Health services use among children diagnosed with medium-chain acyl-CoA dehydrogenase deficiency through newborn screening: A cohort study in Ontario, Canada

Background: We describe early health services utilization for children diagnosed with medium-chain acyl-CoA dehydrogenase (MCAD) deficiency through newborn screening in Ontario, Canada, relative to a screen negative comparison cohort. Methods: Eligible children were identified via newborn screening between April 1, 2006 and March 31, 2010. Age-stratified rates of physician encounters, emergency department (ED) visits and inpatient hospitalizations to March 31, 2012 were compared using incidence rate ratios (IRR) and incidence rate differences (IRD). We used negative binomial regression to adjust IRRs for sex, gestational age, birth weight, socioeconomic status and rural/urban residence. Results: Throughout the first few years of life, children with MCAD deficiency (n = 40) experienced statistically significantly higher rates of physician encounters, ED visits, and hospital stays compared with the screen negative cohort. The highest rates of ED visits and hospitalizations in the MCAD deficiency cohort occurred from 6 months to 2 years of age (ED use: 2.1-2.5 visits per child per year; hospitalization: 0.5-0.6 visits per child per year), after which rates gradually declined. Conclusions: This study confirms that young children with MCAD deficiency use health services more frequently than the general population throughout the first few years of life. Rates of service use in this population gradually diminish after 24 months of age

On the establishment of trust in the Russian forest sector

Godkänd; 1999; 20070515 (keni

Network Governance for Sustainable Development : a case study of the Swedish Energy Agency's Sustainable Municipality Programme 2003 - 2007

The view of networks has changed within the field of policy studies. Once they were considered as hampering the policy process, but today they are accepted as a legitimate policy instrument. The Swedish Government, for instance, makes use of networks to steer society. One attempt to do so is the Sustainable Municipality Programme launched by the Swedish Energy Agency in 2003. Five municipalities where selected to participate in this collaborative process to further sustainable energy policies. This thesis explores the potential of network governance theory as a model for describing policy making. A case study addressing three questions was conducted. Firstly, can the Sustainable Munici-pality Programme be described within the framework of network governance theory? Secondly, is this governance network successful in its struggle to achieve its goals? Thirdly, can this example of network governance further a discussion exploring a scenario where inter-municipality network governance might pose a challenge to the principle of local government? The first and second question is answered by focusing on four functions that the governance network should fulfil; to give priority to projects; to mobilize resources, to complete projects and, to evaluate the process. In order to answer the first question the case study focuses on the interaction within the governance network. Is the process organised in a fashion recognisable as network govern-ance, as an ideal type of coordination? The analysis shows that network governance theory provides an analytic framework well suited to shed light on the process. The analysis also shows that the three first functions were achieved. Through negotiations the network gave priority to different projects. The thesis focuses on three of these. The first project includes the education of maintenance person-nel. The second is a research project, investigating different actors' possibilities to plan for a more sustainable use of energy. The third project is a research project carried out within the field of physi-cal planning. The fourth function, evaluation, still poses a problem since the actors themselves are not content with the evaluation model they produced. In order to answer the third question the case study explores the notion of local government and how it can be safeguarded within a governance network. Two indicators are used to analyse this aspect of the process; the democratic anchorage of the governance network and the transparency of the process. The analysis shows that the process has been transparent and that local politicians have had an opportunity to meta govern the process. It is, however, undoubtedly so that the actors, or municipalities, gain influence over each other's policy processes. This causes discontent since local priorities get affected, sometimes negatively. In the end of 2007, four of the five municipalities decided to remain within the programme, or the governance network, for another three years. They are now joined by an additional 60 municipalities.Godkänd; 2008; 20080211 (ysko)</p

Teaching community in sustainable development : aim, realization and evaluation. Final report from project "Teaching communities" (självförbättrande lärartem)

A model for the educational development of university teachers (a type of teaching community) has been tested. University staff from different faculties worked and reflected together over the teaching and learning practice in a couple of courses. The community was supervised by an educational developer with a doctoral degree in psychology, and they worked in close collaboration with both undergraduate students and PhD students. The teaching staff that participated improved their teaching skills, extended their repertoire of learning tools, and experienced increased self-reliance. Their motivation and enthusiasm for teaching increased, and today they act as "missionaries" for good teaching and learning practices at the University. It was not obvious, however, that this educational development promoted their academic careers. New project ideas emerged from the teaching community.Godkänd; 2006; 20071210 (ysko