Psychometric properties of the Swedish version of the Fear of Complications Questionnaire

Objectives: To translate and evaluate the psychometric properties of the Swedish version of the Fear of Complications Questionnaire. Design: Cross-sectional study design and scale development. Settings: Totally, 469 adults (response rate 63.5%) with Type 1 diabetes completed the questionnaires. Participants were recruited from two university hospitals in Sweden. Participants: Eligible patients were those who met the following inclusion criteria: diagnosed with Type 1 diabetes, diabetes duration of at least 1 year and aged at least 18 years. Methods: The Fear of Complications Questionnaire was translated using the forward-backward translation method. Factor analyses of the questionnaire were performed in two steps using both exploratory and confirmatory factor analysis. Convergent validity was examined using the Hospital Anxiety and Depression Scale and the Fear of Hypoglycaemia Fear Survey. Internal consistency was estimated using Cronbach’s alpha.Results: Exploratory factor analysis supported a two-factor solution. One factor contained three items having to do with fear of kidney-related complications and one factor included the rest of items concerning fear of other diabetes-related complications, as well as fear of complications in general. Internal consistency was high Cronbach’s alpha 0.96. The findings also gave support for convergent validity, with significant positive correlations between measures (r = 0.51 to 0.54). Conclusion: The clinical relevance of the identified two-factor model with a structure of one dominant subdomain may be considered. We suggest, however a one-factor model covering all the items as a relevant basis to assess fear of complications among people with Type 1 diabetes.

Development of a ESES Solar Thermal Lab on Full Scale System

The main aim of this project is to develop an ESES lab on a full scale system. The solar combisystem used is available most of the time and is only used twice a year to carry out some technical courses. At the moment, there are no other laboratories about combisystems. The experiments were designed in a way to use the system to the most in order to help the students apply the theoretical knowledge in the solar thermal course as well as make them more familiar with solar systems components. The method adopted to reach this aim is to carry out several test sequences on the system, in order to help formulating at the end some educating experiments. A few tests were carried out at the beginning of the project just for the sake of understanding the system and figuring out if any additional measuring equipment is required. The level of these tests sequences was varying from a simple energy draw off or collector loop controller respond tests to more complicated tests, such as the use of the ‘collector’ heater to simulate the solar collector effect on the system. The tests results were compared and verified with the theoretical data wherever relevant. The results of the experiment about the use of the ‘collector’ heater instead of the collector were positively acceptable. Finally, the Lab guide was developed based on the results of these experiments and also the experience gotten while conducting them. The lab work covers the theories related to solar systems in general and combisystems in particular. 

Development of an instrument measuring the quality of residential care facilities for older people

Aims. To validate the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM). The instrument’s items measure environmental elements important for supporting the needs of older people, and conceptualized within eight domains. Methods. Item relevance was assessed by a group of experts and measured using content validity index (CVI). Test-retest and inter-rater reliability tests were performed.  The domain structure was assessed by the inter-rater agreement of a second group of experts, and measured using Fleiss kappa. Results. All items attained a CVI above 0.78, the suggested criteria for excellent content validity. Test-retest reliability showed high stability (96% and 95% for two independent raters respectively), and inter-rater reliability demonstrated high levels of agreement (95% and 94% on two separate rating occasions). Kappa values were very good for test-retest (κ = 0.903 and 0.869) and inter-rater reliability (κ = 0.851 and 0.832). Domain structure was good,  Fleiss’ kappa was 0.63 (range 0.45 to 0.75).    Conclusion. The S-SCEAM of 210 items and eight domains showed good content validity and construct validity. The instrument is suggested for use in measuring of the quality of the physical environment in residential care facilities for older persons.

Kraftutveckling för manuella trädfällningsredskap : Force development for manual tree felling tools

The objective with this study has been to build general models of the mechanics in tree felling with chain-saw and to compare felling torque for different tools. The theoretical models are completed and validated with a comparative study. The study includes a great number of felling tools of which some are used with different methods. Felling torque was measured using a naturally like measuring arrangement where a tree is cut at about 3.7 m height and then anchored with a dynamometer to a tree opposite to the felling direction. Notch and felling cut was made as ordinary with exception that the hinge was made extra thin to reduce bending resistance. The tree was consequently not felled during the trials and several combinations of felling tools and individuals could be used on the same tree.The results show big differences between tools, methods and persons. The differences were, however, not general, but could vary depending on conditions (first of all tree diameters). Tools and methods that push or pull on the stem are little affected by the size of the tree, while tools that press on the stump are very much dependent of a large stump-diameter. Hand force asserted on a simple pole is consequently a powerful tool on small trees. For trees of medium size there are several alternative methods with different sizes and brands of felling levers and wedges. Larger and more ungainly tools and methods like tree pusher, winch, etc. develop very high felling torque on all tree sizes. On large trees also the felling wedge and especially the use of several wedges together develop very high felling torque.

