Utvärdering - till vilken nytta? : En studie om hur utvärderingar användas och vad som gör dem användbara

Syftet med denna studie är att göra en metaanalys kring användningen av utvärderingen Aktiveringspolitikens Janusansikte. Utvärderingen har genomförts i fyra stadsdelar i Malmö inom ramen för storstadssatsningen. Fokus har legat på att undersöka om resultatet av utvärderingen Aktiveringspolitikens Janusansikte har använts i de utvärderade verksamheterna, samt vilka faktorer som påverkar användande eller icke-användande av utvärderingar. För att analysera vilken typ av användning som har förekommit har Carol H Weiss modell för användning av utvärderingsresultat används. Denna har kombinerats tre förklaringsfaktorer för att försöka förstå varför det sker eller varför det inte sker någon användning av utvärderingsresultat. Dessa faktorer är den personliga faktorn, den kontextuella faktorn och utvärderingsfaktorn. Undersökningen visar att användningen av Aktiveringspolitikens Janusansikte inte varit så utbredd i de undersökta stadsdelarna. Däremot framkommer det en generellt positiv inställning till utvärderingar. Dessa ses som mycket viktiga för att utveckla och förbättra verksamheten. Interaktiv användning av utvärderingar är vanligt, men även användning i förstärkande eller mobiliserande syfte förekommer. Några viktiga faktorer för att utvärderingar skall användas identifieras också. Delaktighet uppges som en utmärkande framgångsfaktor om syftet är att utvärderingens resultat skall användas av den utvärderade verksamheten. Vidare är också en öppenhet, för lärande i organisationen viktigt. Utvärdering är en färskvara och resultaten måste återföras till verksamheten i rätt tid för att de skall vara användbara. Förtroende för utvärderaren och tillförlitligheten till metoden är av största vikt för att utvärderingens resultat inte skall förkastas. Abstract in English The aim of this study was to do a meta analysis concerning the use of the evaluation Aktiveringspolitikens Janusansikte. The evaluation was done in four district city councils in the municipality of Malmö. These four district city councils are all part of the governmental issued program Storstadssatsningen. The main focus of the study was to investigate if the findings of the evaluation were utilized in the evaluated city councils and what factors influence utilization and non-utilization. Carol H Weiss model for evaluation utilization was used as a base for the analysis. In combination with these three explanatory factors was used to explain use or non-use of evaluation findings. These factors are the personal factor, the contextual factor and the evaluation factor. The study shows that the utilization of the evaluation findings was limited. There was however a general interest and acceptance for evaluations in the studied organisations. Evaluations are considered important tools for the improvement of both the activity offered and the organisational structure. Interactive use is very common but the findings are also used to reinforce prior beliefs and to mobilize support for ideas. A few important factors affecting the use or non use are also identified. Participation is put forth as an important factor if the aim with the evaluation is to have a direct bearing on the activity and the organisation as a whole. An open mind for learning within the organizational structure is also important. The life-span of an evaluation is rather limited, at least with regard to the utilization. Thus the timing of the feed-back is essential. Lastly one should also mention the importance of the personal relations to the evaluator, trust in both the person and his/her methods are necessary for a successful feed-back of the results from the evaluation

An investigation into the validity of cervical spine motion palpation using subjects with congenital block vertebrae as a 'gold standard'

BACKGROUND: Although the effectiveness of manipulative therapy for treating back and neck pain has been demonstrated, the validity of many of the procedures used to detect joint dysfunction has not been confirmed. Practitioners of manual medicine frequently employ motion palpation as a diagnostic tool, despite conflicting evidence regarding its utility and reliability. The introduction of various spinal models with artificially introduced 'fixations' as an attempt to introduce a 'gold standard' has met with frustration and frequent mechanical failure. Because direct comparison against a 'gold standard' allows the validity, specificity and sensitivity of a test to be calculated, the identification of a realistic 'gold standard' against which motion palpation can be evaluated is essential. The objective of this study was to introduce a new, realistic, 'gold standard', the congenital block vertebra (CBV) to assess the validity of motion palpation in detecting a true fixation. METHODS: Twenty fourth year chiropractic students examined the cervical spines of three subjects with single level congenital block vertebrae, using two commonly employed motion palpation tests. The examiners, who were blinded to the presence of congenital block vertebrae, were asked to identify the most hypomobile segment(s). The congenital block segments included two subjects with fusion at the C2–3 level and one with fusion at C5-6. Exclusion criteria included subjects who were frankly symptomatic, had moderate or severe degenerative changes in their cervical spines, or displayed signs of cervical instability. Spinal levels were marked on the subject's skin overlying the facet joints from C1 to C7 bilaterally and the motion segments were then marked alphabetically with 'A' corresponding to C1-2. Kappa coefficients (K) were calculated to determine the validity of motion palpation to detect the congenitally fused segments as the 'most hypomobile' segments. Sensitivity and specificity of the diagnostic procedure were also calculated. RESULTS: Kappa coefficients (K) showed substantial overall agreement for identification of the segment of greatest hypomobility (K = 0.65), with substantial (K = 0.76) and moderate (K = 0.46) agreement for hypomobility at C2-3 and C5-6 respectively. Sensitivity ranged from 55% at the C5-6 CBV to 78% at the C2-3 level. Specificity of the procedure was high (91 – 98%). CONCLUSION: This study indicates that relatively inexperienced examiners are capable of correctly identifying inter-segmental fixations (CBV) in the cervical spine using 2 commonly employed motion palpation tests. The use of a 'gold standard' (CBV) in this study and the substantial agreement achieved lends support to the validity of motion palpation in detecting major spinal fixations in the cervical spine

