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Coming theses from other universities

  • Legitimizing the knowledge of mental health service users in shared decision making : Promoting participation through a web-based decision support tool Author: Katarina Grim Link: Publication date: 2019-06-24 13:43

    Aim: The overall aim of this thesis was to explore the manner in which user knowledge and user perspectives can be included and supported in shared decision making (SDM) in mental health services.

    The thesis consists of four studies. Study I explored what needs service users identify to participate in deliberative processes and decision making in their care. Study II examined how a decision support tool (DST) for SDM can be designed to enhance service users’ ability to have active and meaningful roles in SDM. Study III investigated barriers and facilitators associated with the implementation of a web-based DST designed to provide a concrete structure to support SDM. In study IV, a theoretical analysis was performed to elucidate the barriers associated with user knowledge being expressed and legitimized in decision-making processes.

    Methods: A key feature of the project involved a process of exploring decisional and informational needs, of developing and testing and implementing a DST for SDM. Qualitative data have been collected through focus group and individual interviews with service users and service providers, usability testing with service users and checklists.

    Findings: The findings show a number of characteristics specific to the mental health service context that needs to be considered when developing support for SDM. Decisions were often complex and found to encompass a number of life domains. Issues related to social context and individual recovery highlighted the necessity to include the knowledge perspectives of service users throughout decision processes. In response, phases for preparation and follow-up was emphasized in the DST.

    The results indicate that supportive structures are required for service users to express their knowledge perspectives and for providers to include them in their decision-making. Moreover, existing barriers related to organizational structures and to power differentials need to be addressed.

    Conclusions and implications: A DST specifically designed for the mental health context, that methodically invites service users to participate in each phase of the decision-making process might function as a guiding structure to validate service users as knowledgeable agents.

  • Kronisk njursjukdom i ett livsförloppsperspektiv : risker och konsekvenser Author: Per-Ola Sundin Link: Publication date: 2019-06-11 14:07
  • Homicide Injury Quantification : Measures of injury severity in homicide victims and associations with homicide characteristics Author: Fredrik Tamsen Link: Publication date: 2019-06-03 13:12

    Some previous studies have found that the amount and severity of injuries in homicide victims correlate with different homicide characteristics, such as the victim-offender relationship and drug influence of the offender. If such relationships exist, they may be used by homicide investigators as part of an offender profiling.

    Furthermore, injury severity may be helpful in understanding the nature of lethal violence. If the injuries change over time or differ between regions, this may say something about the underlying causes and thus help society to take preventive measures. However, measures of injury severity are often missing in homicide epidemiology. This may in part be due to a lack of standardized and accessible ways to quantify injuries in homicide victim.

    To address these issues, there is a need for methods to quantify injury severity in homicide victims. The aim of the current thesis was to investigate different types of injury measures and their applicability to homicide victims. The aim was also to use such measures to address research questions related to offender profiling.

    Starting off with injury scores used in trauma research and two scores developed specifically for homicide victims, these measures were applied to a general homicide population. Since there is no obvious “gold standard” for injury severity quantification on homicide victims, one had to be defined to validate the applied methods. Out of forensic experience and rational reasoning, the Sum of all AIS scores (SAIS) was proposed as a reference measure. The other scores were then evaluated through their correlations with the SAIS.

    In the following study, the injury severity in homicides from different time periods was measured. There were statistically significant increases over time with respect to excessive injuries and the number of lethal injuries per victim. These changes can reflect both a brutalization of homicidal violence, improved trauma care, or shifts in the methods by which people are killed.

    Next, the associations between injury severity and homicide characteristics were analysed. No relevant associations between injury severity and victim-offender relationship were found. Neither were there any connections between benzodiazepine influence in the offender and injury severity on the victim. Thus, the studies do not support the use of injury severity scores for offender profiling in a general homicide population.