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Coming theses from other universities

  • Taxane-Induced Peripheral Neuropathy among Early-Stage Breast Cancer Survivors : Prevalence, Risk Factors, Quality of Life and Genetic Prediction Models Author: Kristina Engvall Link: http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-201635 Publication date: 2024-03-15 10:10

    Background: Taxane-induced peripheral neuropathy (TIPN) is a common and distressful side effect. Little is known on how long TIPN persist and its effect on health-related quality of life (HRQL). The overall aim of this thesis was to study the prevalence and severity of persistent TIPN, to investigate its impact on HRQL and to explore the clinical and genetic risk factors for TIPN among early-stage breast cancer survivors (ESBCS).   

    Methods: A population-based cohort of 884 recurrence-free ESBCS diagnosed 2010-2015 in the Southeast Health Care region, Sweden and 1768 control women without prior cancer, who received a postal questionnaire including EORTC chemotherapy-induced peripheral neuropathy (CIPN20) and QLQ-C30 instruments. Prevalence of TIPN symptoms and clinical risk factors were explored. Adjusted relative risks (RR) were estimated for ESBCS compared to control women. For impact on HRQL, adjusted mean scores of QLQ-C30 scales among ESBCS with and without TIPN were calculated. Blood samples from 362 ESBCS were whole-exome sequenced. We leveraged logistic regression models to develop and validate polygenic prediction models to estimate the risk of persistent PN symptoms in a training and test cohort.   

    Results: The response rate was 79% for ESBCS and 59% for controls. The median time post-taxane was 3.6 years. The adjusted RR for ESBCS vs. controls was highest (RR 1.8) for tingling in feet and numbness in feet. Individual sensory symptoms occurred in 9%-48% and motor symptoms in 7%-61% of ESBCS. The most prevalent symptoms were difficulty opening jar and cramps in feet. Paclitaxel, older age, overweight, diabetes mellitus, vibrating hand tools, smoking and autoimmune disease were independent risk factors (Study I). All 13 sensory and motor TIPN symptoms at increased risks among ESBCS had a significant impact on global health status, which worsened with increased severity of TIPN. Between 30%-93% of ESBCS with moderate-severe TIPN reported a clinically important impairment of functioning and personal finances. Moderate-severe difficulty climbing stairs and problems standing/walking were associated with medium-large clinically important differences (Study II). In the explorative sub-study, two of five prediction models based on genetic and clinical risk factors obtained AUC results above 60% in the test cohort. Using the model for numbness in feet (35 SNVs) in the test cohort, 73% survivors were correctly predicted. For tingling in feet (55 SNVs) 70% were correctly predicted (Study III).

    Conclusions: Most sensory and motor symptoms are more common among taxane-treated ESBC survivors than in women from the general population, many symptoms persist ≥3.6 years. Persistent TIPN symptoms are associated with clinically relevant impairment of HRQL. Polygenic prediction models including clinical risk factors may be used to estimate the risk of persistent taxane-induced numbness in feet and tingling in feet. 

  • Playing along (with)in the hard yard? Play, practices, and occupational justice in Irish schoolyards Author: Michelle Bergin Link: http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-104586 Publication date: 2024-03-14 06:56

    This thesis aims to generate knowledges on practice possibilities concerned with children’s play and occupational justice in Irish schoolyards. Navigating the intersections between theory and practice required an ongoing examination of the tensions and points of resonance between ideas, ideals, and practices. Drawing on critical occupational perspectives, four distinct yet interrelated studies contribute to the thesis aim, exploring play, particularly the play of children with minoritized identities, as an issue of occupational justice from diverse perspectives. Minoritized draws attention to the active social processes that create inequitable opportunities for children because of their identities relative to gender, race, ethnicity, socioeconomic status, religion, sexuality, and disability.

    In Study I, a scoping review using the Joanna Briggs institute methodology, showed a paucity of existing research on the play of Irish Traveller children, an ethnic minoritized community. Using an existing conceptual model to categorise reported influencing factors emphasized the distinct restricting factor of racism on Irish Traveller children’s play. To address the problematization of at-risk representations of Irish Traveller children, as reflective of culturist assumptions, greater attention to children’s own diverse constructions of play as a capability is proposed.

