To ensure that the resources of the health care sector are used effectively, new technologies need to be evaluated before implementation to examine if they generate health outcomes at an acceptable cost. This information can be collected by performing health economic evaluations in which the costs and health outcomes of different technologies are compared. To estimate the effect on health care budgets, there is also a need for information about the prevalence of the specific disease. Health outcomes in health economic evaluations are often measured in quality-adjusted life years (QALYs), which are calculated by multiplying the remaining life years after an intervention by a weight representing the health-related quality of life (HRQoL) during those years. This thesis aims to provide deeper knowledge of the health economic aspects of diabetic retinopathy (DR), an eye complication that affects patients with diabetes and may in the worst case lead to blindness. The focus is on three empirical and two methodological health economic research questions. The empirical research areas cover prevalence, costs, and HRQoL related to patients with DR. The methodological research questions explore the performance of different methods for estimation of QALY weights. This is of interest since it has been argued that the most common methods for estimating QALY weights may not capture all relevant vision-related aspects of quality of life. The analyses comprehend the validity of different methods for estimating QALY weights among patients with DR and if the results of one of the specific methods for estimating QALY weights, the time trade-off (TTO) exercise, are affected by patients’ subjective life expectancy (SLE). The empirical results demonstrate that DR is seen in approximately 40% and 30% of patients with type I and type II diabetes respectively, indicating that the prevalence of DR has decreased in both of these patient groups. Healthcare costs vary considerably between different severity levels of the disease, being estimated at €26, €257, €216, and €433 per patient per year for background retinopathy, proliferative diabetic retinopathy (PDR), diabetic macular oedema (DMO), and PDR combined with DMO respectively. Blindness due to DR is associated with an increased use of transportation services, caregiving services, and assistive technologies as well as productivity losses. This suggests that preventing the progression of DR may lower healthcare costs. Patients with vision impairment due to DR have lowered HRQoL in various dimensions, but the diagnosis of DR in itself has only a limited effect on HRQoL. The results on the methodological research questions show that different methods for estimating QALY weights seem to give different results. In comparison to EQ-5D, the Health Utilities Index Mark 3 (HUI-3) is the most sensitive method for detecting differences in QALY weights due to DR, and if decisions are to be made based on values from the general public, it can be recommended for use in cost-utility analyses of interventions directed at DR. Neither of the direct methods, TTO and the visual analogue scale, seems to be sensitive to differences in visual function, and more research is needed concerning the role of vision in people’s responses to the TTO exercises. In TTO exercises with time frames based on actuarial life expectancy, the patients’ SLE has an effect on their willingness to trade off years for full health. Thus, applying time frames deviating from patients’ SLE may result in biased QALY weights. Such bias may appear stronger within patient populations than within the general public. In conclusion, this thesis offers estimates for prevalence, costs, and QALY weights that can be used in economic evaluations of interventions directed at DR and as benchmarks for future DR research in order to follow up consequences of changes in diabetes care. In addition, it demonstrates that the choice of method for estimating QALY weights may have an impact on whether an intervention is considered cost-effective.

The aim of the study was to describe and analyse the design of learning environments and how children in preschool, preschool class and primary school create meaning and learn from the teaching aids offered to them in scientific activities planned by teachers. The theoretical reference frame was obtained from multimodal and design-oriented theory, with its focus on the creative dimensions of learning and detailed aspects of how learning takes place. The study is based on video-observations and constituted an in-depth study of a limited number of occasions spent in preschool, preschool classes and the first year of primary school when science lessons were in progress. Four children’s groups, thirty-six children and five teachers took part in the study, from different schools and municipalities. The children are aged between three and seven. The video-observations have been transcribed as text and analysed with analytical concepts found within the theoretical framework. The results show that considering the number of children in the children’s groups, relatively few children take part in the scientific learning contexts. Changes in the balance of power were evident in the learning settings and followed the interaction patterns that were identified in the children’s groups.  The results also show that children create representations – both individually and corporately – in new or different ways that are made up of analogies expressed in terms of equivalent, existential, expressive and figurative analogies. The children’s verbal expressions that corresponded with the responses expected by the teachers were highly valued, were paid attention to and were recognised as know-how. This meant that many of the potential meanings that exist in children’s meaning-making in science become invisible. The results have educational implications for teachers’ work at the local level and for teacher training.

