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  • Public defence: 2019-05-10 13:00 Forum Humanum, Jönköping
    Monwell, Bodil
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Social Work. Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue).
    En dyster parentes – opiatregeln i svensk LARO-behandling 2010–20162019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Opioids are well documented to arouse euphoria, relieve pain, and to have a high dependency potential. Opioid dependence is a serious chronic condition with a high risk of extensive worsened health, relapse and premature death.

    Opioid maintenance treatment (OMT) is well researched and has strong scientific support. In Sweden, OMT over time was subjected to polarised and infected political debate and has been strictly regulated by the National Board of Health and Welfare (NBHW). During 2010–2016 NBHW redefined the diagnostic concept of “opiate dependence” in the regulation SOSFS 2009:27. Dependence to only three opioids: heroin, opium or morphine, could give eligibility to OMT (here called the “opiate rule”). The purpose stated was to prevent those dependent to other opioides, e.g. buprenorphine,from receiving OMT. Applicants with severe opioid dependence were thereby divided into two subgroups: those with “opiate” dependence related to heroin, morphine or opium, and those with opioid dependence who lacked documentation in relation to the three opiates. The question is whether there were differences between these groups concerning problem severity or substance-related diagnostics that could justify differences in access to OMT?

    A population (n = 127) actualised for OMT during 2005-2011 in Jönköping County is studied regarding severity of problems, diagnostics and trajectories in and out of treatment. In order to provide precise drug use data, a cognitive tool for taking anamnestic information, called the Drug List, was developed.

    In Study I, using the Addiction Severity Index, the two groups were found to be quite similar in severity of health problems, social situation and drug problems, including overdoses and injections.

    In Study II, the Drug List was found to be superior to a traditional way of taking anamnestic data, more sensitive and giving more precise data, without taking more time. Validity was shown in relation to faked drugs.

    In Study III, using a structured diagnostic interview, ADDIS, with the Drug List, showed that both two groups qualified for severe opioid dependence, that opiates and other opioids had contributed equally to the development of opioid dependency, and that the two groups also had similar additional substance dependence problems.

    Study IV investigated how “the opiate rule” affected practice by interviewing representatives of OMT clinics as well as a representative of a users’ association. The regulation created dilemmas for clinics as well as for users. Users developed a strategy of getting "negative merits" for being eligible to OMT. Clinicians developed strategies to find ways “around” the regulation in order to admit patients in OMT.

    Study V followed those who had applied for OMT and found four trajectory subgroups – those denied OMT, those discharged, those readmitted, and those who remained in treatment. The study provides evidence for a more positive development being related to more involvment in OMT concerning health, social situation as well as substance use problems. Being denied or discharged is related to increased risks of a negative development.

    The thesis conclude that there was no support for dividing applicants according to “the opiate rule”. The purpose of top-down control using regulations, is to guarantee uniform and knowledge-based care. In this case the regulation had negative effects in these respects, increasing risks for the applicants, and lost credibility from the profession. The opiate rule in SOSFS 2009:27 is therefore a dismal parenthesis in the history of OMT in Sweden, and could be studied to prevent similar mistakes in the future.

  • Public defence: 2019-05-17 10:00 B1014, Jönköping
    Duras, Toni
    Jönköping University, Jönköping International Business School, JIBS, Statistics.
    Applications of common principal components in multivariate and high-dimensional analysis2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis consists of four papers, all exploring some aspect of common principal component analysis (CPCA), the generalization of PCA to multiple groups. The basic assumption of the CPC model is that the space spanned by the eigenvectors is identical across several groups, whereas eigenvalues associated with the eigenvectors can vary. CPCA is used in essentially the same areas and applications as PCA.

    The first paper compares the performance of the maximum likelihood and Krzanowski’s estimators of the CPC model for two real-world datasets and in a Monte Carlo simulation study. The simplicity and intuition of Krzanowski's estimator and the findings in this paper support and promote the use of this estimator for CPC models over the maximum likelihood estimator.

    Paper number two uses CPCA as a tool for imposing restrictions on system-wise regression models. The paper contributes to the field by proposing a variety of explicit estimators, deriving their properties and identifying the appropriate amount of smoothing that should be imposed on the estimator. 

    In the third paper, a generalization of the fixed effects PCA model to multiple populations in a CPC environment is proposed. The model includes mainly geometrical, rather than probabilistic, assumptions, and is designed to account for any possible prior information about the noise in the data to yield better estimates, obtained by minimizing a least squares criterion with respect to a specified metric.

    The fourth paper survey some properties of the orthogonal group and the associated Haar measure on it. It is demonstrated how seemingly abstract results contribute to applied statistics and, in particular, to PCA.

