Det är som att komma hem : betydelsen av svenskspråkig service för klienter inom socialservice

Only abstract. Paper copies of master’s theses are listed in the Helka database (http://www.helsinki.fi/helka). Electronic copies of master’s theses are either available as open access or only on thesis terminals in the Helsinki University Library.Vain tiivistelmä. Sidottujen gradujen saatavuuden voit tarkistaa Helka-tietokannasta (http://www.helsinki.fi/helka). Digitaaliset gradut voivat olla luettavissa avoimesti verkossa tai rajoitetusti kirjaston opinnäytekioskeilla.Endast sammandrag. Inbundna avhandlingar kan sökas i Helka-databasen (http://www.helsinki.fi/helka). Elektroniska kopior av avhandlingar finns antingen öppet på nätet eller endast tillgängliga i bibliotekets avhandlingsterminaler.Mitt intresse att närmare fördjupa mig i ämnet socialservice på svenska ligger som bakgrund till denna forskning. Jag har valt att forska bland klienter som får sin service på enheten för svensk socialservice i Helsingfors med fokus på aktiva klienter inom utkomststöd och handikappservice. Syftet med forskningen är att få veta vilka faktorer som bidrar till att klienterna kommer till den svenska enheten, hur de upplever den svenska servicen och vilken betydelse språket har för dessa klienter. I undersökningen närmar jag mig språket genom dialogen. Modersmålet utgör en viktig del i dialogen mellan socialarbetare och klient. Genom ett gemensamt språk uppnås en känsla av samhörighet och jämlikhet. Förutom den språkliga aspekten lyfter forskningen fram även andra kulturella aspekter som bidrar till att klienter väljer svensk service. Också tvåspråkighetens inverkan på val av servicespråk är en synvinkel som beaktas i denna forskning. Forskningen stöder sig på människors upplevelser och erfarenheter och därför utgår jag från ett hermeneutiskt- fenomenologiskt perspektiv. I de tolv intervjuer som utfördes i denna forskning såg jag dessa klienter som experter och min egen roll var att fungera som tolkare av dessa expertutlåtanden. Vad som är viktigt och avgörande då en klient väljer svenska framom finska som servicespråk, inom den öppna vården på socialverket, i en tvåspråkig kommun som Helsingfors, var en viktig aspekt, som jag sökt svar på. Forskningen visar att klienterna kommer slumpmässigt till den svenska enheten och att deras första upplevelse av enheten är mycket positiv. En hemlik känsla och en upplevelse av att bli beaktad som en människa, är tankar som informanterna lyfter fram i sina beskrivningar av den första kontakten med den svenska enheten. Ur forskningen framgår att de som kan välja (de tvåspråkiga) servicespråk väljer svenskt och att det finns behov av en etnisk plats för klienter i behov av svensk service. En plats där språket inte bara förmedlar budskap och information, utan där den finlandssvenska klienten får uppleva gemensamma värden, jämlikhet och öppenhet i en ömsesidig relation. Den onödiga byråkratin och skammen bland utkomststödsklienter, är upplevelser som klienterna i denna forskning bl.a.lyfter fram

Life without professional work-perceptions about one’s self, interpersonal relations and social life after retirement

The aim of this study is to understand how healthy, older adults in Sweden perceive their life situation after retirement. The study is based on a lifeworld approach, and a phenomenographic method was used. Eighteen participants were interviewed, and data were analysed according to the phenomenographic principle of qualitatively different categories. Two categories were developed. The first category, “perceptions that draw attention inward, towards one’s self”, was further described in three subcategories: Sense of decreased status in society, the desire to keep aging at a distance, and contemplation of one’s own existence. The second category, “perceptions that draw attention outward, away from one’s self” was further described in the following four subcategories: caretaking of family members, involvement in social relationships, finding of deep meaning in animals and nature and engagement with society. In the discussion, the findings are further illuminated through comparisons with concepts such as maturity, wisdom and gerotranscendence, and reflections on the findings’ relevance to a caring context follow. The conclusion suggests this study can provide knowledge that will allow healthcare providers to bridge the gap between generations in order to provide high-quality care. However, for a more profound caring dialogue, for example, about the end of life, a deeper analysis is required

How primary health care physicians make sick listing decisions: The impact of medical factors and functioning