Cutaneous nociception and neurogenic inflammation evoked by PACAP38 and VIP

Pituitary adenylate cyclase-activating peptide-38 (PACAP38) and vasoactive intestinal peptide (VIP) belong to the same secretin–glucagon superfamily and are present in nerve fibers in dura and skin. Using a model of acute cutaneous pain we explored differences in pain perception and vasomotor responses between PACAP38 and VIP in 16 healthy volunteers in a double-blind, placebo-controlled, crossover study. All participants received intradermal injections of 200 pmol PACAP38, 200 pmol VIP and placebo into the volar forearm. Measurements included pain intensity on a visual analog scale (VAS), blood flow by laser Doppler flowmetry, visual flare and wheal. Pain intensities after PACAP38 and VIP were mild and limited to a short time of about 100 s after injection. The area under the VAS-time curve was larger following PACAP38 (P = 0.004) and VIP (P = 0.01) compared to placebo. We found no statistical difference in pain perception between PACAP38 and VIP. Skin blood flow increase, flare and wheal were larger after both PACAP38 (P = 0.011) and VIP (P = 0.001) compared to placebo. VIP induced a considerably larger increase in skin blood flow, flare and wheal than PACAP38 (P = 0.002). In conclusion, we found that peripheral nociceptive cutaneous responses elicited by PACAP38 and VIP are similar in healthy volunteers. This suggests that acute pain and vasomotor responses following intradermal injections of PACAP38 and VIP are primarily mediated by VPAC receptors

Review of methods used by chiropractors to determine the site for applying manipulation

Background: With the development of increasing evidence for the use of manipulation in the management of musculoskeletal conditions, there is growing interest in identifying the appropriate indications for care. Recently, attempts have been made to develop clinical prediction rules, however the validity of these clinical prediction rules remains unclear and their impact on care delivery has yet to be established. The current study was designed to evaluate the literature on the validity and reliability of the more common methods used by doctors of chiropractic to inform the choice of the site at which to apply spinal manipulation. Methods: Structured searches were conducted in Medline, PubMed, CINAHL and ICL, supported by hand searches of archives, to identify studies of the diagnostic reliability and validity of common methods used to identify the site of treatment application. To be included, studies were to present original data from studies of human subjects and be designed to address the region or location of care delivery. Only English language manuscripts from peer-reviewed journals were included. The quality of evidence was ranked using QUADAS for validity and QAREL for reliability, as appropriate. Data were extracted and synthesized, and were evaluated in terms of strength of evidence and the degree to which the evidence was favourable for clinical use of the method under investigation. Results: A total of 2594 titles were screened from which 201 articles met all inclusion criteria. The spectrum of manuscript quality was quite broad, as was the degree to which the evidence favoured clinical application of the diagnostic methods reviewed. The most convincing favourable evidence was for methods which confirmed or provoked pain at a specific spinal segmental level or region. There was also high quality evidence supporting the use, with limitations, of static and motion palpation, and measures of leg length inequality. Evidence of mixed quality supported the use, with limitations, of postural evaluation. The evidence was unclear on the applicability of measures of stiffness and the use of spinal x-rays. The evidence was of mixed quality, but unfavourable for the use of manual muscle testing, skin conductance, surface electromyography and skin temperature measurement. Conclusions: A considerable range of methods is in use for determining where in the spine to administer spinal manipulation. The currently published evidence falls across a spectrum ranging from strongly favourable to strongly unfavourable in regard to using these methods. In general, the stronger and more favourable evidence is for those procedures which take a direct measure of the presumptive site of care– methods involving pain provocation upon palpation or localized tissue examination. Procedures which involve some indirect assessment for identifying the manipulable lesion of the spine–such as skin conductance or thermography–tend not to be supported by the available evidence.https://doi.org/10.1186/2045-709X-21-3