Syftet med detta arbete är att studera utomhusundervisning inom biologiämnet i grundskolans senare år. Arbetet syftar även till att fastställa Ekobussens roll i utomhusundervisningen. Frågeställningarna lyder som följande: •Vilken inställning har lärare till utomhusundervisning inom biologi? •Vad finns det för fördelar och nackdelar med utomhusundervisning? •Vad får elever ut av utomhusundervisning? •Hur använder sig lärare av Ekobussen och vilken inställning har de till den? För att få svar på dessa frågor genomfördes en enkätundersökning med lärare och elever samt djupintervjuer av tre lärare. Resultatet i undersökningen visar att både lärare och elever anser att utomhusundervisning inom biologiämnet inte bedrivs i tillräcklig utsträckning. Orsaker till detta är bland annat osäkerhet hos lärare, brist på bra exkursionsplatser i närområdet samt att det är schematekniskt svårt att få tid att komma ut. Undersökningen visar att de stora fördelarna med utomhusundervisning inom biologi är att eleverna anser sig koppla teoretisk och praktisk kunskap samman samt att många sinnen stimuleras vilket underlättar inlärningen. / The purpose of this work is to study outdoor education in biology, in the later years of compulsory school, and to investigate the role of “Ekobussen” in outdoor education. The questions at issue runs: •What do teachers think about outdoor education in biology? •What benefits and disadvantages are there with outdoor education? •What do the pupils gain by outdoor education? •What are the attitudes of “Ekobussen” by teachers and how do they use it in their work? To answer these questions we handed out a questionnaire to both teachers and pupils, and we also interviewed three teachers. The result of the investigation shows that both teachers and pupils believe that they are not having enough outdoor education in biology. The causes of this are among other things; unsure teachers, no good outdoor areas to examine in the immediate surroundings of the school and lack of time. The investigation shows that the greatest advantages of outdoor education in biology are that the pupils feel that they can connect theoretical- and practical knowledge and that many senses are stimulated which facilitates learning.

In this essay I compare the description of the Thirty Years’ War in a number of German and Swedish encyclopedias published between 1854 and 2005. The essay is a historiographical research with focus on three areas; the description of the war background, the reason of the Swedish intervention in the war and the picture of the Swedish king Gustav II Adolf with the consequences of the war and the peace of Westphalia. I want to analyze the differences and similarities in the way the history is being told in the German and Swedish encyclopedias. The research shows a transformation from a narrative, nationalistic, partial description with focus on individuals and specific events to a more analytical and objective description with focus on structures. Even if the Swedish encyclopedias show a greater change over the time, the encyclopedias from both countries represent a similar progress over time in the way the war is described. A change in the way the history is being presented can be observed somewhere in the middle of the 20th century. The way the war is described, tends to be more homogenous during the second half of the 20th century, while the national context is present in all encyclopedias. The writing of history is contemporary and it’s affected of the social landscape in which it’s written. All articles about the Thirty Years’ War are written out of a national perspective, which makes it the main dissimilarity between the German and the Swedish articles.

