Coming theses from other universities
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Health promoting potential of Arts on prescription : Studies of people on sick leave for common mental disorders and/or non-specific musculoskeletal pain
Link: http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-66474
Common mental disorders (CMD) and non-specific musculoskeletal pain have a major impact both on individual well-being and societal burden. Anxiety and depressive disorders are widespread, leading to high levels of sick leave, especially among women. Arts activities are increasingly recognised as a means of promoting health for individuals with CMD and of helping to manage long-term pain.
This thesis examines whether, and if so, how and to what extent Arts on Prescription (AoP) can serve as a health-promoting programme for individuals on sick leave due to common mental disorders (CMD) and/or non-specific musculoskeletal pain. It comprises three quantitative studies employing a quasi-experimental prospective design, with baseline assessments and follow-ups at 6 and 12 months, alongside one qualitative study based on focus groups.
Results in Study I showed significantly greater reductions in depression over time in the intervention group compared to the control group. However, this difference was not maintained after adjusting for sick leave. The within-group change over time for stress, anxiety, and depression was significant for both groups, with a larger effect observed in the intervention group compared to the control group, regardless of the adjustment for sick leave. The results of Study II indicated no statistically significant difference between the groups in the change in sense of coherence (SOC) strength over time. Both groups demonstrated statistically significant within-group increases in SOC, with the intervention group exhibiting an effect size that was double that of the control group. This reflected a medium effect size for the intervention group compared to a small effect size for the control group, regardless of whether sick leave adjustments were made. No statistically significant results were found in Study III regarding changes in general self-efficacy (GSE), either for between-group or within-group differences over time. The estimated effect size for within-group changes in GSE over time was small in both the intervention and control groups. Descriptive statistics on the effect of sick leave status revealed a significant difference in general GSE across various levels of sick leave. Participants on 25% sick leave had the highest GSE values, while those on full-time sick leave reported the lowest GSE values. Financial concern and educational level served as indicators of social determinants of health and health inequalities in the analyses. Descriptive statistics in Studies I-III revealed that participants frequently concerned about finances reported higher stress, anxiety, and depression levels (Study I), alongside the weakest SOC (Study II) and the lowest GSE (Study III). In contrast, those never concerned about their finances exhibited lower stress, anxiety, and depression, the strongest SOC, and the highest GSE. This difference encompassed all SOC sub-dimensions, Comprehensibility, Manageability, and Meaningfulness, while Meaningfulness remained stable in other analyses across Studies I-III. Conversely, educational level showed no significant effect. These findings suggest that financial concern can be a critical factor influencing mental health and well-being. In Study IV, the findings indicate that the participants' involvement in AoP fostered a sense of belonging, relief from daily demands, and a feeling of being moderately challenged through the arts activities. These challenges, when embraced, led to a sense of reward manifested as increased confidence and self-efficacy as the participants perceived they had successfully performed the arts activities. Together, these experiences contributed to health-promoting changes within the individual, such as transformed perceptions of their abilities, increased self-respect, and regained motivation and hope for the future
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Psoriasis - Interactions Between Genetic Susceptibility, Bacterial Microbiome, and Gene Expression
Link: http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-208826
Psoriasis is a common immune-mediated inflammatory disease, caused by a combination of genetic predisposition and environmental trigger factors. In spite of extensive research regarding the pathogenesis of psoriasis, many specific immunopathogenic mechanisms still remain unclear.
The aim of this thesis is to gain further insight into the pathogenesis of psoriasis through studying the bacterial microbiome of the skin and pharynx, the correlation between the microbiome and genetic susceptibility, and through studying pathway and cluster analysis of gene expression in patients with psoriasis.
Study I compared the bacterial microbiome of lesional and non-lesional skin of patients with psoriasis before and after treatment with narrowband ultraviolet B. Study II compared the bacterial microbiome of the pharynx and lesional and non-lesional skin of patients with psoriasis to healthy controls. Study III explored the association between the severity of psoriasis and abundance of the Streptococcus genus on the skin in individuals with specific psoriasis-associated gene variants. Study IV aimed to find novel pathways associated with psoriasis and to identify possible future therapeutic targets by conducting pathway and cluster analysis of differentially expressed genes of lesional and non-lesional skin of patients with psoriasis compared to healthy controls.