Abstract Background The decision to issue sickness certification in Sweden for a patient should be based on the physician's assessment of the reduction of the patient's work capacity due to a disease or injury, not on psychosocial factors, in spite of the fact that they are known as risk factors for sickness absence. The aim of this study was to investigate the influence of medical factors and functioning on sick listing probability. Methods Four hundred and seventy-four patient-physician consultations, where sick listing could be an option, in general practice in Örebro county, central Sweden, were documented using physician and patient questionnaires. Information sought was the physicians' assessments of causes and consequences of the patients' complaints, potential to recover, diagnoses and prescriptions on sick leave, and the patients' view of their family and work situation and functioning as well as data on the patients' former and present health situation. The outcome measure was whether or not a sickness certificate was issued. Multivariate analyses were performed. Results Complaints entirely or mainly somatic as assessed by the physician decreased the risk of sick listing, and complaints resulting in severe limitation of occupational work capacity, as assessed by the patient as well as the physician, increased the risk of sick listing, as did appointments for locomotor complaints. The results for patients with infectious diseases or musculoskeletal diseases were partly similar to those for all diseases. Conclusion The strongest predictors for sickness certification were patient's and GP's assessment of reduced work capacity, with a striking concordance between physician and patient on this assessment. When patient's complaints were judged to be non-somatic the risk of sickness certification was enhanced.</p

Association between the number of coadministered P-glycoprotein inhibitors and serum digoxin levels in patients on therapeutic drug monitoring

BACKGROUND: The ABC transporter P-glycoprotein (P-gp) is recognized as a site for drug-drug interactions and provides a mechanistic explanation for clinically relevant pharmacokinetic interactions with digoxin. The question of whether several P-gp inhibitors may have additive effects has not yet been addressed. METHODS: We evaluated the effects on serum concentrations of digoxin (S-digoxin) in 618 patients undergoing therapeutic drug monitoring. P-gp inhibitors were classified as Class I, with a known effect on digoxin kinetics, or Class II, showing inhibition in vitro but no documented effect on digoxin kinetics in humans. Mean S-digoxin values were compared between groups of patients with different numbers of coadministered P-gp inhibitors by a univariate and a multivariate model, including the potential covariates age, sex, digoxin dose and total number of prescribed drugs. RESULTS: A large proportion (47%) of the digoxin patients undergoing therapeutic drug monitoring had one or more P-gp inhibitor prescribed. In both univariate and multivariate analysis, S-digoxin increased in a stepwise fashion according to the number of coadministered P-gp inhibitors (all P values < 0.01 compared with no P-gp inhibitor). In multivariate analysis, S-digoxin levels were 1.26 ± 0.04, 1.51 ± 0.05, 1.59 ± 0.08 and 2.00 ± 0.25 nmol/L for zero, one, two and three P-gp inhibitors, respectively. The results were even more pronounced when we analyzed only Class I P-gp inhibitors (1.65 ± 0.07 for one and 1.83 ± 0.07 nmol/L for two). CONCLUSIONS: Polypharmacy may lead to multiple drug-drug interactions at the same site, in this case P-gp. The S-digoxin levels increased in a stepwise fashion with an increasing number of coadministered P-gp inhibitors in patients taking P-gp inhibitors and digoxin concomitantly. As coadministration of digoxin and P-gp inhibitors is common, it is important to increase awareness about P-gp interactions among prescribing clinicians

Interindividual Variability of Drug Transport Proteins : Focus on Intestinal Pgp (ABCB1) and BCRP (ABCG2)

