Medical doctors’ specialty choice : in relation to personality, cultural capital and social background

Globally and in Sweden, there is a lack of doctors in some medical specialities. With a growing population and increasing demand for a functional healthcare sector, there is a need to understand more about medical doctors’ specialty choices. The aim of this thesis is to obtain a deeper understanding of the processes that precede medical doctors’ specialty choice and to investigate how factors such as personality, cultural capital and social background have bearing on that choice. The four studies included in the thesis achieved this purpose. The studies were conducted in the same order as they are presented in the thesis, and studies I and II were completed before studies III and IV were designed. The first two studies were conducted with quantitative methods, whereas studies III and IV were conducted with qualitative methods. The results from studies I and II guided the research questions and methods for studies III and IV. An interpretative and pragmatic research tradition was adopted. In study I, the well-established research instrument Big Five Inventory was used to examine personality traits. In studies II and III, Pierre Bourdieu’s theoretical concepts of field, habitus and different forms of capital were used to interpret the findings. No particular theoretical framework was used in study IV, as the results were instead discussed in relation to previous research. The findings of this thesis suggest that many factors are at play in medical doctors’ specialty choice. Upbringing, school achievements, medical school and encounters with the healthcare system all have bearing on specialty choice. Furthermore, study I concluded that there are significant associations between specialty choice and personality. Surgeons had higher scores in conscientiousness and lower scores in agreeableness. Psychiatrists had higher scores in being open to new experiences, but this was not significant when adjusting for confounding factors. Study II established that medical doctors ranked perceived status differently for different specialities. Perceived status was also related to one’s own choice of specialty. The content analysis in study III revealed two themes: toward an understanding of the medical profession and different specialities and positions in the medical field. The first theme showed that social background plays a part in gaining access to medical education in the first place. Furthermore, parents who are medical doctors transfer knowledge about the specialties to their children - interpreted in this thesis as cultural capital. In the second theme, it became clear that the investments needed to become a specialist vary among specialities. It is difficult to gain access to education in the surgical specialities, whereas for other specialities there are more opportunities. The findings from study II about perceived status were reinforced, and surgical specialities stood out as having more prestige than any of the other specialities. Social networks, role models and being seen by superiors were also part of this theme. Three themes were established in study IV. In the first theme, to be invited or not, encounters with the healthcare system were important. Role models and a good work environment were positive aspects, whereas a poor work environment was a reason for rejecting a choice. In the second theme, to fit in or not, the importance of having a personality that was in line with one’s chosen specialty was explored. The third and last theme, to contribute or not, illuminated the desire to contribute to the medical field within a chosen specialty. Thoughts about disadvantaged patient groups and types of patient relations were at the core of this theme. This thesis concludes that medical doctors’ specialty choice is a long-term, complex and sometimes contradictory process in which many factors are considered. These dimensions include personal characteristics such as personality traits, social background and the formation of habitus as well as characteristics of patient relations and the type of medicine. In addition, positive and negative encounters with the healthcare system increase or decrease the likelihood of choosing a particular specialty. Finally, perceived status and prestige are central to understanding the attractiveness of different specialties

