Mening og magt i skoleledelse: konstruktioner af styring i højtpræsterende skoler i et internationalt komparativt perspektiv

Nyt og alternativt bidrag til studier af skoleledelse i højtpræsterende skoler Afhandlingen undersøger skoleledelse som et styringsfænomen i relation til moderne magt- og styringstendenser i uddannelsessektoren. Undersøgelsen tager afsæt i dybdegående, komparative casestudier af meningsskabelses- og magtprocesser i- og om skoleledelse i fire højtpræsterende skoler i henholdsvis Danmark og Ontario, Canada. Studiet af skoleledelse i vedvarende højtpræsterende skoler i et internationalt komparativt perspektiv bidrager til den internationale uddannelsesforskning ved at anlægge en alternativ og poststrukturel erkendelsesposition. Ved at forlade en universel og normativt foreskrivende forskningstilgang skaber undersøgelsen adgang til at forstå skoleledelse som et historisk og socialt styringsfænomen, der udmønter neoliberale og governmentale styringsidéer forbundet med den internationale, økonomiske uddannelseskonkurrence. Homogenisering i en konkurrenceorden eller en forbedringsorden De analytiske fund af menings- og magtkonstruktioner på tværs af de fire højtpræsterende peger bl.a. på flg. empiriske tendenser: De sociale meningsskabelses- og magtprocesser i skoleledelse ser tendentielt ud til at være relationelt forbundet med enten en styringsmæssig ’konkurrenceorden’ (DK) eller en ’forbedringsorden’ (ON). Decentralisering og konkurrence i den danske policyweb afføder en tendens til diversitet i, hvad der tilskrives betydning i skolens dannelses- og uddannelsesindhold samt i den lokale ledelse af skolens demokratiske organisering. De historisk tværgående, komparative analyser fremviser en tendens til institutionel homogenisering i uddannelsesformålet og fremviser konturerne af en internationalt forekommende monofaglig præstationsorden. Studiet af magtmekanismer giver adgang til at forstå skoleledelse som en styringsfunktion, der får internationale policy-idéer til at ’glide ind’ i skolens socialitet gennem meningsskabelse. Det empiriske grundlag Den empiriske undersøgelse bygger på kvalitative og kritisk komparative case-analyser af meningsskabelses- og magtkonstruktioner set i- og om skoleledelse i fire komparativt sammenlignelige, højtpræsterende skoler; to i Danmark og to i Ontario, Canada

The Danish HIV Birth Cohort (DHBC) - a nationwide, prospective cohort

PURPOSE: The purpose of the Danish HIV Birth Cohort (DHBC) is to investigate the significance of HIV-1 infection in pregnancy and after delivery in women living with HIV (WLWH) in Denmark and their children, in the era of antiretroviral therapy and other interventions for treatment and prophylaxis. PARTICIPANTS: All WLWH giving birth to one or more children in Denmark after 31 December 1999 are included, with consecutive ongoing enrolment, if they are living with HIV and pregnant, or if they are diagnosed with HIV in relation to pregnancy, delivery or shortly after delivery. FINDINGS TO DATE: DHBC has been used to describe trends in the management of pregnancies in WLWH and their outcomes on a nationwide basis, mode of delivery and predictors of emergency caesarean section as well as risk factors during pregnancy in WLWH for birth-related complications compared with women from the general population (WGP). We have found that HIV-exposed, but uninfected (HEU) children born to WLWH had a lower median birth weight and gestational age and were at higher risk of intrauterine growth retardation than children born to WGP. We have investigated risk of in-hospital admission and use of antibiotics during the first 4 years of life among HEU children and showed that HEU children had an increased risk of overall hospital admission compared with a matched control group of unexposed children. Further, we compared anthropometric outcomes in children with a matched control group of children not exposed to HIV. FUTURE PLANS: To continuously investigate the significance of HIV infection and antiretroviral therapy in pregnancy and after delivery in WLWH in Denmark and their HEU children and compare these findings with children born to WGP

Use of antiretroviral therapy in pregnancy and association with birth outcome among women living with HIV in Denmark:A nationwide, population-based cohort study