The appearance of adverse drug reactions is a common reason for hospitalization in Western countries. Research on underlying biological mechanisms for interindividual variability in drug response aims to better identify patients with exceptional genetic traits, disease conditions or risk of drug-drug interactions and thereby help to prevent adverse drug reactions. Active transport mechanisms are involved in the absorption and disposition of several therapeutic agents. The main objective of this thesis was to investigate factors potentially affecting transport proteins and thus contributing to variability in drug absorption and disposition. Studies of physiological, genetic, environmental, and pathological factors were included. The main focus was the two ATP-binding cassette (ABC) transporters: P-glycoprotein 170 (Pgp) and Breast Cancer Resistance Protein (BCRP). Quantification of transport protein mRNAs along the human intestine indicated that eight of the nine investigated drug transporters were expressed in a region-dependent manner. Effects of drug-drug interactions may therefore vary depending on the site of absorption. The genetic aspect was illustrated by identification of sequence variation in the gene encoding BCRP, the most highly expressed ABC transporter along the human intestine. Drug-drug interactions are important environmental causes of interindividual variability. An evaluation of the effects of Pgp-mediated drug-drug interactions showed that patients receiving Pgp inhibitors had elevated serum concentrations of the Pgp substrate digoxin and that digoxin concentrations were positively correlated with the number of co-administered Pgp inhibitors. The final topic in this thesis was that of drug-disease interactions. BCRP and Pgp were down-regulated during active inflammation in patients with ulcerative colitis. This may contribute to altered concentrations of drug in the intestinal mucosa during periods of inflammation and possibly to changes in drug absorption. To summarize, results of this thesis emphasize the complex background to the interindividual variability of drug transport proteins, where physiological, genetic, environmental and pathological factors all can contribute

Interindividual Variability of Drug Transport Proteins : Focus on Intestinal Pgp (ABCB1) and BCRP (ABCG2)

The appearance of adverse drug reactions is a common reason for hospitalization in Western countries. Research on underlying biological mechanisms for interindividual variability in drug response aims to better identify patients with exceptional genetic traits, disease conditions or risk of drug-drug interactions and thereby help to prevent adverse drug reactions. Active transport mechanisms are involved in the absorption and disposition of several therapeutic agents. The main objective of this thesis was to investigate factors potentially affecting transport proteins and thus contributing to variability in drug absorption and disposition. Studies of physiological, genetic, environmental, and pathological factors were included. The main focus was the two ATP-binding cassette (ABC) transporters: P-glycoprotein 170 (Pgp) and Breast Cancer Resistance Protein (BCRP). Quantification of transport protein mRNAs along the human intestine indicated that eight of the nine investigated drug transporters were expressed in a region-dependent manner. Effects of drug-drug interactions may therefore vary depending on the site of absorption. The genetic aspect was illustrated by identification of sequence variation in the gene encoding BCRP, the most highly expressed ABC transporter along the human intestine. Drug-drug interactions are important environmental causes of interindividual variability. An evaluation of the effects of Pgp-mediated drug-drug interactions showed that patients receiving Pgp inhibitors had elevated serum concentrations of the Pgp substrate digoxin and that digoxin concentrations were positively correlated with the number of co-administered Pgp inhibitors. The final topic in this thesis was that of drug-disease interactions. BCRP and Pgp were down-regulated during active inflammation in patients with ulcerative colitis. This may contribute to altered concentrations of drug in the intestinal mucosa during periods of inflammation and possibly to changes in drug absorption. To summarize, results of this thesis emphasize the complex background to the interindividual variability of drug transport proteins, where physiological, genetic, environmental and pathological factors all can contribute

