Coming dissertations at Uppsala university
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Det ekonomisk-politiska spelet : Konkurrens om idéproduktion i ett svenskt landskap av ekonomiska experter och politiska beslutsfattare 1962–1990
Link: http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-542305
This dissertation deals with Swedish economic policy in the historical context of late 20th century economic turmoil. At its heart there is a landscape of economic experts and policymakers, which embodies the competitive nature of economic policy. Such competition in production of economic and political ideas is what constitutes this “landscape of expertise”, within which power struggles, negotiations and compromises take place. By combining previous research on economic ideas and political processes of change a new perspective on the Swedish model and its transformation during the period 1962–1990 is presented. The dissertation’s contribution to the fields of policy change and history of economic ideas is to explore the landscape of expertise and its heterogeneity of ideas. This contribution shows that economic policy is a complex area where different historical paths are intertwined. The combination of complexity and longevity makes it a particularly suitable subject for scholars of economic history.
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Optimized prediction of mortality by use of register-based information in an intensive care unit population
Link: http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-543744
The primary objective of this thesis was to explore the importance of comorbidity for long-term survival following admission to the intensive care unit (ICU). By use of routinely collected laboratory biomarkers and by utilising a more detailed analysis of the patient’s hospital discharge history, we aim to challenge traditional risk prediction models and measures of comorbidity. We also apply the more comprehensive prediction model to understand how preexisting comorbidities may interact with a critical illness in older ICU patients and compare long-term mortality with the general population. Finally, we aim to understand the importance of comorbidity in relation to socioeconomic status (SES) when the measurement of comorbidity is optimised.
The study was performed by linking data from the Swedish Intensive Care Register (SIR), a hospital clinical laboratory database and several national public authority registers. Routinely collected laboratory biomarkers and quantitative comorbidity measures were compared in Cox regression models adjusting for age, sex and baseline comorbidities with Charlson Comorbidity Index (CCI) and the Simplified Acute Physiology Score (SAPS) version 2 or 3. The mortality in older ICU patients was then compared with individuals from the general population with a landmark of one year. Also, associations between socioeconomic factors and mortality were estimated by using Cox regression models adjusting for age, sex, SAPS3 and baseline comorbidity.
Routinely collected biomarkers discriminate both short- and long-term mortality in general ICU patients, almost as well as the SAPS II. The more comprehensive comorbidity prediction model provides a separation of risk categories within strata of age, the CCI, and intermediate SAPS3 strata. Older patients admitted to the ICU, and who survive the first year after an ICU admission, return to close to the mortality rate of the general population having similar comorbidity. Low educational level was associated with an increased long-term mortality rate after ICU admission. In a Landmark analysis, the association was weaker during the first year after ICU admission than after the first year, suggesting that risk factors other than those specifically related to ICU admission may be important.
By utilising extensive population-based data, the project contributes to the development of methods within registry-based epidemiological research. The importance of specific comorbidities in defined subgroups of intensive care patients should be of interest not only to intensive care specialists but also in a broader healthcare perspective.
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eHealth : An Exploration of Adoption and Implementation in Swedish Primary Care from Patients’ and Healthcare Professionals’ Perspectives
Link: http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-543908
The World Health Organization (WHO) resolution on eHealth, adopted in 2005, served as a catalyst for global eHealth development. eHealth refers to the use of Information and Communication Technology (ICT) to support health. In line with this, Sweden, in its current strategy, aims to become a world leader in eHealth by 2025. While Sweden is arguably at the forefront of digitalisation, the use and optimism of eHealth services among citizens remains low.
This research aimed to describe how Swedish primary care patients have adopted two eHealth services and to deepen our understanding of the influence of implementation on this process. The two eHealth services were: 1) video consultations (VCs) through the Alltid Öppet application and 2) the Swedish Patient Accessible Electronic Health Record (PAEHR) 1177 Journal.
Six Studies were conducted. Studies I-IV, investigating patients’ adoption of VCs and PAEHR, using a quantitative approach, a cross-sectional design, surveying primary care patients. Descriptive and comparative analyses, as well as logistic regressions, were conducted. Studies V and VI, investigating the implementation of VCs and PAEHR, used a qualitative approach, collecting data using individual and focus group interviews.
The studies found inequalities in eHealth adoption, which may worsen in the future. Patients' older age, negative perceptions, and low digital and information literacy were among the identified adoption barriers. Additionally, the low usability of eHealth services further discourages use. Healthcare professionals (HCPs) facilitate patients’ adoption, but they may also contribute to the digital divide. A lack of comprehensive implementation strategies, particularly for patients, is a major barrier to adoption, and infrastructure issues exclude certain populations. Lastly, the COVID-19 pandemic accelerated eHealth implementation and adoption, but it also contributed to the challenges with the need for a rushed and unprepared implementation.
In conclusion, this research underscores the urgent need to address these barriers and reshape the development of eHealth to mitigate growing health disparities. Patients should be better supported and their literacy levels improved. HCPs should also be provided with comprehensive training and ongoing support. Developers must ensure high-quality eHealth services, implementers should adopt more comprehensive strategies, and policymakers must enhance the current infrastructure. Future research should not only delve deeper into these issues but also identify effective strategies to remove barriers and promote widespread adoption.