Introduction

BACKGROUND: National quality registries (NQRs) purportedly facilitate quality improvement, while neither the extent nor the mechanisms of such a relationship are fully known. The aim of this case study is to describe the experiences of local stakeholders to determine those elements that facilitate and hinder clinical quality improvement in relation to participation in a well-known and established NQR on stroke in Sweden. METHODS: A strategic sample was drawn of 8 hospitals in 4 county councils, representing a variety of settings and outcomes according to the NQR's criteria. Semi-structured telephone interviews were conducted with 25 managers, physicians in charge of the Riks-Stroke, and registered nurses registering local data at the hospitals. Interviews, including aspects of barriers and facilitators within the NQR and the local context, were analysed with content analysis. RESULTS: An NQR can provide vital aspects for facilitating evidence-based practice, for example, local data drawn from national guidelines which can be used for comparisons over time within the organisation or with other hospitals. Major effort is required to ensure that data entries are accurate and valid, and thus the trustworthiness of local data output competes with resources needed for everyday clinical stroke care and quality improvement initiatives. Local stakeholders with knowledge of and interest in both the medical area (in this case stroke) and quality improvement can apply the NQR data to effectively initiate, carry out, and evaluate quality improvement, if supported by managers and co-workers, a common stroke care process and an operational management system that embraces and engages with the NQR data. CONCLUSION: While quality registries are assumed to support adherence to evidence-based guidelines around the world, this study proposes that a NQR can facilitate improvement of care but neither the registry itself nor the reporting of data initiates quality improvement. Rather, the local and general evidence provided by the NQR must be considered relevant and must be applied in the local context. Further, the quality improvement process needs to be facilitated by stakeholders collaborating within and outside the context, who know how to initiate, perform, and evaluate quality improvement, and who have the resources to do so

A many-analysts approach to the relation between religiosity and well-being

The relation between religiosity and well-being is one of the most researched topics in the psychology of religion, yet the directionality and robustness of the effect remains debated. Here, we adopted a many-analysts approach to assess the robustness of this relation based on a new cross-cultural dataset (N=10,535 participants from 24 countries). We recruited 120 analysis teams to investigate (1) whether religious people self-report higher well-being, and (2) whether the relation between religiosity and self-reported well-being depends on perceived cultural norms of religion (i.e., whether it is considered normal and desirable to be religious in a given country). In a two-stage procedure, the teams first created an analysis plan and then executed their planned analysis on the data. For the first research question, all but 3 teams reported positive effect sizes with credible/confidence intervals excluding zero (median reported β=0.120). For the second research question, this was the case for 65% of the teams (median reported β=0.039). While most teams applied (multilevel) linear regression models, there was considerable variability in the choice of items used to construct the independent variables, the dependent variable, and the included covariates

A Many-analysts Approach to the Relation Between Religiosity and Well-being

The relation between religiosity and well-being is one of the most researched topics in the psychology of religion, yet the directionality and robustness of the effect remains debated. Here, we adopted a many-analysts approach to assess the robustness of this relation based on a new cross-cultural dataset (N = 10, 535 participants from 24 countries). We recruited 120 analysis teams to investigate (1) whether religious people self-report higher well-being, and (2) whether the relation between religiosity and self-reported well-being depends on perceived cultural norms of religion (i.e., whether it is considered normal and desirable to be religious in a given country). In a two-stage procedure, the teams first created an analysis plan and then executed their planned analysis on the data. For the first research question, all but 3 teams reported positive effect sizes with credible/confidence intervals excluding zero (median reported β = 0.120). For the second research question, this was the case for 65% of the teams (median reported β = 0.039). While most teams applied (multilevel) linear regression models, there was considerable variability in the choice of items used to construct the independent variables, the dependent variable, and the included covariates

Causes of corruption

This thesis consists of an introductory chapter and four essays. Although possible to read individually they all analyse the causes of corruption and hence complement each other. The four essays collectively illustrate the complex nature of corruption. Often many interrelated factors work together in causing corruption. Hence, discovering how these factors, individually and together, cause corruption is vital in combating corruption. The first essay helps to explain the path dependency of corruption. It shows that even if the legal system and enforcement level in a corrupt country or organisation is altered to become identical to that in a non corrupt, the level of corruption may not converge. The second essay analyses how the decision making structure influences corruption. It is found that even though the profits of corruption may be monotonically related to changes in the organisational structure the incidence of corruption is not necessarily so. The third essay looks on how corruption may spread between different organisations or countries as they interact with each other, with corrupt/non corrupt behaviour being more likely to be transmitted from successful to nonsuccessful entities than vice versa. The fourth and final essay investigates how the freedom of information can impact on corruption. Looking on both regulatory and technical constraints on information flows, the conclusion is that relaxation of both constraints simultaneously is needed to combat corruption