We found significant differences in the relative abundance of the bacterial genera Prevotella and Cutibacterium in both pharynx and skin and Finegoldia and Anaerococcus in the skin, which could be related to differences in regulated pathways relating to mitochondria and neutrophil function. We also found that the abundance of Streptococcus on the skin associated with severity of psoriasis in patients with certain genetic variants, suggesting that the microbiome’s effect on the manifestation of psoriasis is dependent on genetic predisposition.
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Sexual and reproductive health equity in Sweden : From policy to the perspectives of young people with migration experience, and healthcare providers
Link: http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-71791
This thesis explores potential challenges to achieving sexual and reproductive health (SRH) equity in Sweden, focusing on young people with migration experience. It includes three qualitative studies, each addressing a specific aim. The findings of these studies are presented in four papers.
Study I is a policy analysis that aims to examine how migrants were represented in the discourses embedded within Swedish sexual and reproductive health and rights (SRHR)-related policies, and how migrants’ SRHR-related issues were framed and addressed within these discourses. To this end, 54 policy documents were critically examined and the results are presented in Paper I. The results show how migrants’ discursive representation in Swedish SRHR-related policies is often associated with the concept of vulnerability. Moreover, a discourse of otherness appears when discussing what is defined as honor-related violence and oppression. The results also indicate that framing migrants’ issues with regard to SRHR oscillates between two competing discourses. The first one tends to prioritize the structural level, as mainly reflected in adopting the human rights- based discourse, whereas the second tends to frame migrants’ SRHR issues and needs as individual issues requiring individual-level solutions.
Study II builds on interviews with 20 young people with migration experience. It aims to explore accounts of encounters of young people with migration experience with SRH services, and discourses on sexuality. The first part of the results is outlined in Paper II. It highlights how the interplay between participants’ negative perceptions of youth clinics, difficult access, and the perception of the irrelevancy of SRH services contributed to low service use. The first part of the results also shows how the experiences and attitudes toward school-based sexuality education differed substantially among participants, ranging from positive to less positive or negative. The second part of the results is presented in Paper III. It highlights the various constructions of sexuality in the participants’ discourses. Sexuality was constructed as a border marker that contributes to making a distinction between discursive constructions of mainstream Swedish society and ethnicized migrant communities. It was also constructed as a domain for negotiating risk, where sex was depicted as a risk associated with negative SRH outcomes. Finally, sexuality was constructed as a domain for negotiating sexual agency at the societal and interpersonal levels.
Study III is based on interviews with 31 healthcare providers. It aims to examine healthcare providers’ accounts of encounters with migrants when providing SRH services in Sweden. The results are presented in Paper IV. They illuminate the complex relations between person-centered care, culture, and knowledge positions that underlay the participants’ accounts. While some participants understood person-centered care as individualized care where the influence of culture on the encounter should be de-emphasized, others tended to highlight this influence. Participants related this influence to different perceived dilemmas and described strategies to navigate them. The main strategies involved practicing cultural humility (e.g., self-reflection, self-critique, and openness) and seeking cultural competency. Moreover, many participants experienced that migrant patients lacked knowledge about the body and sexuality. This disadvantaged knowledge position affected migrant involvement in care. The results also pointed to several organizational challenges as well as dilemmas stemming from the interplay between migrants’ structural and individual disadvantages.
The results of the three studies are integrated using a theoretical framework combining Fraser’s theory of justice and concepts of equity, othering, and belonging, along with a proposed concept of sexual-cultural citizenship. The thesis argues that the challenges to SRH equity highlighted in these studies represent forms of injustice stemming from either misrecognition, maldistribution, or misrepresentation, or an interplay of two or more of these dimensions of injustice. These challenges contribute to contesting the full sexual- cultural citizenship of young people with migration experience.