Travel Report from the first field trip within the SIDA supported project "Mini-grids supplied by renewable energy - improving technical and social feasibility : Including visits to Ihushi Development Center, Tweyambe Secondary School and Mavuno Project in Tanzania. Conducted in April 2011

This report describes the outcome of the first visit to Tanzania, within the project "Mini-grids supplied by renewable energy - improving technical and social feasibility". The trip included visits to three different organizations; Ihushi Development Center (IDC) near Mwanza, TIDESO near Bukoba, and Mavuno Project in Karagwe. At IDC, a brief evaluation of the current power system was done and measuring equipment for long term measurements were installed. At all three locations investigations regarding the current and future electricity demand were conducted and connections to people relevant to the study were established. The report is including as well some technical specifications as some observations regarding organization and management of the technical systems. The trip was including only short visits and therefore only brief introductions to the different organizations, based on observations done by the author. The report is hence describing the author’s understanding of the technical system and social structures after only short visits to each of the organizations, and may differ from observations done at another point in time, over a different time period, or by some other person.This report describes the outcome of the first visit to Tanzania, within the project "Mini-grids supplied by renewable energy - improving technical and social feasibility". The trip included visits to three different organizations; Ihushi Development Center (IDC) near Mwanza, TIDESO near Bukoba, and Mavuno Project in Karagwe. At IDC, a brief evaluation of the current power system was done and measuring equipment for long term measurements were installed. At all three locations investigations regarding the current and future electricity demand were conducted and connections to people relevant to the study were established. The report is including as well some technical specifications as some observations regarding organization and management of the technical systems. The trip was including only short visits and therefore only brief introductions to the different organizations, based on observations done by the author. The report is hence describing the author’s understanding of the technical system and social structures after only short visits to each of the organizations, and may differ from observations done at another point in time, over a different time period, or by some other person.

Entry, re-location and growth in the Swedish wholesale trade industry

Wholesale trade has an intermediate position between manufacturing and retail in the distributional channel. In modern economies, consumers buy few, if any, products directly from manufacture or producer. Instead, it is a wholesaler, who is in direct contact with producers, buying goods in larger quantities and selling them in smaller quantities to retailers. Traditionally, the main function of a wholesaler has been to push goods along the distributional channel from producer to retailer, or other nonend user. However, the function of wholesalers usually goes beyond the process of the physical distribution of goods. Wholesalers also arrange storage, perform market analyses, promote trade or provide technical support to consumers (Riemers 1998). The existence of wholesalers (and other intermediaries) in the distributional channel is based on the effective and efficient performance of distribution services, that are needed by producers and other members of the supply chain. Producers usually do not enjoy the economies of scale that they have in production, when it comes to providing distributional services (Rosenbloom 2007) and this creates a space for wholesalers or other intermediaries. Even though recent developments in the distributional channel indicate that traditional wholesaling activities now also compete with other supply chain organizations, wholesaling still remains an important activity in many economies (Quinn and Sparks, 2007). In 2010, the Swedish wholesale trade sector consisted of approximately 46.000 firms and generated an annual turnover of 1 300 billion SEK (Företagsstatistiken, Statistics Sweden). In terms of turnover, wholesaling accounts for 20% of the gross domestic product and is thereby the third largest industry. This is behind manufacturing and a composite group of firms in other sectors of the service industry but ahead of retailing. This indicates that the wholesale trade sector is an important part of the Swedish economy. The position of wholesaling is further reinforced when measuring productivity growth. Measured in terms of value added per employee, wholesaling experienced the largest productivity growth of all industries in the Swedish economy during the years 2000 through 2010. The fact that wholesale trade is one of the important parts of a modern economy, and the positive development of the Swedish wholesale trade sector in recent decades, leads to several questions related to industry dynamics. The three topics that will be examined in this thesis are firm entry, firm relocation and firm growth. The main question to be answered by this thesis is what factors influence new firm formation, firm relocation and firm growth in the Swedish wholesale trade sector?

Large-scale metabolomic profiling identifies novel biomarkers for incident coronary heart disease

Analyses of circulating metabolites in large prospective epidemiological studies could lead to improved prediction and better biological understanding of coronary heart disease (CHD). We performed a mass spectrometry-based non-targeted metabolomics study for association with incident CHD events in 1,028 individuals (131 events; 10 y. median follow-up) with validation in 1,670 individuals (282 events; 3.9 y. median follow-up). Four metabolites were replicated and independent of main cardiovascular risk factors [lysophosphatidylcholine 18∶1 (hazard ratio [HR] per standard deviation [SD] increment = 0.77, P-value<0.001), lysophosphatidylcholine 18∶2 (HR = 0.81, P-value<0.001), monoglyceride 18∶2 (MG 18∶2; HR = 1.18, P-value = 0.011) and sphingomyelin 28∶1 (HR = 0.85, P-value = 0.015)]. Together they contributed to moderate improvements in discrimination and re-classification in addition to traditional risk factors (C-statistic: 0.76 vs. 0.75; NRI: 9.2%). MG 18∶2 was associated with CHD independently of triglycerides. Lysophosphatidylcholines were negatively associated with body mass index, C-reactive protein and with less evidence of subclinical cardiovascular disease in additional 970 participants; a reverse pattern was observed for MG 18∶2. MG 18∶2 showed an enrichment (P-value = 0.002) of significant associations with CHD-associated SNPs (P-value = 1.2×10-7 for association with rs964184 in the ZNF259/APOA5 region) and a weak, but positive causal effect (odds ratio = 1.05 per SD increment in MG 18∶2, P-value = 0.05) on CHD, as suggested by Mendelian randomization analysis. In conclusion, we identified four lipid-related metabolites with evidence for clinical utility, as well as a causal role in CHD development.