Det första vårdmötet på akutmottagning : En systematisk och integrativ litteraturstudie

Akutsjuksköterskan möter patienter med en rad olika upplevda symtom och uppvisade tecken på sjukdom eller skada. I det första vårdmötet utför akutsjuksköterskan en systematisk första bedömning av allvarlighetsgraden. Det första vårdmötet är avgörande för patientens fortsatta vård, därav finns betydelse att belysa det som hämmar och stärker akutsjuksköterskan i det första vårdmötet. Syftet med studien var att utforska tillgänglig vetenskaplig litteratur gällande vilka faktorer som påverkar akutsjuksköterskans arbete i samband med det första vårdmötet med patient på akutmottagning. En systematisk och integrativ litteraturstudie valdes som metod där åtta vetenskapliga artiklar ingick. Två teman framträdde; "Egna begränsningar inverkar på bedömning och fortsatt vård" och "Utrymme för en fungerande vårdmiljö inverkar på vårdmötet". Resultatet påvisade att det första vårdmötet anses som svårt och komplicerat, där erfarenhet och kunskap hos akutsjuksköterskan bidrog till en säkrare första bedömning. Vidare påverkades även akutsjuksköterskan av organisatoriska faktorer såsom bristande bemanning och en brist på samsyn mellan akutsjuksköterska och verksamhet

IPOs prestation på den svenska marknaden : En kvantitativ studie av marknadsnoteringar på Nasdaq OMX Stockholm och First North under år 2011-2015

En börsnotering (initial public offering, IPO) innebär att ett bolag väljer att sälja sina aktier på en publik marknad. Genom åren har IPOs påvisats vara starkt korrelerade med något som kallas underprissättning. När ett bolag noteras på en handelsplats har det visat sig att i genomsnitt sätts teckningskursen markant lägre relativt vad marknaden värderar bolagets aktie. Det är detta som definieras som underprissättning. Samtidigt tenderar IPOs att prestera sämre, eller underavkasta, marknaden på längre sikt. Denna studie syftar att undersöka dessa två företeelser för att förkasta eller bekräfta hur situationen sett ut på den svenska marknaden mellan åren 2011-2015. De två handelsplatser som studerats är Nasdaq OMX Stockholm och First North. På Nasdaq OMX Stockholm var underprissättningen 10,25% i snitt under den studerade perioden. På First North var underprissättningen 6,15%, medan den genomsnittliga underprissättningen för samtliga bolag var 7,45%. Avkastningen för de båda handelsplatsernas IPOs fortsatte att öka på en månads och ett års sikt. Relevanta referensindex användes för att jämföra denna avkastning med avkastningen på marknaden. Det visade sig att de IPOs som valts ut på Nasdaq OMX Stockholm överavkastade sitt referensindex OMXSPI på en månad och ett år, med 5,37% och 24,40%. En signifikant differens kunde bara påvisas på ett år. Bolagen på First North presterade sämre än sitt referensindex i snitt på både en månad och ett år, med 2,62% och 6,40%.men ingen signifikant bekräftelse kunde göras för att generalisera dessa resultat på hela populationen. Denna studie konstaterar att det varit en genomsnittlig underprissättning på 7,45% under perioden 2011-2015. Det kan inte påvisas någon entydig signifikant differens mellan IPOs prestation och marknaden.Initial public offering (IPO) means that a company chooses to sell its shares in a public market. Through the years IPO’s have been strongly correlated with something called underpricing. When a company is listed on a trading platform, it has been found that, on average, the subscription price is significantly lower relative to the market value of the company's share. This is defined as underpricing. At the same time, the IPO’s tend to perform worse, or underperform the market in the longer term. This study aims at investigating these two phenomena in order to reject or confirm how the situation has appeared on the Swedish market between 2011-2015. The two trading platforms studied are Nasdaq OMX Stockholm and First North. At Nasdaq OMX Stockholm, the underpricing was 10.25% on average during the study period. On First North, the underpricing was 6.15%, while the average underpricing for all firms was 7.45%. The return on the IPO’s of both trading platforms continued to increase in one month and one year term. Relevant reference indexes were used to compare this return with the return on the market. It turned out that the IPO’s selected on Nasdaq OMX Stockholm exceeded their OMXSPI reference index in one month and one year, with 5.37% and 24.40% in average. A significant difference could only be detected in one year. The companies at First North performed poorer than their reference index on average for both one month and one year, with 2.62% and 6.40%. No significant confirmation could be made to generalize the results at First North for the entire population. This study finds that there has been an average underpricing of 7.45% over the period 2011- 2015. No unequivocal significant difference between IPO performance and the market can be detected

