PUBLIC HEALTH SISTEM IN SWEDEN

The Swedish health care system is a socially responsible system with an explicit publiccommitment to ensure the health of all citizens. Quality health care for all is a cornerstone ofthe Swedish welfare state. The 1982 Health and Medical Services Act not only incorporatedequal access to services on the basis of need, but also emphasizes a vision of equal health forall. Three basic principles areintended to apply to health care in Sweden. The principle ofhuman dignity means that all human beings have an equal entitlement to dignity, and shouldhave the same rights, regardless of their status in the community. The principle of need andsolidarity means that those in greatest need take precedence in medical care. The principle ofcost—effectiveness means that when a choice has to be made between different health careoptions, there should be a reasonable relationship between the costs and the effects, measuredin terms of improved health and improved quality of life

Isothermal Microcalorimetry, a New Tool to Monitor Drug Action against Trypanosoma brucei and Plasmodium falciparum

Isothermal microcalorimetry is an established tool to measure heat flow of physical, chemical or biological processes. The metabolism of viable cells produces heat, and if sufficient cells are present, their heat production can be assessed by this method. In this study, we investigated the heat flow of two medically important protozoans, Trypanosoma brucei rhodesiense and Plasmodium falciparum. Heat flow signals obtained for these pathogens allowed us to monitor parasite growth on a real-time basis as the signals correlated with the number of viable cells. To showcase the potential of microcalorimetry for measuring drug action on pathogenic organisms, we tested the method with three antitrypanosomal drugs, melarsoprol, suramin and pentamidine and three antiplasmodial drugs, chloroquine, artemether and dihydroartemisinin, each at two concentrations on the respective parasite. With the real time measurement, inhibition was observed immediately by a reduced heat flow compared to that in untreated control samples. The onset of drug action, the degree of inhibition and the time to death of the parasite culture could conveniently be monitored over several days. Microcalorimetry is a valuable element to be added to the toolbox for drug discovery for protozoal diseases such as human African trypanosomiasis and malaria. The method could probably be adapted to other protozoan parasites, especially those growing extracellularly

Determination of fungal activity in modified wood by means of micro-calorimetry and determination of total esterase activity

Beech and pine wood blocks were treated with 1,3-dimethylol-4,5-dihydroxyethylen urea (DMDHEU) to increasing weight percent gains (WPG). The resistance of the treated specimens against Trametes versicolor and Coniophora puteana, determined as mass loss, increased with increasing WPG of DMDHEU. Metabolic activity of the fungi in the wood blocks was assessed as total esterase activity (TEA) based on the hydrolysis of fluorescein diacetate and as heat or energy production determined by isothermal micro-calorimetry. Both methods revealed that the fungal activity was related with the WPG and the mass loss caused by the fungi. Still, fungal activity was detected even in wood blocks of the highest WPG and showed that the treatment was not toxic to the fungi. Energy production showed a higher consistency with the mass loss after decay than TEA; higher mass loss was more stringently reflected by higher heat production rate. Heat production did not proceed linearly, possibly due to the inhibition of fungal activity by an excess of carbon dioxide

Patients’ experiences of continuity of care : What is needed and how can it be measured?