Frequent attenders at pediatric emergency departments- parental experiences

Introduktion: I sjukvården är mångbesökare ett begrepp som definieras som de personer som besöker en vårdinrättning fyra eller fler gånger under en 12 månaders period. Tidigare forskning om mångbesökare på barnakutmottagningar beskriver sökorsak och karakteristiska för dessa individer men saknar en kvalitativ inriktning som beskriver mångbesökares upplevelser. Det finns ett behov av att föräldrar till barn som definieras som mångbesökare berättar om sina upplevelser av vården de erhållit på akutmottagningen för att vårdpersonal som möter denna grupp ska få ökad förståelse av deras behov och förväntningar. Syfte: Syftet är att undersöka hur föräldrar till barn som är definierade som mångbesökare upplever vården på barnakutmottagningen. Metod: Kvalitativ metod med semi-strukturerade intervjuer. En pilotstudie med fyra intervjuer genomfördes för att testa metoden. Urvalet bestod av föräldrar till barn som definieras som mångbesökare och som inte var kroniskt sjuka. Intervjuerna transkriberades och analyserades enligt kvalitativ innehållsanalys med manifest ansats. Resultat: Analysen resulterade i tre kategorier; Vårdpersonalens bemötande, Osäker vård skapar oro och Förväntningar på vården. I resultatet framkom att föräldrarna upplevde att vårdpersonalens bemötande varierade mellan olika besök. Föräldrarnas oro för barnet fanns både innan och under besöket och kunde förvärras av vårdpersonalens omhändertagande av barnet. Föräldrarna upplevde att deras förväntningar på vården inte alltid uppfylldes och önskade ett större stöd från vårdpersonalen på akutmottagningen. Diskussion: Föräldrar till barn som definieras som mångbesökare har ett behov av att bli tagna på allvar och få hjälp med att lindra sin oro för sitt barn när de söker till barnakutmottagningen. Vårdpersonalens bemötande måste alltid vara professionellt så att föräldrarna inte utsätts för onödigt lidande. Tydlig information kring väntetider behövs för att minska föräldrars frustration. Slutsats: Det är viktigt med ett bra bemötande oavsett sökorsak eller barnets antal besök på barnakutmottagningen. Specialistsjuksköterskan behöver ta föräldrars oro på allvar och försöka lindra deras lidande.Introduction: Frequent attenders is a term used in health care services that define a person attending a health care setting more than four times during a 12 month period. Recently published research concerning frequent attenders in pediatric emergency departments describes their reasons for attending a health care service or characteristics of these individuals but lacks a qualitative approach exploring their experiences. There is a need of these experiences to be shared so that health care personnel caring for this group may gain a greater understanding of their needs and expectations. Aim: The aim of this study is to describe how parents of children defined as frequent attenders experience the care received at a pediatric emergency department. Method: Qualitative approach with semi-structured interviews. A pilot study of four interviews was conducted to test the method. Sampling consisted of parents of children defined as frequent attenders and that were not diagnosed with a chronic illness. The interviews were transcribed and analyzed according to qualitative content analysis. Results: The analysis resulted in three main categories; The treatment of health care personnel, Uncertain care causes anxiety and Expectations of care. Parents experienced that the treatment of health care personnel varied between visits. The parents’ anxiety of the child was present before and during the visit and could worsen by the health care personnel care for the child. The parents experienced that their expectation of care was not always met and they expressed a need of greater support from the health care personnel at the pediatric emergency department. Discussion: The parents of the children defined as frequent attenders have a need to be taken more seriously and to receive help to ease their anxiety they have for their child when they visit the pediatric emergency department. The treatment from health care personnel always needs to be professional to prevent causing unnecessary suffering for the parents. Clear information regarding wait time is required to reduce parental frustration. Conclusion: It’s important not to let the cause of the visit or number of visits effect on how personnel treat families. The advanced nurse practitioner need to take parents’ concerns into account and try to ease their suffering

How easy is the start-up of thinking classroom? : A qualitative case study about obstacles and opportunities with the implementation of thinking classroom from the perspective of primary school teachers