Postpartum Depression: Standardizing Motherhood? by Pamela J. Regus Under the Direction of Wendy S. Simonds ABSTRACT An expansion of the medicalization of Postpartum Depression (PPD) is evident in increased screening for maternal depression that begins in pregnancy and continues in the postpartum period, and in the growing number of medical professionals alerted to watch for signs of maternal distress. Although a definitive etiology ofPPDremains elusive, the scientific and medical fields – highly imbued with authority to create knowledge in Western society – promote essentialist views of motherhood that espouse “natural” attributes such as maternal instincts and tendencies to nurture. Mothers who struggle with these standards of motherhood are then defined as being ill and become patients under the care of the medical profession until they can perform adequately in their motherhood roles, or they face social condemnation and legal repercussions for being “bad” mothers. Because characteristics of the “normal” postpartum period are said to be similar to symptoms of general depression, how do some women come to identify their postpartum experiences as depression while others do not? Does the choice of traditional obstetrics or an alternative, such as midwifery, make a difference in the incidence of postpartum depression? And what changes in the social support network occur in a woman’s life as a result of a diagnosis ofPPD? Using Foucault’s theory of docility, critical constructionism, and postmodern feminism as the theoretical focus, and in-depth interviews as the research method, I compare the postpartum experiences of mothers who have been diagnosed with postpartum depression with mothers who have not been diagnosed. The sample includes mothers who gave birth with the assistance of obstetrics and mothers who gave birth with the assistance of certified nurse-midwives. In order to examine the differences in approaches to and treatment of postpartum depression, I also interview a sample of obstetricians and certified nurse-midwives. Findings show that medical professionals use gender-normative assessments, such as physical appearance, language, and nurturing tendencies to determine whether the mother is performing as expected; if not, she is defined as ill and treated with antidepressant medication. Although the majority of mothers in the sample experienced feelings of depression in the postpartum period, many resisted diagnosis and medication. Mothers found the greatest support in their peers, rather than those closest to them, citing the ability to talk candidly about the struggles they face in their motherhood roles as the way to avert or heal from PPD. This finding highlights the enforcement of normative motherhood within the social institutions of the family and medicine; thus, cultural change from ideological representations of motherhood may come about through peer relationships. INDEX WORDS: Postpartum depression, Motherhood, Medicalization, Expansion of medical control, Maternal behavior, Childbearing years, Normative motherhood

In this study, I conduct a multiple method content analysis of literature on postpartum depression (PPD) from two on-line sources, Medline and LexisNexis. The purpose of the study is to determine how the medical profession defines and frames PPD, and to consider the implications of its movement into the medical model. I use the theories of Foucault, Gramsci, critical constructionism, and postmodern feminism to examine the effect of the medicalization of PPD on women’s lives. Using both simple descriptive statistics and qualitative analysis, I show the expansion of medical control over women’s bodies in the childbearing years beyond the physical to include the emotional and psychological aspects as well, which results in standardized maternal behaviors and emotions that tighten the boundaries of motherhood.

Ett flertal både internationella och nationella undersökningar visar att svenska skolelever blir allt sämre på matematik. Ett delområde som ofta utpekas är geometri. Denna undersökning syftar till att ta reda på hur ämnet geometri har utvecklats i den svenska skolan samt vilka metoder och begrepp lärare använder sig av när de undervisar i geometri i de tidigare skolåren. Empirin har hämtats från åtta semistrukturerade intervjuer och från studier av gamla läroplaner. Resultatet visar att lärare använder en mängd begrepp och metoder i sin undervisning men att det finns ett behov av fortbildning hos lärarna. Undersökningen visar också att ämnets betydelse i skolans styrdokument har varierat över tid. / A number of both international and national enquires shows that Swedish pupils are getting worse results in mathematics. One area that’s frequently pointed out is geometry. This enquiry intends to find out how the subject of geometry has developed in the Swedish school and witch methods and concepts teachers who teach in preschool and the early school years grade use in their teaching. This enquiry is based upon eight semi structured interviews and from studying previous curriculums. The result shows that teachers use a great deal of concepts and methods in their teaching but that there are a need for further education among teachers. The enquiry also shows that the significance of the subject has changed over time.