Aim: The overall aim for this thesis was to explore continuity of care through patients’, family carers’, and health care personnel’s perceptions, and to develop and evaluate a patient-reported experience measure of continuity of care. Method: This thesis consists of four studies; I have a qualitative explorative design and II have a qualitative descriptive design, whereas III and IV are methodological studies. In studies I and II, data were collected from four geographically disparate areas in Sweden; in studies III and IV, data were collected in one of these areas. Data were collected using individual (I, II, III), focus groups, pair interviews (II), and questionnaires (III, IV). Data were analyzed using constructivist grounded theory (I), conventional content analysis (II), and according to classical test theory (III), and Rasch measurement theory (IV). Results: For patients to experience continuity of care, all aspects were interconnected, as access to tailored information was essential for gaining mutual understanding regardless of who was performing a care task. This required clarity in responsibilities and roles, interprofessional collaboration, and a trusting relationship over time and space between each link in the patient’s care trajectory (I). Further, Study II showed that to achieve continuity of care, professional and cross disciplinary cooperation at micro, meso and macro levels were needed. Continuity of care is dependent on long-term and person-centered relationships, dynamic stability in the organizational structure, and shared responsibility for cohesive care enabling uniform solutions for knowledge and information exchange (II). Studies III and IV resulted in the Patient-Experienced Continuity of care Questionnaire (PECQ). The instrument contains 20 items measuring four dimensions of continuity of care: Information (four items), Relation (six item), Management (five item), and Knowledge (five item). Overall, the PECQ showed satisfactory measurement properties according to classical test theory and Rasch measurement theory (III, IV) regarding factor structure, unidimensional, local independence, response category function, differential item functioning for age and sex, and internal consistency reliability. Conclusion: Continuity of care is perceived as multidimensional, containing several important aspects working in synergy and varying over time. To achieve continuity of care, information and knowledge sharing need to cross disciplinary and organizational boundaries. Collaborative responsibility is needed, vertically through all levels of the system, instead of focusing on personal responsibility horizontally. The PECQ can provide information on different dimensions of continuity, useful for driving quality improvements in the primary care context.

Integrating Behavior Change Techniques into an AI-Powered Virtual Coach for Mobile Applications

This thesis highlights the importance of fall prevention, as falls are a leading cause of injuries. Previous work led to the development of a mobile application that offers personalized training programs focused on fall-prevention exercises, based on the individual’s physical abilities. The application includes a virtual coach, featuring a conversational AI-powered system that enables users to engage in more human-like interactions. The system uses conversational properties from large language models to provide personalized information and guidance. The application is developed using Flutter and the backend is built using Python, which manages the AI model integration and data handling through frameworks like LangChain and FastAPI. While this version of the application does not account for user behavior changes over time, the proposed solution aims to address this limitation by enhancing personalization and implementing motivational approaches to sustain long term commitment. To achieve this, the thesis investigates the integration of behavior change techniques, grounded in the self-determination theory and the persuasive systems design model. These have shown potential in enhancing user motivation, and the thesis will explore how these can be applied to further improve user engagement and fall prevention outcomes. The results indicate that providing choice and tailoring have a statistically significant positive impact on behavior change at a 95% confidence level. Particularly through the implementation of a notification system that allows users to select the timing of reminders and other notifications. While other techniques did not demonstrate statistical significance within this study, their theoretical relevance suggests they may still offer value under different conditions or with alternative implementations. To fully realize the potential of these techniques, further investigation and optimization are necessary

The patient´s needs and expectations of the encounter with the district nurse in home care.