  • Public defence: 2019-05-17 12:00 Hb116, Jönköping
    Öberg, Joakim
    Jönköping University, School of Education and Communication, HLK, Learning Practices inside and outside School (LPS), Plats, Identitet, Lärande (PIL).
    Samhällskunskap från styrdokument till undervisning: Tjugo lärare ramar in vad som påverkar deras praktik2019Doctoral thesis, monograph (Other academic)
    Abstract [en]

    The purpose of this doctoral thesis in social studies didactics is to examine what teachers in social studies themselves perceive as the most important influencing factors for transforming the social studies subject, based on the intentions of the curriculum (the formulation arena), into social studies classroom teaching and assessment (the realisation arena), and how these perceptions have changed over time. It is thus what happens between the formulation arena and the realisation arena - the transformation arena, that is the focus of this thesis. The study is based on a hermeneutic-phenomenological lifeworld approach where phenomenological description and hermeneutic interpretation are essential. The empirical data consist of lifeworld interviews with 20 teachers in social studies in lower and upper secondary school; ten with long professional experience and ten fairly recently graduated.

    Based on inspiration from the frame factor theoretical perspective, the result is thematically organised according to four dimensions of influencing factors: the personal dimension, the didactic dimension, the governing dimension and the societal dimension. Each of these dimensions is divided into a number of variations. The dimensions are defined along a continuum of the personally close to the societally distanced. In addition to these dimensions, the student-related aspect, which accounts for the students as an influencing factor, was introduced. The teachers in the study do not talk about the students as an influencing factor without linking them to one of the four dimensions.

    The conclusion drawn from the study is that the 20 teachers all have very different stories about what they perceive as the most important influencing factors. Some focus on personal background or personal interests. Others focus on didactic ideas, on the curriculum or on organisational and economic frames. The study also shows that the teachers all have one or two dominant dimensions discernible in their stories, which also affect how they talk about the other dimensions. The teachers' stories also show that they feel that the teaching and what affects it change significantly over time. At the collective level, the two respondent groups differ on a number of aspects; however, the interview material reveals similarities among the individual teachers, whether they have worked for 40 years or are newly graduated, when it comes to other aspects.

    Perhaps the most important contribution of the study is that it exemplifies theoretical perspectives by, for instance, highlighting that what affects the teaching of a subject is so complex that the framework factor theoretical scaffolding must be adapted to the specific study and its issues and research materials.

  • Public defence: 2019-05-17 13:00 Forum Humanum, Jönköping
    Kapetanovic, Sabina
    Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue).
    Mutual actions - Developmental links between aspects of the parent-adolescent relationship and adolescent risk behaviors2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Adolescence is a critical time for the onset or intensification of engagement in risk behaviors, such as delinquency and alcohol use. Parents are often advised to supervise adolescents or set rules for behavior control in order to protect their adolescents from harm. But are such parenting strategies advantageous in preventing adolescents from engaging in risk behaviors? Little is known about what role adolescents play in the parent- adolescent relationship and their own psychosocial development? The overall aim of the dissertation was to investigate how parent- and adolescent-driven communication efforts occurring in the parent-adolescent relationship relate to risk behaviors in early to mid- adolescence.

    Findings show that adolescent-driven communication efforts (i.e. disclosure about their everyday activities) play a prominent role in the parent-adolescent relationship and adolescent engagement in risk behaviors. Adolescent disclosure is linked to parental knowledge of an adolescent’s whereabouts, parent-adolescent emotional connectedness, and decreases in adolescent risk behaviors over time. While parental behavioral control of adolescent whereabouts can indeed be protective of adolescent engagement in risk behaviors, parents’ soliciting efforts are related to higher levels of engagement in delinquency and substance use. This is particularly true for boys and adolescents with detached and fearless temperament. However, when adolescents are willing to communicate, parents can elicit more disclosure from their adolescents through soliciting efforts.

    This dissertation suggests that parents and adolescents both play important roles in parenting and parent-adolescent relationships. Parents can protect their adolescents from engagement in risk behaviors, especially when adolescents share information with their parents.

  • Public defence: 2019-05-24 13:00 Forum Humanum, Jönköping
    Möller, Saffran
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Functioning in prosthetic users provided with and without a microprocessor-controlled prosthetic knee – relative effects on mobility, self-efficacy and attentional demand2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: To undergo a lower limb amputation is a traumatic experience affecting the individual on physical as well as psychological levels and often leading to limitations in a person´s daily life. Following an amputation individual often receive a prosthesis to address impairments in mobility and functioning. The mechanical properties of the prosthesis can vary, and the choice of specific components to include in the device has been demonstrated to influence patient outcomes. Studies investigating the relative effects of different prosthetic knee components have generally focused upon physical and biomechanical outcomes, providing a rather narrow view of health-related states in prosthetic users. There is a need to view health and wellbeing of prosthetic users from a broader perspective by evaluating outcomes that reflect a variety of different factors that can influence their functioning.