Maternal stress and allergic disease in offspring

The theory of developmental origins of health and disease (DOHaD), hypothesize that diseases like allergy is formed in-utero and early life by interaction between adverse environmental factors and genetic predisposition. The study population in this thesis consists of mother-child pairs from the PreventADALL cohort. The overall aim of this doctoral thesis was to evaluate maternal pre- and postpartum stress and the risk of abdominal pain and allergic disease in offspring. In Study 1, the proportion of maternal perceived stress at 18- and 34-weeks was described and the association between symptoms of allergic disease and maternal perceived stress explored in n=2164 pregnant mothers. Study 2 described the prevalence of infant colic, abdominal pain and other pain and discomforts in n=1852 infants at 3 months age and perinatal factors associated with the abdominal outcomes. The correlation between maternal perceived stress in pregnancy and postpartum, maternal saliva cortisol and infant saliva cortisol (n=1057) was explored in study 3. Finally, Study 4 investigated if maternal perceived stress during pregnancy or postpartum were associated with infant allergic sensitization at 12 months age (n=1757). Results from Study 1 showed that maternal stress was reported by 15 % of the mothers at 18 weeks and 13% at 34 weeks. Symptoms of asthma, rhinitis and food allergy reported by the mother were associated with high perceived stress and increased stress in the third trimester. Infant colic was reported in n=59 infants, abdominal pain in n=115 and other pain and discomforts in n=119 infants at 3 months age. High maternal perceived stress was not associated with any of the abdominal and pain symptoms. Neither were the infant saliva cortisol levels at 3 months age (Study 3). Furthermore, maternal perceived stress during pregnancy and postpartum and maternal saliva cortisol at 18 weeks were not correlated, neither were infant saliva cortisol levels (n=1057). In Study 4, infants and their mothers with perceived stress were included. The maternal stress in pregnancy and postpartum were not associated with infant sensitization (n=139) at 12 months age. Conclusion: Symptoms of allergic disease can be stressful for mothers in pregnancy. Abdominal pain is a common symptom in 3-month-old infants. Maternal stress in pregnancy is not a risk-factor for abdominal pain, other pain and discomforts or infant colic. Maternal perceived stress in pregnancy and postpartum does not correlate with neither maternal cortisol in pregnancy nor infant cortisol at 3 months age. Maternal stress in pregnancy and postpartum is not associated with allergic sensitization in their offspring at 12 months of age. These findings could be an important information to communicate to the mothers who experience stress during pregnancy. The knowledge that maternal stress does not affect colic, abdominal pain, or allergic sensitization could relieve the mother

Vårdnadshavares strikta skadeståndsansvar – en kritisk granskning av ansvaret och dess processrättsliga konsekvenser