Pharmacokinetics of mercury from dental amalgam

PHARMACOKINETICS OF MERCURY FROM DENTAL AMALGAM Gunilla Sandborgh Englund Dept. of Basal Oral Sciences, Karolinska Institutet, S-141 04Huddinge The overall aim of the present work has been to obtain quantitative and qualitativedata on mercury from dental amalgam in humans. The influence of amalgam removal on mercury levels in blood, plasma and urine hasbeen studied in twelve volunteers. All amalgam fillings were removed during one dentalsession. A transient increase of mercury in blood and plasma was observed within48 h after amalgam removal, and sixty days after the mercury levels in all mediahad decreased to about 60% of the pre removal levels. A bi-exponential model wasapplied on mercury in plasma with the median half-time of the second phase being88 days. The kinetics of mercury in urine was fitted to a mono-exponential model,the median half-time being 46 days. The pharmacokinetics of mercury vapor was studied after a single dose exposurein human volunteers. Nine subjects were exposed to 400 µg/m3 mercury vapor for15 min. The retention was on average 67% of the inhaled mercury dose. A rapid absorptionphase was seen in blood and plasma, followed by a bi-exponential decline. In plasmathe median half-time of the second phase was 10 days with a large inter-individualvariation. The estimated total amount of mercury excreted via urine during 30 daysranged from 8% to 41%. Mercury levels in saliva and feces before and after amalgam removal were studied.The fecal mercury concentrations were more than ten times higher in the pre-removalsamples than those found in a reference group with no amalgam fillings. Two daysafter removal, the fecal mercury concentrations increased about 100 times, followedby a significant decrease. Sixty days after amalgam removal, the mercury levels infeces were still slightly higher than in the reference group. In saliva the medianmercury levels declined from the pre-removal level of 200 nmol/kg to 1 nmol/kg sixtydays after amalgam removal. The kidney is a target organ for inorganic mercury and in animal studies decreasedrenal function has been shown after placement of amalgam fillings. The mercury levelsin blood, plasma and urine and the kidney function were studied before and afteramalgam removal. A number of sensitive renal parameters were determined: the glomerularfiltration rate (GFR) and the excretion of N-acetyl-ß glucose aminidase (NAG),ß2-microglobuline and albumin. No signs of kidney dysfunction were detectable. Effects on mercury levels in blood, plasma and urine after 14-days treatment witha chelating agent (DMSA) or placebo were studied in twenty subjects, relating theirsymptoms to mercury exposure from amalgam fillings. In addition, these effects wererelated to possible changes of symptoms. Three cases of generalized hypersensitivereactions were encountered at the end of the treatment period. A significant increasein urinary mercury excretion was apparent during DMSA treatment, and the blood mercurylevels decreased. There was no evidence that chelating therapy alleviated symptomsallegedly attributable to mercury from amalgam fillings. In summary, amalgam fillings constitute a significant source of exposure to mercury.Mercury levels in blood, plasma, urine, saliva and feces decrease considerably afterthe removal of dental amalgam. No adverse effects on the kidney function were observedfrom the mercury exposure in conjunction with amalgam removal. DMSA treatment appearsto mainly affect the mercury excretion from the kidney, and the risk of hypersensitivityreactions is considerable during prolonged treatment. Combined evaluation of thedecline of mercury in plasma after amalgam removal and after the single dose exposureclearly verifies the pharmacokinetics of mercury as at least tri-exponential. Thepharmacokinetic analysis of mercury verifies the daily mercury dose in subjects withan average number of amalgam fillings to be 5-9 µg per day. Key words: Human, dental amalgam, mercury, blood, plasma, urine, saliva, feces,pharmacokinetics, kidney, chelating agents. ISBN 91-628-2791-

Upplevelse av stöd från den psykiatriska vården till barn som har föräldrar med psykisk sjukdom : sett ur barns och vårdpersonals perspektiv

Barn påverkas av föräldrars psykiska sjukdom i form av oro, rädsla och skuld samt har en förhöjd risk att själva drabbas av psykisk sjukdom. En utmaning för den psykiatriska vården är det ökande antalet av vuxna med psykiatrisk sjukdom som även är föräldrar till minderåriga barn. Sjuksköterskor inom psykiatrin har en viktig roll när det gäller att uppmärksamma dessa barn samt se till att de får adekvat hjälp och stöd. Syftet med studien var att beskriva hur barn till föräldrar med psykisk sjukdom upplever det stöd de får ifrån den psykiatriska vården samt beskriva vårdpersonals upplevelser av stöd till dessa barn. Metoden som användes var kvalitativa forskningsintervjuer som genomfördes med sex barn som har föräldrar med psykisk sjukdom och fjorton vårdpersonal som arbetar inom den psykiatriska vården. Intervjuerna analyserades med kvalitativ innehållsanalys och resultatet utmynnade i fyra kategorier. 1. Barn till föräldrar med psykisk sjukdom upplever sig bli hjälpta av stödet från den psykiatriska vården även om det bör förbättras. 2. Vårdpersonal upplever att den psykiatriska vården erbjuder olika verksamheter som ger ett gott stöd till barn även om det bör förbättras. 3. Vårdpersonal upplever att barn behöver uppmärksammas, informeras och stödjas i kontakten med sina föräldrar. 4. Vårdpersonal upplever svårigheter i form av osäkerhet kring sin egen kunskap samt föräldrars ovilja att blanda in barn i den psykiatriska vården. En slutsats av studien är att barn till föräldrar med psykisk sjukdom får ett relativt gott stöd även om det behöver förbättras. För att göra detta krävs utbildning av vårdpersonal och att verksamheten har framtagna rutiner och användbara metoder för att kunna stödja barn.Children get affected by parents mentally illness in form of anxiety, fear and guilt and also have an enhanced risk to suffer from mentally illness themselves. A challenge to the psychiatric care is the increasing number of adults with a mental illness who also are parents to under aged children. Nurses in the psychiatric care have an important role when it comes to notice these children and make sure that they receive adequate help and support. The purpose of the study was to describe how children of mentally ill parents experience the support they receive from the psychiatric care and describe psychiatric healthcare workers experiences of these children’s support. The method that was used in this study was qualitative interviews with six children of mentally ill parents and fourteen psychiatric healthcare workers. The interviews were analysed based on qualitative content analysis and gave four categories as result. 1. Children of mentally ill parents experience help due to the support from the psychiatric care even though it should be improved. 2. Psychiatric healthcare workers experience that the psychiatric care offers a variable of activities that give a good support to children even though it should be improved. 3. Psychiatric healthcare workers experience that children need attention, be informed and supported in their relationship to their parents. 4. Psychiatric healthcare workers experience difficulties like insecurity about their own knowledge and parents’ unwillingness to involve the children in the psychiatric care. A conclusion from this study is that children of mentally ill parents receive a relatively good support even though it needs to be improved. To do that it takes education of the psychiatric healthcare workers and that the psychiatric care is given routines and useful methods to support children