Det första vårdmötet på akutmottagning : En systematisk och integrativ litteraturstudie

Akutsjuksköterskan möter patienter med en rad olika upplevda symtom och uppvisade tecken på sjukdom eller skada. I det första vårdmötet utför akutsjuksköterskan en systematisk första bedömning av allvarlighetsgraden. Det första vårdmötet är avgörande för patientens fortsatta vård, därav finns betydelse att belysa det som hämmar och stärker akutsjuksköterskan i det första vårdmötet. Syftet med studien var att utforska tillgänglig vetenskaplig litteratur gällande vilka faktorer som påverkar akutsjuksköterskans arbete i samband med det första vårdmötet med patient på akutmottagning. En systematisk och integrativ litteraturstudie valdes som metod där åtta vetenskapliga artiklar ingick. Två teman framträdde; "Egna begränsningar inverkar på bedömning och fortsatt vård" och "Utrymme för en fungerande vårdmiljö inverkar på vårdmötet". Resultatet påvisade att det första vårdmötet anses som svårt och komplicerat, där erfarenhet och kunskap hos akutsjuksköterskan bidrog till en säkrare första bedömning. Vidare påverkades även akutsjuksköterskan av organisatoriska faktorer såsom bristande bemanning och en brist på samsyn mellan akutsjuksköterska och verksamhet

Determinants of Demand for Wine – price sensitivity and perceived quality in a monopoly setting

The purpose of this paper is to characterise the demand for wine. In contrast to the majority of current research efforts this paper treats wine as a heterogeneous good with a range of inherent characteristics. Each wine included in the study is described by twelve variables including, among others, price, quality, sensory attributes and country of origin. Using unique data that cover 90 percent of all wines sold in Sweden we conclude that consumers do recognise quality in wine, that price elasticity is non-constant and decreasing with price and that consumers put a great deal of weight on the country of origin of the wine.consumer preferences; wine; quality; price elasticity; heterogeneous goods

Comparison of individual and neighbourhood socioeconomic status in case mix adjustment of hospital performance in primary total hip replacement in Sweden : a register-based study

Background Case mix adjustment is a pre-requisite for valid measurement of healthcare performance and socioeconomic status (SES) is important to account for. Lack of information on individual-level SES has led to investigations into using a proxy for SES based on patient area of residence. The objective of this study was to use neighbourhood SES for case mix adjustment of performance indicators in total hip replacement (THR) in Sweden, and to compare with use of individual SES. Methods Data from patient administrative systems and the Swedish Hip Arthroplasty Register were extracted for all patients undergoing THR in four Swedish regions. For each subject, individual data and neighbourhood data on country of birth, educational level, and income were provided by Statistics Sweden. Three variables were selected for analysis of performance; EQ-5D, hip pain and length of stay (LoS). In addition to socioeconomic information, several important clinical characteristics were used as case mix factors. Regression analysis was used to study each variable’s impact on the three outcome variables and model fit was evaluated using mean squared error. Results A total of 27,121 patients operated between 2010 and 2016 were included in the study. Both educational level and income were higher when based on neighbourhood information than individual information, while proportion born in Sweden was similar. Higher SES was generally found to be associated with better outcomes and lower LoS, albeit with certain differences between the different measures of SES. The predictive ability of the models was increased when adding information on SES to the clinical characteristics. The increase in predictive ability was higher for individual SES compared to neighbourhood SES. When analysing performance for the two providers with most diverging case mix in terms of SES, the inclusion of SES altered the relative performance using individual as well as neighbourhood SES. Conclusions Incorporating SES improves case mix adjustment marginally compared to using only clinical information. In this patient group, geographically derived SES was found to improve case mix adjustment compared to only clinical information but not to the same extent as actual individual-level SES