Sammanfattning Bakgrund: Första gången två personer möts är de främlingar för varandra. Möten innebär samspel mellan de människor som berörs. Mötet styrs av erfarenheter, förväntningar och tolkningar av situationen. Genom att bekräfta, acceptera och vara tillmötesgående närmar sig parterna varandra vilket kan leda till öppenhet och bättre kontakt. Syfte: Syftet med studien var att beskriva patienternas behov och förväntningar i mötet med distriktssköterskan i hemsjukvården. Metod: Studien utfördes med en kvalitativ ansats. Åtta patienter med hemsjukvård intervjuades enskilt i sina hem. Narrativ intervju användes. Materialet analyserades sedan utifrån Lundman och Graneheims kvalitativa innehållsanalys. Resultat: Två teman framkom, Att få känna sig som en värdefull människa på sina egna villkor samt Att få medicinsk vård av en kompetent distriktssköterska. Patienternas behov och förväntningarna i mötet med distriktssköterskan i hemsjukvården är att få hjälp med att behålla sin identitet och sin värdighet som människa. Patienterna vill att distriktssköterskan ska se patienten som en person med känslor och tankar och ta dessa på allvar. Patienterna behöver känna sig sedda och bekräftade, få känna sig som någon inte bara en i mängden. När patienten känner sig sedd och bekräftad skapas förtroende och trygghet. Patienterna har behov av att distriktssköterskan har förmågan att känna till sin egen kompetens och brister. Detta leder till ett förtroende och respekt för distriktssköterskan. Slutsats: Slutsatsen är att man inte kan möta människor efter en speciell mall. Varje möte måste ske individuellt med fokus på den enskilda individens behov och förväntningar. Behovet att få känna sig som en värdefull människa på sina egna villkor är viktigare än att få medicinska insatser gjorda.Abstract Background: The first time two people meet, they are strangers to each other. Encounters involve interaction between the people involved. The encounter is determined by the experiences, expectations and interpretations of the situation. By confirming, accepting and being courteous to each other there can be transparency and better contacts. Aim: The aim of this study was to describe patients' needs and expectations of the encounter with the district nurse in home care. Method: The study was conducted by using a qualitative approach. Eight patients with home health care were interviewed individually in their homes. Narrative interviews were used for the encounters. The material was then analyzed by applying Lundman and Granheim method for qualitative content analysis. Result: Two themes emerged. The patients feeling of being treated like a valuable human being on their own terms and To get medical care of a qualified district nurse. The patients' needs and expectations of the encounters with a district nurse in home health care are to help them preserve their identity and their dignity as human beings. Patients want the district nurse to recognize the patient as a person with feelings and thoughts and to be taken seriously. Patients need to feel seen and acknowledged, to feel that they are not just one of many. When the patient feels seen and confirmed there is confidence and security. Conclusion: The conclusion is that one cannot meet people using one specific template. Each encounter must be unique with focus on the individual's needs and expectations. The need to feel like a valuable human being, met on their own terms is perceived as being more important than having their medical needs attended

How the use of gamification in migraine tracking effects the perceived feeling of motivation

The problem with logging migraines is that patients often forget, or simply choose not to log their migraines. To solve this problem, we investigate in this thesis whether gamification can make a difference in their motivation. To investigate whether gamification makes a difference, an AB test was performed. An A prototype, without gamification, and a B prototype, without gamification, were developed in the initial phases of this thesis, these were tested on people outside of the target group. Motivation was measured using Self Determination Theory and its sub-theory Organic integration. Gamification elements chosen to use in the B-prototype is based on the desired feel of the prototype, the elements included an avatar, badges, and progress bars. The A/B-test was performed on 10 people, 5 for each prototype, and all the participants were diagnosed with migraine and had some previous experience of logging their migraines and symptoms. The result includes interview questions about their experience, observations of user tests and answers from a questionnaire. The results showed no significant overall difference between the two prototypes; however, discussion and some hypotheses can be created by the results. Most difference between the results can be seen in integration regulation, a subcategory of motivation, where the prototype without gamification got a higher result.Detta examensarbete kommer att undersöka möjligheten att använda gamification i mobila applikationer för migränpatienter, för att se om det kommer att hjälpa migränpatienter med deras loggning. Problemet med att logga migrän är att patienter ofta glömmer, eller helt enkelt väljer att inte logga sin migrän. För att lösa detta problem undersöker vi i detta examensarbete om gamification kan göra skillnad i deras motivation. För att undersöka om gamification gör skillnad gjordes ett AB-test. En A-prototyp, utan gamification, och en B-prototyp, utan gamification, utvecklades i de inledande faserna av detta examensarbete, dessa testades på personer utanför målgruppen. Motivation mättes med hjälp av Self Determination Theory och dess underteori Organic integration. Gamification-element som valts att använda i B-prototypen är baserade på den önskade känslan av prototypen, elementen inkluderade en avatar, badges och progressbar. A/B-testet utfördes på 10 personer, 5 för varje prototyp, alla deltagare var diagnostiserade med migrän sedan innan och hade tidigare erfarenhet av att logga sin migrän och symptom. Resultatet inkluderar intervjufrågor om deras upplevelse, observationer av användartester och svar från en frågeenkät. Resultaten visade ingen signifikant skillnad mellan de två prototyperna, men diskussion och vissa hypoteser kan skapas av resultaten. Mest skillnad mellan resultaten kan ses i integration regulation, en underkategori av motivation, där prototypen utan gamification resultat visa högre nummer på likert-skalan