Summary In September 2010 an amendment of law was made which meant that legal guardians, in addition to their already existing supervisory responsibility, became subject to strict liability for damages caused by their children through a criminal offence. The aim of the regulation is to decrease juvenile delinquency. The purpose of this thesis is to investigate and critically analyze the strict liability for legal guardians in 3 ch. 5 § the Tort Liability Act and to account for some procedural aspects relevant to the adjudication of the regulation on strict liability. In the light of what has been presented in the thesis my conclusion is that the scope of the strict liability for legal guardians, in spite of a maximum sum per loss event and pure economic losses being exempted, is extensive. In several respects the law is unclear regarding the prerequisites for the liability, especially the meaning of the term loss event and when rights of recourse exist. The regulation, in my opinion, is in need of clarifications in order for its scope to be predictable for legal guardians. 3 ch. 6 § and 6 ch. 2 § the Tort Liability Act is applied restrictively and appears to demand quite a lot concerning the circumstances legal guardians have to invoke in order to run a successful defense based on apportionment. Existing case law is not entirely uniform, which results in a lack of foreseeability as to how the regulation of apportionment is being applied. In my thesis several procedural issues have been identified in connection to the application of the strict liability for legal guardians. Most common is for the private claim made towards the legal guardians to be in joint processing with the criminal offence committed by their child. Which rules to apply from the Code of Judicial Procedure in joint processing, is to a certain extent ambiguous. This results in doubt regarding processing in the absence of the legal guardians, an obligation to inform the legal guardians about processing in their absence and when service of a summons is to be completed. Legal guardians can further on have to render compensations higher than the set maximum sum, even though the damage refers to the same loss event. This happens because of the burden of pleading is placed on the legal guardians. Legal guardians may also have to pay compensation although their child is found not to have committed a criminal offence. The reason for this, amongst others, is the rules on leave of appeal – which means that the processing for the legal guardians and the processing for the child not necessarily is connected. Finally, the possibilities for the legal guardians and the person who suffered loss, to access legal assistance differs essentially. Legal guardians are rarely represented by an attorney, a circumstance that complicates the possibilities for legal guardians to create an understanding of their strict liability, of the regulation of apportionment and of procedural aspects that affects their strict liability.Sammanfattning I september 2010 trädde en lagändring i kraft som innebar att vårdnadshavare, utöver sitt redan befintliga tillsynsansvar, blev strikt skadeståndsansansvariga för skador som deras barn vållat genom en brottslig handling. Regleringen ska verka preventivt och minska ungdomsbrottsligheten. Syftet med min uppsats har varit att utreda och kritiskt granska det strikta skadeståndsansvar som 3 kap. 5 § SkL ålägger vårdnadshavare samt att redogöra för några processrättsliga aspekter relevanta vid tillämpningen av regleringen om deras strikta ansvar. Mot bakgrund av vad om framkommit i uppsatsen drar jag slutsatsen att vårdnadshavarnas skadeståndsansvar, trots en beloppsbegränsning per skadehändelse och trots att rena förmögenhetsskador uteslutits, är omfattande. I flera avseenden är regleringen oklar rörande förutsättningarna för ansvaret, särskilt innebörden av begreppet skadehändelse och när regressrätt föreligger. Regleringen är enligt min mening i behov av tydliggöranden för att dess omfattning ska bli förutsägbar för vårdnadshavarna. Jämkningsmöjligheterna enligt 3 kap. 6 § SkL och enligt 6 kap. 2 § SkL tillämpas restriktivt och det synes krävas en hel del av vårdnadshavarna beträffande vad de åberopar för grundande omständigheter om de ska vinna framgång med en talan om jämkning. Befintlig praxis är i flera avseenden inte enhetlig, vilket medför att förutsägbarheten beträffande hur jämkningsbestämmelserna tillämpas kan kritiseras. I uppsatsen identifieras ett flertal processrättsliga problem i samband med tillämpningen av vårdnadshavarnas strikta ansvar. Vanligast är att det enskilda anspråket, som riktats mot vårdnadshavarna, handläggs tillsammans med det brottmål som barnet står åtalat för. Vid gemensam handläggning är det i viss mån oklart när målet ska följa RB:s regler för brottmål respektive för tvistemål. Detta medför betänkligheter kring utevarohandläggning, informationsskyldighet om utevarohandläggning och när delgivning av stämning ska ske. Vidare kan vårdnadshavare komma att behöva erlägga ersättning högre än beloppsbegränsningen för en och samma skadehändelse, då de har åberopsbördan för att de redan har betalt en femtedels prisbasbelopp för aktuell skadehändelse. Vårdnadshavare kan även komma att behöva betala skadestånd trots att barnet inte anses ha begått en brottslig handling. Detta beror bland annat på reglerna om prövningstillstånd, som medför att processen för vårdnadshavare och processen för barnet inte behöver följas åt. Slutligen skiljer sig förutsättningarna väsentligen åt för den skadelidande och för vårdnadshavarna att erhålla stöd vid utformningen och framförande av talan. Endast sällan är vårdnadshavare företrädda av ombud, vilket borde försvåra för vårdnadshavare att skapa förståelse för deras strikta ansvar, vilka möjligheter de har att få skadeståndet jämkat och hur processrättsliga aspekter kan påverka ansvaret

