity of agile methodologies is steadily increasing. This study is an intent to balance the agile change literature with a psychological perspective and quantitative measures of an agile change made within a Swedish organization. Organizational change recipients’ beliefs (discrepancy, appropriateness, valence, efficacy, &amp; principal support) and trust in management were measured in an online survey to see how well these variables could predict a successful agile change towards transparency. The results indicate a lack of support for several previously cited success factors in the agile literature and a need for more quantitative and research-driven literature. No support could be found for a relationship between discrepancy, appropriateness, valence, principal support, trust in management, and the outcome of a successful implementation of transparency. Efficacy was found to be a significant and robust predictor of the outcome. More research is needed to ensure the generalizability of the results.