    Study II completed virtual and walking interviews with ten primary school teachers to explore their practices and experiences of particularly children with minoritized identities play in Irish schoolyards. The reflexive thematic analysis highlighted how prevailing norms interrelated with the locus of risks of exclusion to children’s individual choices and how teachers’ while valuing play, prioritised safety and an absence of conflict. Knowledges constructed on teachers and children negotiating individual and collective interests within diverse occupations in relationships (with)in the schoolyard, resonated with conceptualisations of collective occupations as constitutive with the production of the social space.

    Study III used individual and group walking interview methods to explore with 23 children their play in two Irish primary schools, identified as disadvantaged. Using the lens of the theory of practice architectures, the analysis highlighted children’s contrasting representations of play as habitual and emerging situated relational processes. Children’s acceptance of social hierarchies, individualistic and exclusionary social practices within schoolyards generated insights into the consequences of significant constraints and normative ideas on children’s play. Play was thus interrelated with the reproduction of what was termed the “hard yard”. However, the transformative potential of play was also suggested in how shared play created possibilities for fun, solidarity, and friendship.

    Study IV drawing on earlier studies, engaged six occupational therapists from diverse sites of practice in a critical action research inquiry to interrogate existing practices and generate practice possibilities focused on play and occupational justice in Irish schoolyards. Putting the theory of practice architectures to use again, the analysis drew attention to how habitual practices interrelated with constraints including circumscribed professional identities, service expectations and cultural norms to (re)produce practice possibilities, in tension with occupational justice ideals. Furthermore, the research process using dialogical focus group and occupational mapping methods provided a mechanism for raising consciousness that (re)mattered occupations and occupational justice.

    In conclusion, this thesis contributes nuanced understandings of play as socially situated practices interrelated with significant constraints and diverse social practices (with)in the particularities of Irish schoolyards. The ways in which inequities were (re)produced in habitual, individualistic, and exclusionary practices within schoolyards, and relationships of solidarity and fun were created within shared play supports understandings of the centrality of occupations to (in)justice. The insights generated problematized inclusive practices drawing attention to normative discourses, the individualising of choices, the neglect of substantive issues, such as racism and the significance of vulnerabilities and friendships. This thesis suggests practice possibilities that extend beyond play as an individual concern to consider ethical responsibilities to raise consciousness on the relational nature of collective practices with(in) shared spaces. Furthermore, in connecting (with) theorizing on occupation as collective, the theory of practice architectures and mechanisms of raising consciousness this thesis contributes to understandings of praxis.

  • To do or not to do? Physical activity in relation to socioeconomic status and health – a salutogenic perspective in the context of targeted health dialogues Author: Lisbeth Johansson Link: http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-63764 Publication date: 2024-03-07 15:51

    It is well known that physical activity (PA) has a major positive impact on health and that the performance of PA is lower in low socioeconomic groups. However, more knowledge about the relationship between PA and health is needed especially between and within socioeconomic groups.

    This thesis aimed, from a salutogenic perspective, to increase the understanding of the relationship between physical activity and health in the adult population, with a particular focus on people with economic difficulties. A further aim was to validate questions about physical activity and to explore the people’s experiences of PA from a sense of coherence perspective, all in the context of targeted health dialogues.

    The first study in this thesis is a validation study. It validates a PA interview form and questions about sedentary time used in the targeted health dialogues. Studies II and III comprise quantitative analyses of PA, health and psychological factors in the population, especially in groups with low socioeconomic status (SES). Study IV is a qualitative deductive study based on interviews with participants with low SES in the targeted health dialogues. The deductive analysis contains the participants’ experiences of PA from a sense of coherence perspective.

    The findings in study I showed that the interview form and the single-item question about sedentary time could be considered as acceptable to use in Swedish targeted health dialogues. In study II, physically active people with low SES were shown to have the same odds of reporting good self-rated health compared to those with low PA and high SES. The findings in study III showed that within the group of people with self-reported economic difficulties, higher levels of PA were related to better mastery and more vitality. Study IV showed that it is essential for the participants to have an awareness of the health benefits of PA and their challenges in performing PA. The participants also constructed a plan to follow while utilising their resources, and their intrinsic motivation to achieve the PA recommendations and the PA benefits.

    This thesis brings a deeper knowledge and understanding of the healthperspective of PA. This knowledge can be used to further develop thetargeted health dialogues in a salutogenic way. It will give people,especially those with lower SES, the opportunity to use their resourcesto increase PA and thereby improve their future health.

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