Industriellt samarbete för hållbar utveckling

Från att lagar och regler har varit den främsta faktorn för att motivera företag och industrier att arbeta med miljöfrågor har påtryckningar från konsumenter och övriga intressenter blivit mer viktigt. Många intressegrupper får tillgång till hållbarhetsrelaterad information och blir därför insatta och medvetna om miljö och sociala aspekter på produktion och konsumtion. En stor utmaning för företagen är att ta ansvar för sin verksamhet och på ett trovärdigt sätt kommunicera hur de arbetar till sina intressenter. Företagen tar ansvar för miljöproblem direkt relaterade till deras egen produktion, vilket kan ses som strategiskt CSR-arbete. Större mer komplexa problem som berör hela samhället och som går utanför det enskilda företagets ramar och gränser kallas ofta för ”wicked problems”. ”Wicked problems” karaktäriseras av att de angår och påverkar hela samhället och kan inte lösas av en part utan någon form av samarbete måste till för att identifiera och kartlägga problematiken. Det finns inga enkla snabba lösningar, utan ett stort antal aspekter måste belysas för att finna fungerande lösningar. Syftet med projektet är att beskriva förutsättningar för strategiskt samarbete kring användningen av naturresurser. Studien fokuserar främst på att undersöka motiven för att medverka i ett industriellt samarbete, vad parterna förväntar sig av samarbetet samt vilka utmaningar och framgångsfaktorer samarbetet innebär. Studien genomförs genom en fallstudie av aluminiuminitiativet genom intervjuer av medlemmar i samarbetet. Studien visar att det finns flera motiv till att gå med i ett industriellt samarbete, dels från externa påtryckningar men även interna drivkrafter. Ett av de mer framträdande motiven som framkom, var påtryckningar från intressenter och osäkerheten kring förändrade förutsättningar för industrin orsakade av att branschen uppfattas som mindre ansvarstagande i miljöfrågor. Förväntningar som dominerar hos deltagarna i samarbetet är främst att skapa trygghet och stabilitet inom branschen. Även utbyte av erfarenheter och ny kunskap samt förväntningar att samarbetet kan fötväntas ge positiva fördelar för det egna företaget och branschen i stort. Sammanfattningsvis förväntar sig deltagarna att samarbetet på sikt ska leda till en hållbar värdekedja för aluminium. De utmaningar som framkom i den här studien var att komma överens om hur man når de gemensamma målen och hur man definierar målen. Det krävs att alla deltagare ger och tar i diskussionerna för att hitta en gemensam plan och målbild. Framgångsfaktorer för ett lyckat samarbete är engagemang samt att skapa gemensamma målbilder. Även delaktighet från NGO framkom i studien som en viktig förutsättning för att skapa trovärdighet för samarbetet och certifieringen. Certifieringen i sig är en del av framgångarna med samarbetet, den ger en tydlig riktlinje för deltagarna och skapar sammanhållning. De intervjuade företagen ser på aluminiuminitiativet som en del av en hållbar strategi för att kunna vara attraktiva in i framtiden, både deras produkter och som arbetsgivare. Hållbarhet är inte bara en fråga om minskade utsläpp, utan också i hög grad en investering för att överleva och växa i framtiden.Historically laws and regulations have been the main factor in motivating companies and industries to work with environmental issues. We now see a shift towards pressure from consumers and other stakeholders becoming more important. Many interest groups have access to sustainability-related information and are therefore informed and aware of the environment and social aspects of production and consumption. A big challenge for the companies is to take responsibility for their business and in a credible way communicate to interested parties how they conduct their business. Companies take responsibility for environmental problems directly related to their own production, which can be seen as strategic CSR work. Larger, more complex problems that affect the whole of society and go beyond the individual company's frameworks and boundaries are often referred to as "wicked problems". "Wicked problems" are characterized by the fact that they concern and affect society as a whole. They cannot be solved by one single party. What is needed is cooperation in order to identify and map the problem. There are no quick fixes. Instead many aspects must be highlighted in order to find working solutions. The purpose of this project is to describe the conditions for strategic collaboration regarding the use of natural resources. The study focuses primarily on investigating the motives for participating in industrial cooperation, what the parties expect from the collaboration and what challenges and success factors the cooperation entails. The study is conducted through a case study of “Aluminiuminitiativet”, The Aluminum Initiative, through interviews with members of the collaboration. The study shows that there are several reasons for joining an industrial collaboration. Some are due to external pressure, but internal driving forces also play a part. One of the more prominent motives that emerged was pressure from interested parties. This was related to the uncertainty surrounding changed conditions for the industry caused by the industry being perceived as less responsible for environmental issues. The main expectations of the participants in the collaboration are primarily to create security and stability in the industry, to exchange experiences and to attain new knowledge. The participants also anticipate that the cooperation may bring positive benefits for the company and the industry as a whole. In summary, the participants expect that the cooperation will eventually lead to a sustainable value chain for aluminum. The challenges that emerged from this study were to agree on how to achieve the common goals and how to define the goals. A requirement for a positive outcome is that all participants give and take in the discussions to find a common plan and goal. Factors that lead to a functioning collaboration are commitment and being able to create common goals. In the study participation from NGOs also emerged as an important prerequisite for creating credibility for the collaboration and certification. The certification itself is part of the success of the collaboration, it provides a clear guideline for the participants and creates cohesion. The interviewed companies look at The Aluminum Initiative as part of a sustainable strategy to ensure that both their product and they as employers stay attractive in the future. Sustainability is not just a matter of reducing emissions. It is also largely an investment in the future survival and growth of the companies