    Aim: The overall aim of this thesis was to describe and compare functioning in individuals with a trans-femoral amputation or knee disarticulation and to evaluate the relative effects of using non-microprocessor-controlled prosthetic knees (non-MPK) or microprocessor-controlled prosthetic knees (MPK).

    Methods: The four studies presented in this thesis used a cross-sectional, quantitative design with different types of data collection methods. These included self-report measures, capacity tests, a survey with two questionnaires and a measure of cortical brain activity during normal level waking and while performing a secondary task. One group of 42 individuals with lowerlimb amputations, using a prosthetic knee with or without microprocessor-control was included in the survey study. Another group of 29 individuals with a lower limb amputation, using a prosthetic knee with or without a microprocessor-control and a control group (n=16) participated in the remaining studies. Statistical tests were used to compare differences between groups using different knee joints, between prosthesis users and controls.

    Results: Individuals using a non-MPK had lower self-reported mobility and balance confidence as well as poorer results on mobility tests compared to those using an MPK. Results revealed no significant differences in self-rated health, daily step count or general self-efficacy. Increased cortical brain activity was seen in frontal cortex in individuals using a non-MPK in single-task walking compare to the MPK group and controls. A significant increase in brain activity was also seen in prefrontal cortex in dual-task walking compared to single-task walking in those walking with an MPK and controls.

    Conclusion: Combined results of all four studies suggest that persons provided with an MPK had better mobility, both self-rated and objectively evaluated, and better self-rated balance confidence than those who were using a non-MPK. Results also showed that an individual’s belief in their own ability was associated with the number of hours they use their prosthesis per week. Participants using a non-MPK had higher levels of cortical brain activity in the frontal cortex during walking, suggesting that the attentional demand required to walk was greater than for individuals using an MPK. Of particular interest for health professionals involved in prosthetic rehabilitation was the finding that significant increases in attentional demand were not always reflected in temporospatial gait parameters. This suggests that cognitive demands may not always be reflected in variables that are commonly evaluated in the clinical setting.

  • Public defence: 2019-06-05 13:00 Forum Humanum, Jönköping
    Rundqvist, Louise
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Biomedical Platform.
    Aspects of regular long-term endurance exercise in adolescents, with focus on cardiac size and function, hormones, and the immune system2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The long-term effects of starting high-intensity training at younger ages are largely unknown. The present studies focused on adolescents who had performed regular endurance exercise for several years at an elite level and compared those subjects with a control group of adolescents of similar age and sex who had not engaged in regular exercise. The knowledges generated by this research will contribute to further understanding of some of the physiological effects of strenuous regular exercise during adolescence.

    Aim: The overall aim of this research was to investigate endurance-trained adolescents, focusing on cardiac size and function, hormones associated with growth and metabolism, and impact on the immune system.

    Methods: All participants underwent echocardiography at rest as well as immediately and 15 minutes after amaximal cardiopulmonary exercise test. Blood samples were taken at rest and analyzed for biomarkers such as hormones, immune cell surface markers, and secreted cytokines and chemokines. The study design was crosssectional (Papers I, III, and IV) and comparative, with a quantitative approach in all four studies. The evaluationin Paper II used a pre-post test design with measurements of cardiac parameters before and after a maximal treadmill test. The studies in Papers I–III compared endurance-trained (active group) and untrained (controls) adolescents matched by age and sex, whereas the analysis in Paper IV considered differences between the sexes in the endurance-trained adolescents.

    Results: Compared with controls, the endurance-trained adolescents showed increased size of all four heart chambers, as well as improved cardiac systolic function at rest. Considering cardiac changes from baseline to immediately after exercise, the systolic and diastolic patterns were similar in both groups, although the diastolic function was more enhanced in the active group. Strong associations between peak oxygen uptake and cardiac size and function could be seen both at rest and after exercise. Circulating hormones at rest did not differ between the two groups. No correlation between insulin-like growth factor 1 and cardiac size was found among the endurance-trained adolescents. Compared with endurance-trained girls, endurance-trained boys exhibited an elevated response to a potent type 1 diabetes-related autoantigen. Conversely, compared with the trained boys, the trained girls showed an increased number of circulating immune cells and increased secretion of C-peptide and proinsulin.

    Conclusions: There are many benefits associated with regular exercise, and the present research did not provide any data to oppose that statement. Factors such as increased cardiac size at rest and exercise-related effects on cardiac functions do occur and therefore should be expected in endurance-trained adolescents with high peak oxygen uptake. Indeed, this should be interpreted as a sign of physiological adaptation and not as pathophysiology. The greater cardiac dimensions observed in these subjects could not be related to increased resting levels of hormones associated with growth and metabolism. The endurance-trained adolescents did show some sex-related differences with regard to their immune response at rest.