The Nurse Professional Competence (NPC) scale : self-reported competence among nursing students on the point of graduation

BACKGROUND: International organisations, e.g. WHO, stress the importance of competent registered nurses (RN) for the safety and quality of healthcare systems. Low competence among RNs has been shown to increase the morbidity and mortality of inpatients. OBJECTIVES: To investigate self-reported competence among nursing students on the point of graduation (NSPGs), using the Nurse Professional Competence (NPC) Scale, and to relate the findings to background factors. METHODS AND PARTICIPANTS: The NPC Scale consists of 88 items within eight competence areas (CAs) and two overarching themes. Questions about socio-economic background and perceived overall quality of the degree programme were added. In total, 1086 NSPGs (mean age, 28.1 [20-56]years, 87.3% women) from 11 universities/university colleges participated. RESULTS: NSPGs reported significantly higher scores for Theme I "Patient-Related Nursing" than for Theme II "Organisation and Development of Nursing Care". Younger NSPGs (20-27years) reported significantly higher scores for the CAs "Medical and Technical Care" and "Documentation and Information Technology". Female NSPGs scored significantly higher for "Value-Based Nursing". Those who had taken the nursing care programme at upper secondary school before the Bachelor of Science in Nursing (BSN) programme scored significantly higher on "Nursing Care", "Medical and Technical Care", "Teaching/Learning and Support", "Legislation in Nursing and Safety Planning" and on Theme I. Working extra paid hours in healthcare alongside the BSN programme contributed to significantly higher self-reported scores for four CAs and both themes. Clinical courses within the BSN programme contributed to perceived competence to a significantly higher degree than theoretical courses (93.2% vs 87.5% of NSPGs). SUMMARY AND CONCLUSION: Mean scores reported by NSPGs were highest for the four CAs connected with patient-related nursing and lowest for CAs relating to organisation and development of nursing care. We conclude that the NPC Scale can be used to identify and measure aspects of self-reported competence among NSPGs.

Development, capabilities and technology : an evaluative framework

In this paper we present a framework to be used for evaluation of Information and Communication Technology for Development (ICT4D) projects. The framework is based on Sen´s notion of development as freedom where human capabilities and functionings are seen as key aspects to development. Sen´s capability approach presents an alternative way of seeing and evaluating development (alternative to more traditional ways of measuring development). The approach is based on expanding freedoms, or eliminating unfreedoms, for people so that they can live a life that they have reason to value. Even though Sen is referenced a lot in ICT4D literature the analysis rarely goes further then stating that Sen presents an alternative to traditional ways of development. Reasons can be that the capability approach does not specifically mention technology, in addition to the lack of guidelines presented by Sen on how to use the framework. The aim of this paper is to operationalize the evaluation process and to include a clear role for technology in Sen´s capability framework. The framework is validated with a case on distance education from Bangladesh. 

Health system context and implementation of evidence-based practices-development and validation of the Context Assessment for Community Health (COACH) tool for low- and middle-income settings

Background: The gap between what is known and what is practiced results in health service users not benefitting from advances in healthcare, and in unnecessary costs. A supportive context is considered a key element for successful implementation of evidence-based practices (EBP). There were no tools available for the systematic mapping of aspects of organizational context influencing the implementation of EBPs in low- and middle-income countries (LMICs). Thus, this project aimed to develop and psychometrically validate a tool for this purpose. Methods: The development of the Context Assessment for Community Health (COACH) tool was premised on the context dimension in the Promoting Action on Research Implementation in Health Services framework, and is a derivative product of the Alberta Context Tool. Its development was undertaken in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua in six phases: (1) defining dimensions and draft tool development, (2) content validity amongst in-country expert panels, (3) content validity amongst international experts, (4) response process validity, (5) translation and (6) evaluation of psychometric properties amongst 690 health workers in the five countries. Results: The tool was validated for use amongst physicians, nurse/midwives and community health workers. The six phases of development resulted in a good fit between the theoretical dimensions of the COACH tool and its psychometric properties. The tool has 49 items measuring eight aspects of context: Resources, Community engagement, Commitment to work, Informal payment, Leadership, Work culture, Monitoring services for action and Sources of knowledge. Conclusions: Aspects of organizational context that were identified as influencing the implementation of EBPs in high-income settings were also found to be relevant in LMICs. However, there were additional aspects of context of relevance in LMICs specifically Resources, Community engagement, Commitment to work and Informal payment. Use of the COACH tool will allow for systematic description of the local healthcare context prior implementing healthcare interventions to allow for tailoring implementation strategies or as part of the evaluation of implementing healthcare interventions and thus allow for deeper insights into the process of implementing EBPs in LMICs.