Unveiling the Concept of Packaging Logistics

An increasingly competitive environment, technological advancements and globalisation are a few of the factors placing higher demands on today’s company activities, e.g. development, production and distribution processes. Company activities have hereby become a complex system, even more so if one company is seen as part of a network of companies. The aim of this article is to present and elaborate on an approach that deals with these matters in an integrated manner – packaging logistics, where the logistics systems are studied from a packaging perspective. This is carried out through putting package definitions and logistics definitions into a model framework based on Porter’s value chain and Christopher’s network theory. Rather than studying packaging and logistics separately, the integrated concept of packaging logistics will give a more complete perspective in problem solving and research. The contribution of this article is to theorise and introduce suggestions to define the subject of packaging logistics

ÄBIC i praktiken. En kvalitativ studie om introduktionen av Socialstyrelsens arbetsmodell Äldres Behov I Centrum.

Author: Caroline Olsson Title: ÄBIC in practice – A qualitative study of the introduction of the working model named “The needs of the elderly in the centre”, developed by the National Board of Health and Welfare in Sweden [translated title] Supervisor: Anders Östnäs Assessor: Dolf Tops The National Board of Health and Welfare in Sweden has developed a new working model named ÄBIC which is to be used by the elderly care in the communities. The purpose of this study was to analyze how this working model was received by the social workers in the community who investigate and handle the needs of the elderly. The aim of the study was also to analyze ageism and how these social workers were affected by ÄBIC when it comes to being the front line workers dealing with discretion. This purpose was explored in semi-structural, qualitative interviews with six social workers in six different communities in Sweden. The results were analyzed with the help of Michael Lipsky´s theory of street-level bureaucracy and Robert Butler´s theory of ageism. The new working model ÄBIC was well accepted by the social workers although there were many challenges associated. Results show that all operators on all levels and areas within the organization affected by the new working model need to be educated and led by inspired managers. A functioning IT-system including the new ÄBIC concept is essential. Although the new working model is more controlling there is still some discretion available for the social worker. When it comes to the elderly, their needs and goals get more visible which is important especially for those who cannot make their voice heard. Despite the introduction of a new working model the social worker still has an important role in order to prevent ageism

Enskild egendom, giftorättsgods eller lite av varje? - En studie av gällande rätt i fråga om surrogat av blandad karaktär

