Coming theses from other universities
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Organization for workplace learning in the digitalization of municipal healthcare services
Link: http://urn.kb.se/resolve?urn=urn:nbn:se:hv:diva-22479
This dissertation will explore the intersection of digitalization and innovation focusing on the management of workplace learning. Adopting a sociocultural perspective, it concentrates on the organizational level, specifically on how management supports workplace learning within municipal healthcare services. The research in the dissertation is delimited to a Nordic healthcare sector, focusing on healthcare within municipal homecare and nursing homes in Sweden and Norway. In many countries, digitalization and innovation are increasingly seen as vital tools for tackling societal challenges and promoting sustainability, particularly concerning the growing gap between available resources and the increasing need for healthcare services. Despite the widespread belief in digitalization and innovation as solutions, and a generally techno-utopian or techno-optimistic outlook on digital technologies, the digital transformation of the healthcare sector has proven to be complex and has not always yielded the anticipated positive results. Factors such as experience, skills, training, knowledge, expectations regarding technology and its use, habits, and the learning environment at the workplace can all impact both the utilization of technology and the potential for driving innovation. This dissertation is built upon two studies, utilizing a qualitative research approach rooted in Engaged Scholarship. In the first study, several rounds of focus group interviews are conducted with managers and employees in municipalities in Sweden and Norway, focusing on current use, needs, and future potential for technology and digitalization, as well as mapping, analyzing, and further needs for development, organization, decisions, and guidelines to then sharpen the focus on learning and knowledge. Study II was organized as a case study following an innovation pilot project in healthcare within a Swedish municipality. Individual and group interviews were conducted with managers and employees, and viii participatory observation took place during workshops throughout the process of the pilot. The results and analyses from the two studies are detailed in the five appended articles. The findings of this dissertation highlight a gap between the current workforce’s competencies and the skills necessary for effectively implementing and utilizing new technologies. It suggests that organizing for workplace learning requires organized learning, with a particular emphasis on active and engaged management. A three-part strategy for organized learning is proposed, which includes: i) individualization through learner-centeredness, ii) the management’s use of tools and strategies, and iii) fostering a participatory learning environment. This dissertation enhances the understanding of organizing for learning in the context of digitalization and innovation within municipal healthcare services, focusing on both individual and organizational perspectives, and particularly the role of management
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Supporting physical activity in people with heart failure : Novel Tools for Intervention and Assessment
Link: http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-208113
Background
Heart failure is a common disease affecting well over 20 million people worldwide. In addition to pharmacological therapy, self-care is efficacious in improving prognosis and generating symptom relief in this population and one important part of self-care behaviour is physical activity. Physical inactivity and sedentary behaviour negatively affect prognosis for the heart failure population but achieving sustained behaviour change relating to physical activity is challenging. There is research published on how to positively influence behaviours relating to physical activity and one means by which this can be achieved is using mobile health applications. One such mobile health tool, which is designed to enhance self-care behaviour is called Optilogg and it constitutes an appropriate platform on which to develop a novel tool to address sedentary behaviour and physical inactivity.
Aim
The aim of this thesis was to develop and evaluate tools for assessing and supporting physical activity in patients with heart failure.
Methods
This thesis describes the development and testing of two tools, through four scientific studies, employing both quantitative and qualitative methods of data collection and analyses. Study I (n = 106) was a cross-sectional study to test a single item self-report screening tool for identifying physically inactive people with heart failure. Study II (n = 10) describes the mixed-method evaluation of the intervention tool called the Activity Coach, along with the development process. Studies III and IV served to evaluate the Activity Coach in terms of study design, potential outcomes and user experiences. Study III (n = 20) was a pilot randomized controlled clinical trial and Study IV (n = 10) a qualitative study using thematic analysis.
Results
The screening tool studied (Study I) had a high specificity (92%), but low sensitivity (30%) in correctly identifying physically inactive people and correlated significantly (ρ = 0.24, p = 0.016) with an objective measure of physical activity. The whole development process of the Activity Coach took 76 months, with the process of defining and implementing it taking 21 months. Key development elements included co-design, defining factor-action pairs, intervention theory, and mixed-method evaluations. The mixed-methods analyses (Study II) showed an acceptable system adherence of 61% and that it could increase motivation to be physically active, but that user selection likely matters, and too physically active people should not be targeted. The pilot randomized controlled clinical trial (Study III) showed that recruiting people for this type of study, while also screening for physical inactivity was challenging with a recruitment rate of 22%. There were significant effects on subjective goal-attainment and health-related quality of life, and a trend towards reduced sedentary behaviour. Following improvements made prior to Study III, the system adherence increased to 69%. The qualitative analysis (Study IV) showed that the Activity Coach was user-friendly, increased motivation to be physically active and that users experienced positive effects on physical health and emotional well-being.
Conclusions
A single-item self-report screening tool may be used to identify those in extra need of intervention. A pilot trial showed challenges in recruiting participants. It also showed high system adherence and potential benefits in subjective goal-attainment and health-related quality of life. Qualitative analyses of user experience highlighted perceptions of user-friendliness and a sense of enhanced well-being. Further validation and updates are recommended before a full efficacy trial is undertaken.
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SARS-CoV-2 and the human immune system : disease, vaccination, and treatment
Link: http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-230214
The worldwide pandemic caused by SARS-CoV-2 had a tremendously negative impact on society and human health. An infection can lead toCOVID-19, a severe disease resulting from a dysregulated inflammatory response, causing severe organ damage and possible death. Vaccination induces B cells to produce pathogen-specific antibodies and differentiate into memory B cells, offering long-term protection against severe disease. However, individuals with conditions such as multiple sclerosis (MS), organ transplantation, or B-cell lymphoma, are treated with immunosuppressants and are at a higher risk for infection. In these individuals vaccines generally exhibit lower efficacy and offer limited protection. Therefore, a coordinated administration of vaccine doses during immunosuppressing medication is recommended. In some cases even a deliberate vaccination does not protect individuals from infection and persistent viremia. For this, different virus-neutralizing agents like intravenous immunoglobulins (IVIGs) collected from healthy virus-experienced individuals show treatment potential.
This thesis focuses on the reaction of the innate immune system to SARSCoV-2 during acute disease, and the clinical impact of vaccination and lastly viremia treatment with IVIGs in different immunocompromised cohorts. First, we found an elevation of pro-inflammatory cytokines during acute disease, with a sex-specific IL-18 increase in men with severe disease. This correlated with a higher inflammatory neutrophil activity in these individuals. Second, we assessed the protective ability of vaccination in MS patients during B-cell depletion therapy interruption. We could show higher levels of virus-neutralizing antibodies in a high-responding subset of patients after three doses. These antibody levels remained high in blood even after recommencing B cell depleting medication. Finally, immunocompromised individuals with persistent SARS-CoV-2 viremia were treated with IVIG collected from virus-experienced individuals. These antibodies efficiently neutralized several SARS-CoV-2 variants and facilitated patient recovery. In summary, this thesis contributes to the understanding of sex-specific acute COVID-19, and the vaccination and treatment of immunocompromised individuals against SARS-CoV-2.