OBJECTIVE: To describe antiretroviral therapy (ART) regimens during pregnancy among women living with HIV (WLWH) in Denmark and to examine the association between ART use in pregnancy and adverse birth outcomes. METHODS: A population‐based cohort study including all pregnancies among WLWH in Denmark between 2000 and 2019. Data were collected through national registries. Temporal trends of ART use in pregnancy were evaluated. Logistic regression models were used to examine the association of ART use in pregnancy and other risk factors with adverse birth outcomes. RESULTS: In total, 589 pregnancies were included. Combination treatment with a nucleoside reverse transcriptase inhibitor (NRTI) and a protease inhibitor (PI) was the most common ART regimen (96%). ART regimen, PI use in pregnancy and timing of ART initiation were not significantly associated with increased odds of preterm birth, small for gestational age or low birth weight. First‐trimester initiation of ART was significantly associated with increased odds of intrauterine growth restriction in the multivariate analysis [adjusted odds ratio (aOR) = 3.78, 95% confidence interval (CI): 1.23–11.59], while first trimester PI use was associated with increased odds of IUGR in the univariate analysis only [OR = 3.24, 95% CI: 1.13–9.30]. Smoking, comorbidity, and maternal HIV RNA ≥ 50 copies/mL were independently associated with increased odds of adverse birth outcomes. CONCLUSIONS: Pregnant WLWH living in Denmark are generally well treated with HIV RNA < 50 copies/mL at delivery and NRTI + PI as the most common ART regimen used in pregnancy. Initiation of ART in the first trimester may be associated with poor fetal growth. The association between ART use in pregnancy and adverse birth outcomes may partly be explained by maternal risk factors

Psychosocial health in pregnancy and postpartum among women living with-and without HIV and non-pregnant women living with HIV living in the Nordic countries - Results from a longitudinal survey study

Background The success of antiretroviral therapy has normalized pregnancy among women living with HIV (WWH) with a very low risk of perinatal transmission of HIV. Despite these advances, WWH still face complex medical and psychosocial issues during pregnancy and postpartum. The aim of this study was to assess differences in psychosocial health outcomes between pregnant WWH, non-pregnant WWH, and pregnant women without HIV, and further identify factors associated with probable depression in the third trimester and postpartum. Methods In a longitudinal survey study, participants were included from sites in Denmark, Finland, and Sweden during 2019-2020. Data was collected in the 3rd trimester, 3 and 6 months postpartum using standardized questionnaires assessing depression, perceived stress, loneliness, and social support. Mixed regression models were used to assess changes over time within and between groups. Logistic regression models were used to identify factors associated with depression in pregnancy and postpartum. Results A total of 47 pregnant WWH, 75 non-pregnant WWH, and 147 pregnant women without HIV were included. The prevalence of depression was high among both pregnant and non-pregnant WWH. There was no significant difference between pregnant and non-pregnant WWH in depression scores, perceived stress scores, or social support scores at any time point. Compared to pregnant women without HIV, pregnant WWH reported worse outcomes on all psychosocial scales. Social support and loneliness were associated with an increased odds of depressive symptoms in the adjusted analysis. Conclusions A high burden of adverse psychosocial outcomes was observed in both pregnant and non-pregnant women living with HIV compared to pregnant women without HIV. Loneliness and inadequate social support were associated with increased odds of depression in pregnancy and should be a focus in future support interventions.Peer reviewe

The experience of pregnancy among women living with HIV in Nordic countries : A qualitative narrative enquiry

Objective: The success of antiretroviral therapy has resulted in the normalization of pregnancy among women living with HIV and a very low risk of perinatal transmission of HIV. Despite these advances, women living with HIV still face complex medical and psychosocial issues during pregnancy. The purpose of this study is to describe experiences of pregnancy and the relevance of social support among women living with HIV in Nordic countries. Methods: This qualitative study examined data from pregnant women living with HIV from sites in Denmark, Sweden and Finland from 2019 to 2020. Data were collected in the third trimester via individual interviews using a hybrid, narrative/semistructured format. The transcribed interviews were analyzed using narrative thematic analysis. Results: In total, 31 women living with HIV were enrolled, of whom 61% originated from an African country and 29% from a Nordic country. The analysis generated four primary narrative themes: just a normal pregnancy, unique considerations and concerns, interactions with healthcare, and social support. Women living with HIV have a strong desire to have normal pregnancies and to be treated like any other pregnant woman. However, this normality is fragile, and being pregnant and living with HIV does come with unique considerations and concerns, such as fear of transmission, antiretroviral therapy, and the need for specialized care, which are fundamental to the women's experiences. Interactions with healthcare providers and social support influence their experiences in both positive and negative ways. Conclusion: The findings emphasize a sense of normality in pregnancy among women living with HIV. However, pregnancy does come with unique considerations and concerns, which highly influence the women's experience of pregnancy. Healthcare providers should focus on person-centered care, ensuring continuity and that women living with HIV do not feel discriminated against throughout their pregnancy.Peer reviewe