Studiens syfte var att undersöka om uppstarten av arbetssättet thinking classroom är enkel, eller om det finns hinder under vägens gång. Samt att få en förståelse för vilka möjligheter samt hinder lärare ser från sitt perspektiv i uppstarten. Under studien genomfördes fyra semistrukturerade observationer samt fyra semistrukturerade intervjuer med två verksamma F–3 lärare. Den data som samlades in vid observationerna analyserades med hjälp av både en deduktiv- och induktiv tematisk analys. Den insamlade data från intervjuerna analyserades med en deduktiv tematisk analys.    Resultaten av observationerna och intervjuerna visade att lärarna stötte på hinder i uppstarten av arbetssättet thinking classroom. Bland annat visade sig att platsbrist vara ett hinder, då lärarnas klassrum hade för få väggytor där eleverna kunde arbeta. Ett ytterligare hinder som lärarna nämnde var tidsbrist, beroende på att de inte hann med att lyssna på alla elevers diskussioner. Även om det fanns hinder för lärarna under uppstarten såg de möjligheter att kringgå dessa. Lärarna nämnde förslag som till exempel att byta till ett större klassrum under lektionerna, för att komma runt platsbristen. För att få mer tid till varje elev gav lärarna som förslag att arbeta i halvklass med eleverna. Resultaten visar också att övergången till detta arbetssätt måste arbetas in med eleverna, då de sociomatematiska och sociala normerna i ett klassrum tar tid att förändra.

Konflikter i parrelationer : hur överenskommelser och samförstånd kan nås

Validerat; 20101217 (root

Sanctions and Gender Inequality : A Quantitative Analysis on the Interplay Between Sanctions and Gender Disparities

This research paper endeavours to investigate the correlation between sanctions and the exacerbation of gender inequality. Specifically, the study aims to assess whether the imposition of sanctions leads to heightened levels of gender-based disparities. In the aftermath of the Cold War, the utilisation of sanctions surged markedly as an instrument for altering states' behaviour in foreign policy. In line with the increased prevalence of sanctions, a growing discourse has emerged surrounding the unanticipated outcomes of these measures. What remains unexamined is whether women are disproportionately affected. This represents a significant gap in the literature as almost no studies address gender-based consequences of sanctions. In compliance with the scarcity in academia, this thesis aims to test the outlined hypothesis that sanctions have been shown to affect women and men differently, that sanctions will have a negative impact on gender equality. This relationship between sanctions and gender inequality will be assessed by conducting OLS regression based on data from The Global Sanctions Data Base (GSDB) and the Quality of Governance (QoG). Control variables have also been incorporated to mitigate the potential impact of these variables on both the independent and dependent variables. In the bivariate model, when controls were not included, a notable level of support for the hypothesis was observed, whilst a substantially weaker, statistically insignificant connection in the multivariate regression analysis was evident. The findings of this study may offer valuable insights to enhance future investigations in the realm of sanctions and gender.

Innovation and less harmful alternatives to tobacco: The case of nicotine pouches regulation

The market for tobacco or tobacco-like products is changing fast. Consumers are increasingly motivated to substitute classic cigarettes with products that are less damaging to health. The COVID-19 crisis, and the growing evidence from the World Health Organisation (WHO) and others that smoking increases the risk of dying from COVID-19, is likely to increase that trend. Alongside measures to reduce tobacco consumption, public-health authorities in some countries have also been at the vanguard of pushing product substitution. There is also vibrant innovation in the market with old and new firms coming up with new products that reduce the harm of tobacco consumption. E-cigarettes are one among such products. A less known example is nicotine pouches. For some years now, tobacco-free nicotine pouches - a tobacco-free version of pre-portioned snus - have been available on the Swedish market. Although the use of the product is increasing and is marketed outside Europe, nicotine pouches are not subject to any specific product regulation - neither in Europe nor elsewhere. That makes the product unique because similar products are regulated in both international treaties and national legislation. It is a matter of time before nicotine pouches will get regulated and the purpose of this report is to provide an analysis of different regulatory approaches and what they entail. This is chiefly done by observing key trends in tobacco-prevention policies and analyzing how the regulation of similar products has developed over time. Because of their product-specific similarities, the reference products for the analysis are snus and e-cigarettes. Obviously, these similarities include aspects of their harm-reduction potential (when compared to cigarettes) but also factors such as nicotine dependence, number of users, and the specifics of their regulation. The analysis is particularly focused on the regulation of these products in Europe and North America, and also takes stock of the factors that shaped the debate and affected the outcome of these regulations. Consideration is also given to the possibility that new conflicts may emerge in the wake of the increased use of nicotine pouches and how this may affect future regulation. In light of this analysis, the report provides a scenario for the regulation of nicotine pouches

Vad händer när jag dör? : en uppsats om arvs- och testamentsrätt

Validerat; 20101217 (root