Denna uppsats behandlar problematiken rörande surrogat av blandad karaktär, det vill säga sådan ersättningsegendom som finansieras delvis genom makes giftorättsgods, delvis genom dennes enskilda egendom. Syftet är att utreda huruvida delningsprincipen, där surrogategendomen delas upp proportionellt i de två egendomsslagen, eller huvudsaklighetsprincipen, vilken innebär att hela surrogatet klassificeras som antingen enskild egendom eller giftorättsgods i sin helhet, ska tillämpas. Det undersöks även om några kvotgränser kan fastställas för klassificeringen. En rättsdogmatisk metod används för att utreda gällande rätt ur ett domarperspektiv. Vidare betraktas även rättsläget ur ett samhällsvetenskapligt perspektiv med motiv att föra en diskussion om hur rätten på området bör se ut. Enskild egendom tillskapas genom äktenskapsförord eller genom villkor i gåva, testamente eller förmånstagarförordnande av tredje man och ingår inte i bodelning mellan makarna. Även det som träder i stället för enskild egendom, så kallat surrogat, är att anse som makes enskilda om inget annat stadgas. Avseende surrogat som betalas med både enskilda medel och giftorättsmedel i form av belånade fastigheter har HD i ett flertal rättsfall använt sig av huvudsaklighetsprincipen och trots förhållandevis låga kvotvärden låtit kontantinsatsens karaktär vara avgörande. Även på enskilda medel i form av kontanter har huvudsaklighetsprincipen tillämpats när de sammanblandats med giftorättsmedel på bankkonto. Vad gäller annan typ av egendom och förvärvsförhålladen är rättsläget dock att betrakta som oklart. Huvudsaklighetsprincipen och delningsprincipen kan i praktiken anses få samma resultat i slutändan. Detta genom de regler om vederlag och skevdelning som återfinns i äktenskapsbalken. Dessa ger möjlighet till att ett kompensationskrav kan riktas mot make som tar sitt giftorättsgods i anspråk för att förvärva eller öka värdet av sin enskilda egendom, alternativt att genom jämkning av oskäligt resultat få behålla mer av sitt giftorättsgods om enskilda medel använts för att öka detta. Reglerna om vederlag och skevdelning tillämpas dock relativt restriktivt och det finns därför anledning att ur ett moraliskt samhällsperspektiv förespråka en användning av delningsprincipen på surrogat av blandad karaktär för att uppnå ett så rättvist resultat som möjligt. Dock föreligger vissa praktiska svårigheter med att fastställa exakta kvotdelar giftorättsgods respektive enskild egendom i surrogategendomen, vilket istället motiverar en tillämpning av huvudsaklighetsprincipen.This thesis explores the challenge concerning mixed substitute property, meaning property acquired partly through the marital property of a spouse, partly through their separate property. The purpose is to investigate whether such property should be classified as both separate and marital, split proportionally, or as either separate or marital in entirety when division of property between spouses occur. It is also investigated if the type of classification differs depending on any established ratios of separate versus marital property. Current law is explored using a legal dogmatic method. Furthermore, the legal framework is examined through a social science perspective, aiming to discuss how the law should be applied. Separate property can be acquired through a prenuptial agreement or through a stipulation in gifts, wills and appointments of beneficiaries by a third party and is not included in the division of property between spouses. Property that has been obtained as substitute for separate property is also still to be considered separate property unless stated otherwise. Concerning property which has been acquired with both separate and marital property in the form of mortgaged real estate, the Supreme Court of Sweden (Högsta domstolen) have in several legal cases, despite relatively low ratios, judged the nature of the down payment to be a deciding factor whether the property have been treated as separate or marital in entirety. The same principle of classifying mixed substitute property as either separate or marital in entirety has also been applied to separate property cash when it has been commingled with marital property on bank accounts. However, current law regarding other methods of acquisition or types of property remains unclear. The choice between treating property as a mix of separate and marital, or as a single type, may in many cases lead to the same results. This is due to rules concerning compensation and uneven division of property in the Swedish Marriage Code (Äktenskapsbalken). These allow claims of compensation towards a spouse who uses marital property to acquire or appreciate the value of their separate property, as well as, through adjustment of unreasonable results from the division of property, allow a spouse to keep more of their marital property if separate property has been used to increase it. The rules concerning compensation and uneven division of property are, however, applied somewhat restrictively. There is therefore a moral reason to advocate for splitting mixed substitute property proportionally between separate and marital, in order to achieve a result as fair as possible. However, there are some practical difficulties with establishing specific ratios of each type of property, which supports treating property entirely as either separate or marital

Kommunikation av risk- och sårbarhetsanalys från länsstyrelse till kommun

This master thesis investigates how the county administrative boards communicate the regional risk and vulnerability analyses to municipalities in Sweden. Information has been gathered through a survey and through a case study involving three county administrative boards. The results revealed that there are possibilities to improve or develop the communication in all the county administrative boards. The information channels are often written or web based, these channels promote one way communication rather than a dialog. The thesis gives suggestion on how to work out a strategy for a more effective communication, the case study also gives ideas on how a county administrative board can work with communication

Effekten av förvärmning med varmluftstäcke innan operation för att förebygga hypotermi under operation

Bakgrund: Oavsiktlig anestesiutlöst hypotermi är mycket vanligt under den perioperativa processen. Hypotermi ger en ökad risk för komplikationer som ökad blödning, infektioner i operationsområdet och obehag för patienten. Syfte: Syftet är att i en systematisk litteraturstudie granska och sammanställa forskningen kring förvärmning med varmluftstäcke innan ankomst till operationsavdelningen och dess påverkan på oavsiktlig anestesiutlöst hypotermi under operation. Metod: Systematisk litteraturstudie med modifierad metaanalys. Resultat: Kontrollgrupperna hade en intraoperativ medeltemperatur på 35.9oC medan interventionsgruppernas var 36.1oC, med en skillnad på 0.2o C. När samtliga studier viktades visade resultatet en positiv effekt på 0.9 % av interventionen. Konklusion: Studiens styrka är måttligt stark och visar på positiva effekter av att förvärma patienterna preoperativt då det kan förebygga hypotermi(<36 oC) hos patienterna