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Background and purpose: Tuberculosis (TB) is one kind of chronic infectious disease which caused by the mycobacterium tuberculosis, and still widely exists in the world. In Taiwan, there are approximately 15,000 new tuberculosis patients and 1,300 died annually. The incidence and mortality rate rank the number one among the legal reported disease in Taiwan. Therefore, how to prevent and control the tuberculosis becomes a crucial policy for Centers for Disease Control (CDC) in Taiwan. Directly Observed Treatment, Short-course (DOTS) is a TB control program implemented in many countries aggressively by the World Health Organization (WHO) since 1993. The implementation method is that patients are supervised by well-trained health care staff while medication is administered, to assure the clients taking each dose of medicine. This policy is intended to cure the patient in time, cutting off the infectious sources, prevent the efficacy of anti-tuberculosis drugs and cease the emerging of multidrug resistant tuberculosis (MDRTB) . For the long-term planning and the target of ¡§Halve the TB over the next ten years,¡¨ the CDC of Taiwan has been enforced the DOTS program since April 1st, 2006. The rate implementing DOTS in smear- positive case has been exceeded 90%. The purpose of this study is to examine the effect of DOTS policy on the outcomes of Tuberculosis before and after the DOTS policy implementation. Methods: The secondary databases from the study hospital were retrieved. The data included 24 months before and after the DOTS implementing (April 1st, 2006). We investigated if there¡¦s significant improvement in treating tuberculosis after the DOTS. Both descriptive and Chi-square tests were used to depict the study sample and to examine the correlation between treatment outcome and DOTS, respectively. Results: There is no difference on treatment outcome between male and female. Male had higher cavity formation on the chest x-ray. There¡¦s more easy treatment completion when the clients were younger than 65 years old. No cavity on the chest x-ray was statistically associated with negative acid fast stain. The chest x-ray showed cavity was related to higher completion rate of treatment. There¡¦s no correlation between the acid fast stain and treatment completion. There¡¦s no significant difference on treatment outcome after the DOTS implementing. Conclusions: There¡¦s no difference in treatment result between the ¡§DOTS¡¨ and ¡§without DOTS¡¨ group after April 2006. The reason we deliberate that may be the study hospital is located at the urban area, which is high prevalence area in tuberculosis and thus have been under control for years. The completion rate in tuberculosis treatment is already high enough. No wonder there¡¦s no such difference. Anyway, we can not ignore the policy of the DOTS, we must keep cooperation with this policy, make great efforts on tuberculosis prevention and control in Taiwan.

<p>Syftet med detta arbete är att studera utomhusundervisning inom biologiämnet i grundskolans senare år. Arbetet syftar även till att fastställa Ekobussens roll i utomhusundervisningen. Frågeställningarna lyder som följande:</p><p>•Vilken inställning har lärare till utomhusundervisning inom biologi?</p><p>•Vad finns det för fördelar och nackdelar med utomhusundervisning?</p><p>•Vad får elever ut av utomhusundervisning?</p><p>•Hur använder sig lärare av Ekobussen och vilken inställning har de till den?</p><p>För att få svar på dessa frågor genomfördes en enkätundersökning med lärare och elever samt djupintervjuer av tre lärare.</p><p>Resultatet i undersökningen visar att både lärare och elever anser att utomhusundervisning inom biologiämnet inte bedrivs i tillräcklig utsträckning. Orsaker till detta är bland annat osäkerhet hos lärare, brist på bra exkursionsplatser i närområdet samt att det är schematekniskt svårt att få tid att komma ut.</p><p>Undersökningen visar att de stora fördelarna med utomhusundervisning inom biologi är att eleverna anser sig koppla teoretisk och praktisk kunskap samman samt att många sinnen stimuleras vilket underlättar inlärningen.</p> / <p>The purpose of this work is to study outdoor education in biology, in the later years of compulsory school, and to investigate the role of “Ekobussen” in outdoor education. The questions at issue runs:</p><p>•What do teachers think about outdoor education in biology?</p><p>•What benefits and disadvantages are there with outdoor education?</p><p>•What do the pupils gain by outdoor education?</p><p>•What are the attitudes of “Ekobussen” by teachers and how do they use it in their work?</p><p>To answer these questions we handed out a questionnaire to both teachers and pupils, and we also interviewed three teachers.</p><p>The result of the investigation shows that both teachers and pupils believe that they are not having enough outdoor education in biology. The causes of this are among other things; unsure teachers, no good outdoor areas to examine in the immediate surroundings of the school and lack of time.</p><p>The investigation shows that the greatest advantages of outdoor education in biology are that the pupils feel that they can connect theoretical- and practical knowledge and that many senses are stimulated which facilitates learning.</p>