Asiens blå pärla : dagvatten som ett positivt inslag i staden : förslag till ett vackert och uthålligt Phnom Penh

Surface water drainage is together with water supply and wastewater management key parts of infrastructure in urban areas. As landscape architects we aim to find solutions that envisage aesthetical, social and ecological perspectives as well as technical. These aspects often go hand in hand and together they are part of the sustainability concept. Phnom Penh was in the sixties known as "the Pearl of Asia". The capital of Cambodia incorporated many green areas and water features and the architecture was blooming. After many troublesome years of cruel regimes and war the city is now degraded and the infrastructure is badly maintained. Corruption is widely spread and private construction companies are ruling the construction market and the urban planning. The city is located on wetland by the conjunction of four great rivers. There are two dominating seasons, wet and dry and they shape the prerequisites for the city planning. Precipitation is a huge problem in the rainy season and most of the urban storm water is together with the city wastewater lead through open canals or drainage pipes to the surrounding wetlands. The wetlands biologically clean the contaminated water before it enters the rivers. The wetlands also possess great water storage capacity. Phnom Penh is protected from flooding by embankments (dikes). The urban storm water reaches the wetlands through sluiceways in the dry seasons. The sluiceways are closed during the rainy season to prevent the city from flooding and the storm water has to be pumped over the dikes. Due to poor urban planning, corruption and increased land prices, the public green and blue areas in and around the city are rapidly disappearing and inundation of the city has become an enormous problem. New satellite cities have popped up in the wetlands and there is a shortage of public parks and spaces in the city centre. The water storage capacity of the wetlands has diminished due to constructions and polluted water reaches the rivers without cleaning and many sensitive ecosystems are lost. Urbanisation is a fast ongoing process in Phnom Penh. The city needs to expand to cope with its increasing number of inhabitants. Development and expansion put a huge strain on the urban ecological and social structures. To protect and keep the sensitive ecosystems of the urban wetlands and lakes, a future city expansion must be well considered and the development should occur in phases. An ecological storm water management tries to imitate nature as far as possible and use the prerequisites of the site. As much as possible of the storm water is therefore taken care of locally in an ecological storm water design. Urban environments generally consist of a majority of impermeable surfaces, which prevent water to infiltrate. New development in Phnom Penh would benefit from ecological storm water design. The pressure on the under dimensioned drainage system of the city would lessen and problems with inundation be reduced. If polluted water was taken care of locally, emissions in the sensitive rivers would diminish. Urban infiltration areas and storage ponds could be incorporated in future urban design. Since flooding is an unavoidable occurring event in Phnom Penh, the city would benefit from adjusting to the rising water levels instead of fighting against them. Floodable areas incorporated in the urban design are efficient in dealing with the problem of inundation in the streets as well as a beautiful variable design feature. We have chosen two sites in Phnom Penh that soon are about to be developed for construction Boeng Cheung Ek and Boeng Kak Lake. These two areas are both hydrologically interesting. They are located on low points in the city and today they serve as natural water storage features. Our thesis resulted in two design proposals that incorporate an ecological storm