Glidninger: ’Usynlige’ forandringer inden for pædagogik og uddannelser

Udgangspunkt for bogens undersøgelser er en undren over, hvordan og hvorfor udefra initierede forandringer af relationer eller tankemønstre ikke registreres af berørte agenter, hvorfor aspekter af styring og ledelse ubemærket glider ind i tænkning og praksis.Vort fælles perspektiv i Forskningsenheden: ’Globalisering, governance og ledelse i uddannelsesinstitutioner’ er at undersøge relationerne mellem globale styringstendenser og deres veje gennem transnationale og nationale agenturer til lokale institutioner. Vi undersøger derfor ikke alene disse tendenser, men er i lige så høj grad interesserede i, hvordan styringen påvirker og bearbejdes på niveauerne og af forskningen: Hvordan institutionerne og aktørerne registrerer – eller måske netop ikke registrerer – påvirkningerne, dér, hvor de rammer praksis. Vi arbejder således på at finde og forklare sammenhænge mellem generelle styringstendenser og lokale oplevelser og reaktioner.Igennem introduktioner til teorier om governance, translationer, diskurser, meningsdannelse og praksis, og igennem brug af teorierne i case analyser indenfor folkeskolen, daginstitutioner, socialpædagogik, voksenuddannelse og universiteter undersøger vi, hvor langt teorierne bringer os, og hvordan de ofte må kombineres eller suppleres for at kunne klargøre vore indsigter.Undersøgelserne interesserer sig i alle casene både for de generelle styringstendenser og for aktørernes muligheder for demokratisk oplysning og deltagelse i stadig mere komplekse praksissammenhænge

Prevalence and distribution of cervical high-risk human papillomavirus and cytological abnormalities in women living with HIV in Denmark - the SHADE

BACKGROUND: Women living with HIV (WLWH) are at increased risk of persistent human papillomavirus (HPV) infection, cervical dysplasia and cervical cancer compared with women from the general population (WGP). We assessed the prevalence and distribution of cervical high-risk (hr) HPV infection and cytological abnormalities in WLWH compared with WGP in Denmark. Predictors of HPV and cytological abnormalities were estimated in WLWH. METHODS: WLWH consecutively enrolled in the Study on HIV, cervical Abnormalities and infections in women in Denmark (SHADE) in 2011 and were examined for cervical HPV and cytological abnormalities. WLWH were matched on age and prior cytological findings with WGP from an earlier study. HIV demographics were retrieved from the nationwide Danish HIV Cohort Study. Logistic regression was used to estimate predictors of hrHPV and cytological abnormalities. RESULTS: Of 334 included WLWH 26.4 % were positive for hrHPV as opposed to 16.6 % WGP (p < 0.0001). WLWH had a higher number of multiple infections (>1 h genotype present) (38.5 % versus 25.7 %, p = 0.030). Hr genotypes in descending order of frequency were HPV58 (7.1 %), 52 (5.4 %), and 16 (4.8 %) in WLWH versus HPV16 (4.1 %), 52 (2.8 %) and 58 (2.4 %) in WGP. Predictors of hrHPV in WLWH were short duration of HAART (adjusted OR per year 0.90 (95 % CI 0.84-0.96)), AIDS prior to inclusion (adjusted OR 3.61 (95 % CI 1.75-7.46)), ≥5 lifetime sexual partners (adjusted OR 2.20 (95 % CI 1.08-4.49)), sexual debut <16 years of age (adjusted OR 2.05 (95 % CI 1.03-4.10)) and CD4 < 350 cells/μL (adjusted OR 2.53 (95 % CI 1.20-5.40)). Cytological abnormalities were prevalent in 10.4 % vs. 5.2 % (p = 0.0003) of WLWH and WGP. In WLWH with hrHPV, short duration of HAART predicted cervical dysplasia (adjusted OR per year 0.83 (95 % CI 0.71-0.97)). CONCLUSIONS: WLWH presented with more cervical hrHPV infections and cytological abnormalities, and a different distribution of hrHPV genotypes compared with WGP. Cervical hrHPV and cytological abnormalities were predicted by short duration of HAART. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12885-016-2881-1) contains supplementary material, which is available to authorized users