African American Education and Progression in Raplh Ellison's Invisible Man

                                  Abstract Literary portraits of African Americans’ struggles in the United States for a more equal society have provided valuable insights into the pain and hardship they had to endure for a large portion of the United States’ existence. Ralph Ellison’s famous novel Invisible Man is one of those novels and is the primary source for this study. In this novel the unnamed African American protagonist tries to find a place of his own within a segregated society and has to succumb to the white man’s will to be part of American society. Despite the segregation and subjugation, the protagonist believes that he can progress in American society through education, but his development is constantly thwarted because of his skin colour. Ellison utilizes features from the bildungsroman to highlight how differently education works for African Americans and white people, since the traditional progression of the bildungsroman is not possible for the protagonist despite his trying to follow its traditional pattern. The thwarted progression instead seems to move the plot into another type of progression, namely a spiritual progression. I will therefore conclude that education in Invisible Man creates segregation and subjugation and that the protagonist’s progression is subverted into a spiritual progression. How the protagonist’s journey can be subverted is related to how power structures and discourses influence people’s actions and beliefs. I will use Michel Foucault’s Discipline and Punish and The Archaeology of Knowledge to explain how power structures and discourses enable segregation, subjugation and a spiritual progression. Furthermore, the result will reveal that, because of surrounding power structures and discourses, the protagonist cannot do anything in this American society other than conform to prevailing power structures or hide himself until he knows how to battle these structures. Keywords: Education; Segregation; Bildungsroman; Michel Foucault; African American.Literary Bachelor Essay</p

Patienters upplevelser av bemötande i omvårdnadssituationer

I dagens sjukvård är det mindre personal som tar hand om flera patienter, vilket kan resultera i att fokus på patienten som en unik person glöms bort. Personalens bemötande är viktigt för att få en god kontakt med patienterna, detta ska byggas på att personalen respekterar människans värdighet, integritet och självbestämmande. Syftet med studien var att belysa patientens upplevelse av bemötande utifrån patientens perspektiv. Genom att se vad som är viktigt för patienterna i bemötandet med personalen och hur patienterna påverkas av bemötandet, kan personal inom sjukvården utföra sitt arbete med större insikt. Metoden är en litteraturstudie där sju vetenskapliga artiklar användes och analyserades med hjälp av Burnards innehållsanalys. Fyra kategorier framkom i analysen: Bemötande, delaktighet, kommunikation och information samt påverkan. Dessa användes for att tydliggöra resultatet. Ida Orlandos omvårdnadsteori har varit modell för den teoretiska referensramen. Resultatet visade att patienterna vill få en individuell omvårdnad där personalen ser dem som personer inte som patienter, de ville få information, vara delaktiga och få prata om sin situation. Patienterna ansåg också det var viktigt att personalen tog sig tid for att lyssna och var där för dem. Slutsats, patienterna ville bli bemötta som en unik person där personalen utgick från varje patient som en individ. Patienterna ville även få vara delaktiga i sin omvårdnad. Den bästa kommunikationen var när personalen använde både verbal och icke verbal kommunikation. Information skall ges på ett lättförståligt sätt för patienterna. Bra information fick patienterna att känna sig trygga

POSSIBLE LEGAL REGULATIONS ON REGIONALIZATION IN ROMANIA

In the present study I have in view the fulfillment of the regionalizing process by retrospection to the four processes in the European Union, but also on the regionalization made by France and Poland, from which Romania could take some important outlines so as to legislate, implicitly by reforming the Constitution, the most preformat possible regional system for the country, in the present social and economic context, as a normal consequence of democratic devotion. I suggested the defining of the new regional local authorities, their responsibilities, the relations that will be stated in the relations with the existing local authorities, in relation with the central ones, their number, so as to lead to the unitary development, as much as possible, of all the regions. The dedication of decentralization as a constitutional principle comes to show our vocation and affiliation to the European culture values and the standards foreseen by the Local Autonomy Charta. </jats:p