water perspective as well as a sustainable city perspective.Dagvattenhantering är liksom dricksvattenförsörjning och avloppshantering viktiga delar av stadens infrastruktur. Landskapsarkitektens uppgift i sammanhanget är att skapa lösningar som tar hänsyn till estetiska, sociala och ekologiska värden, liksom tekniska lösningar. Dessa värden är alla viktiga och tillsammans utgör de grunden för ett uthålligt samhälle. Phnom Penh gick under sextiotalet även under namnet ”the Pearl of Asia”. Kambodjas huvudstad innefattade många grönytor och inslag av vatten och arkitekturen blomstrade. Efter många år av krig och en grym regim har staden förfallit och infrastrukturen är dåligt underhållen. Utbredd korruption är ett stort problem och privata byggföretag styr byggsektorn och stadsplaneringen. Staden är belägen på våtmarker där fyra stora floder flyter samman. Två årstider dominerar, regnperioden och torrperioden, och de skapar förutsättningarna för Phnom Penhs stadsplanering. Nederbörden utgör ett stort problem under regnperioden och en stor del av stadens dagvatten flyter tillsammans med avloppsvattnet i öppna kanaler eller dräneringsledningar ut i de omkringliggande våtmarkerna. Våtmarkerna har förmågan att rena det förorenade vattnet innan det släpps ut i floderna. Våtmarkerna har också en enorm kapacitet att lagra vatten. Höga vallar skyddar Phnom Penh från att översvämmas. Dagvattnet från staden rinner ut i våtmarkerna genom slusskanaler under torrperioden. Slussarna stängs under regnsäsongen för att förhindra att vatten från våtmarkerna översvämmar staden. Vattnet måste då istället pumpas ut från staden över vallarna. På grund av dålig stadsplanering, korruption och ökade markpriser har gröna och blå ytor i staden minskat kraftigt. Detta har medfört att staden oftare och lättare översvämmas. Nya satellitstäder har vuxit fram i våtmarkerna och staden lider brist på gröna offentliga utrymmen. Våtmarkernas vattenlagrande kapacitet har minskat på grund av den nya bebyggelsen och förorenat vatten släpps ut i de känsliga floderna utan rening. Många av stadens känsliga ekosystem har redan gått förlorade. Urbanisering är en snabb pågående process. Staden måste växa för att klara av att försörja den växade befolkningen. Den häftiga expansionen påverkar stadens ekologiska och sociala strukturer. En försiktig och välplanerad stegvis stadsutveckling är nödvändig för att skydda och bevara stadens känsliga våtmarker och sjöar. Ekologisk dagvattenhantering försöker så långt som möjligt efterlikna naturens naturliga förlopp och dra fördel av platsens unika förutsättningar. Så mycket som möjligt av dagvattnet bör tas om hand lokalt i en gestaltning som tar hänsyn till ekologiska dagvattenaspekter. Stadsmiljöer består vanligtvis av mycket hårdgjorda ytor, vilket försvårar infiltration i mark. Nybyggnation i Phnom Penh skulle gynnas av en ekologisk dagvattendesign. Trycket på stadens överbelastade dagvattennät skulle minska och översvämningarnas omfattning skulle reduceras. Lokalt omhändertagande av förorenat dagvatten skulle även medföra mindre utsläpp i de känsliga floderna. Infiltrationsytor och dagvattendammar är ett viktigt inslag i en ekologisk dagvattengestaltning. Eftersom översvämningar är ett oundvikligt och återkommande inslag i Phnom Penh, skulle staden dra fördel av att anpassa sig efter de sjunkande och stigande vattennivåerna istället för att kämpa emot dem. Att integrera översvämningsytor i gestaltningen är både vackert och ett effektivt sätt att bekämpa översvämningar av stadens gator och torg. Vi har intresserat oss för två platser i staden som inom en snar framtid kommer att bebyggas – Boeng Cheung Ek och Boeng Kak Lake. Dessa två platser är särskilt intressanta ur ett hydrologiskt perspektiv. De är belägna på lågpunkter i staden och tjänar idag som viktiga vattenmagasin. Vårt examensarbete mynnade ut i två gestaltningsförslag som tar hänsyn till ekologisk dagvattenhantering så väl som uthållig samhällsbyggnad