Moving together – conditions for intercultural development at a highly diverse Swedish school

This thesis is a case study of a primary school in a highly diverse urban neighbourhood in Sweden. Basic pre-conditions for intercultural school development are studied by examining the overall organisation of teaching, learning and opportunities for collaboration in the investigated case. The study focuses on the targeted support measures to enhance learning for students with an immigrant background: Mother tongue instruction, Swedish as a Second Language, and tutoring in the mother tongue, as well as looking at pedagogical support provided by the school library. The latter has a mission to promote learning and inclusion, where non-native speakers of Swedish are a prioritised group. Communities of practice linked to the work organisation at a meso-level are investigated, and the collaborative relationships between professional groups at the school involved in the various support measures. Teacher relationships and categorisations implied by support measures impact the learning spaces that are shaped for students and the teaching spaces within which teachers work. Collaborative opportunities and convergence of concerns in the teaching spaces combine to shape the overall space for intercultural development. The raw data for the case study consists of interviews, national policy documents and additional information on local work organisation gained through documents and observations. Four articles resulted from the case study, each focusing a specific support measure. An overarching analysis is then made of findings from these articles and the other dimensions of the investigation. The analysis describes the organisation in terms of monocultural or intercultural school cultures, pointing to significant characteristics of the landscapes of practice, with respect to their overall implications for the spaces of school development. In the discussion, findings are considered in relation to research on professional development in education, collaboration, democracy and inclusive schooling. The relative positioning of languages and cultures is given particular attention, to ascertain if the school culture is monocultural or intercultural in the sense given by Lahdenperä (2008), and to what extent it could enable intercultural development. Such positioning plays a role interms of affordances for identity, participation and engagement discussed by Wenger (1998). This case study should be understood against the wider background of recent social developments in Europe linked to globalisation and technological changes. It is argued that looking at the concrete specifics which facilitate or obstruct school development, and simultaneously reflecting on how the different forms of teaching interrelate in the overall organisation and in policy may provide a useful vantage point from which structural changes can be contemplated.The discussion underlines the importance of the physical localisation of activities, continuity in personal contacts and time available for joint pedagogical reflection, as basic conditions for effective intercultural dialogue in the organisation. Finally, the impact of policy is considered, looking at connections between levels of policy, expressed in official steering documents, and conditions for teaching and learning at the level of an individual school.

Should I stay or should I go – Factors associated with hospitalization risk among older persons in Sweden

An increasingly older population will most likely lead to greater demands on the health care system, as older age is associated with an increased risk of having acute and chronic conditions. The number of diseases or disabilities is not the only marker of the amount of health care utilized, as persons may seek hospitalization without a disease and/or illness that requires hospital healthcare. Hospitalization may pose a severe risk to older persons, as exposure to the hospital environment may lead to increased risks of iatrogenic disorders, confusion, falls and nosocomial infections, i.e., disorders that may involve unnecessary suffering and lead to serious consequences. Aims: The overall aim of this thesis was to describe and explore individual trajectories of cognitive development in relation to hospitalization and risk factors for hospitalization among older persons living in different accommodations in Sweden and to explore older persons' reasons for being transferred to a hospital. Methods: The study designs were longitudinal, prospective and descriptive, and both quantitative and qualitative methods were used. Specifically, latent growth curve modelling was used to assess the association of cognitive development with hospitalization. The Cox proportional hazards regression model was used to analyse factors associated with hospitalization risk overtime. In addition, an explorative descriptive design was used to explore how home health care patients experienced and perceived their decision to seek hospital care. Results: The most common reasons for hospitalization were cardiovascular diseases, which caused more than one-quarter of first hospitalizations among the persons living in ordinary housing and nursing home residents (NHRs). The persons who had been hospitalized had a lower mean level of cognitive performance in general cognition, verbal, spatial/fluid, memory and processing speed abilities compared to those who had not been hospitalized. Significantly steeper declines in general cognition, spatial/fluid and processing speed abilities were observed among the persons who had been hospitalized. Cox proportional hazards regression analysis showed that the number of diseases, number of drugs used, having experienced a fall and being assessed as malnourished according to the Mini Nutritional Assessment scale were related to an increased hospitalization risk among the NHRs. Among the older persons living in ordinary housing, the risk factors for hospitalization were related to marital status, i.e., unmarried persons and widows/widowers had a decreased hospitalization risk. In addition, among social factors, receipt of support from relatives was related to an increased hospitalization risk, while receipt of support from friends was related to a decreased risk. The number of illnesses was not associated with the hospitalization risk for older persons in any age group or for those of either sex, when controlling for other variables. The older persons who received home health care described different reasons for their decisions to seek hospital care. The underlying theme of the home health care patients’ perceptions of their transfer to a hospital involved trust in hospitals. This trust was shared by the home health care patients, their relatives and the home health care staff, according to the patients. Conclusions: This thesis revealed that middle-aged and older persons who had been hospitalized exhibited a steeper decline in cognition. Specifically, spatial/fluid, processing speed, and general cognitive abilities were affected. The steeper decline in cognition among those who had been hospitalized remained even after controlling for comorbidities. The most common causes of hospitalization among the older persons living in ordinary housing and in nursing homes were cardiovascular diseases, tumours and falls. Not only health-related factors, such as the number of diseases, number of drugs used, and being assessed as malnourished, but also social factors and marital status were related to the hospitalization risk among the older persons living in ordinary housing and in nursing homes. Some risk factors associated with hospitalization differed not only between the men and women but also among the different age groups. The information provided in this thesis could be applied in care settings by professionals who interact with older persons before they decide to seek hospital care. To meet the needs of an older population, health care systems need to offer the proper health care at the most appropriate level, and they need to increase integration and coordination among health care delivered by different care services.