Kvalitet ur patientens perspektiv : Patienters upplevelser av information, delaktighet och personalens bemötande på en medicinsk vårdavdelning.

Syftet med denna studie var att beskriva patientens upplevelse av information, möjlighet till delaktighet och personalens bemötande under vårdtiden. Syftet var vidare att beskriva hur viktiga patienten ansåg dessa faktorer vara. Studien var en deskriptiv tvärsnittsstudie med kvantitativ ansats. Populationen bestod av patienter över 18 år som vårdats på en utvald medicinavdelning i mellansverige under en period år 2004. Urvalet bestod av 100 utvalda patienter (n=100). Formuläret ”Kvalitet ur patientens perspektiv” (KUPP) har använts som mätinstrument. En övergripande bedömning av vårdens olika dimensioner har gjorts, här med fokus på de faktorer som ingår i dimensionen Identitetsorienterat förhållningssätt – information, delaktighet och bemötande. Resultatet har presenterats i form av ett åtgärdsindex utifrån begreppen: Bristande kvalitet, Balans låg, Balans hög och Övergod kvalitet där resultaten visade totalt för dimensionen Identitetsorienterat förhållningssätt Bristande Kvalitet 15 %, Balans Låg 25 %, Balans Hög 45 % och Övergod Kvalitet 15 %. Resultatet visade vidare att patienterna på den aktuella avdelningen upplevde ett positivt bemötande och ett bemötande med respekt. Angående påståenden gällande informationen erhölls en del positiva resultat, bäst resultat totalt erhöll ”information om avdelningens rutiner” medan ”egenvård, hur jag bäst kan sköta mig” samt ”vilken sjuksköterska som var ansvarig för omvårdnaden” erhöll sämre resultat. Det som erhöll det sämsta resultatet var upplevelsen av delaktighet med en låg procentuell andel på Övergod Kvalitet och en hög procent på Bristande Kvalitet.

Varför gör jag det här? : En studie om kvalitet, likvärdighet och ansvar i en skola

Denna undersökning syftar till att med hjälp av intervjuer undersöka ett antal pedagogers uppfattning av kvalitet, likvärdighet och ansvar i en skola samt hur skolans arbetssätt påverkar kvalitet och likvärdighet för eleverna. De parametrar som finns definierade av skolans ledning som strategiska mål, framgångsfaktorer och nyckelmått på pedagogisk utveckling återkommer inte spontant hos de intervjuade pedagogerna, det räcker inte att tala om kvalitet för att kunna mäta och utveckla den. Den huvudsakliga slutsats som kan dras av undersökningen är att det saknas en gemensam syn på kvalitet och vad kvalitet konkret innebär i det pedagogiska arbetet och det pedagogiska ledarskapet för att skapa och säkerställa kvalitet och likvärdighet inom skolans alla funktioner; kvalificerande, socialiserande och subjektifierande.

Akademisk kvalitet, vad är det? : Om utarmningen av den akademiska autonomin

What is academic quality? On the decline of academic autonomy In light of the transformations that universities currently undergo, with Bologna as a keyword, the following questions are put: What ideals lie behind the assessment of academic “excellence” and “quality”? What agents have the ability to define what is good science and education today? These questions are approached through Pierre Bourdieus concept of field. Looking at the development the last decade, traditional academic values, such as the ideal of universal knowledge as (personal and collective) enrichment and the intellectual independence “of all political authority and economic power”, as stated in the Magna Charta Universitatum, seem to have emerged into the shadow of employability, knowledge control, competitiveness, and economic benefit. In connection with the formation of concepts such as “the knowledge society” and “knowledge based economies” the university has received a somewhat different and more central role in society. The university has come to take the role more of a knowledge producing enterprise clearly directed towards the surrounding society. There are higher demands on academic knowledge to contribute to economic, regional or national development and competitiveness. When the university is regarded as a knowledge company whose task is to accoun tfor the requests of the students, the labour market, and the business world it undertakes to follow trends and short term social phases rather than to critically examine them, which has been a traditional task for the university. If the academic work is guided by the market economical principle, that the client requests decide what quality is, instead of the experts on the academic field themselves (i.e. the scientists,) it is obviously not scientific ideals that constitute the criteria for what is good science and education.

Makt, konst, elit - konstfältets positioner, relationer och resurser i 1940- och 1950-talens Helsingfors

The dissertation examines the power mechanisms and institutional power hierarchies of the 1940s-1950s era arts elite in Helsinki and their influence on issues of taste in the visual arts. For the purposes of this study, the elite is understood to consist mainly of the board members of the principal elected bodies in the field of the arts. The theoretical framework employed is based on Pierre Bourdieu s field theory and the network perspective. The author has examined what the key, pervasive valuations were that governed the exercising of power by the arts elite in issues of taste, involving determination of who was an acknowledged artist and what was good art. The dissertation demonstrates that this exercising of power was governed by certain collective practices which maintained the illusion that the exercising of power was democratic and based on artistic quality. These practices were the corporate system, using artistic arguments in issues of taste, and using networks in the exercising of power. The struggle in the field of the arts was about who ultimately was entitled to define the value of contemporary art; the issue did not arise regarding historical art. Artists managed to gain a leading position as gatekeepers in issues regarding contemporary art. The author discusses a number of conflicts in the field of the arts that highlight the institutional hierarchies and the capital held by the various players. The structural changes that occurred in administration in the field of cultural production in the 1950s led to the separation of bureaucratic competence on the one hand and aesthetic competence on the other. There was a hierarchy in the field of the arts between institutions, between instruments of legitimisation, and between the symbolic and social capital of players in the field. The hierarchy in the arts ultimately depended on how well the elite could influence tastes through the instruments at their disposal. The various instruments of legitimisation grants, purchases, etc. were ranked differently in the evaluation of acknowledged artists and good art. The dissertation discusses what values, in the form of types of symbolic capital, the arts elite embraced and what role these played in the elite s exercising of power, with particular focus on gender, language, region and economic capital. The aesthetic capital of an artist was of only minor importance in the exercising of power by the arts elite. The dissertation further discusses the points of contact between the arts elite and players in other fields, such as the economic, media and consumer fields. When the arts elite, through the Academy of Fine Arts, became an active player in the art market, this led to a hierarchy where the division between acknowledged and not-acknowledged galleries became sharper.

"En plan för jämställdhet borde kanske utarbetas, men förekommer det ett behov?" : En kartläggning av 26 svenskspråkiga kommuners främjande av jämställdhet

Jämställdhetslagen från 1995 kräver att både myndigheter och arbetsgivare med aktiva och målinriktade åtgärder främjar jämställdheten, och denna pro gradu-avhandling undersöker närmare hur denna lag implementerats i de finlandssvenska kommunerna (kommuner med majoritetsspråk svenska) under en 10årsperiod. I kommunerna jobbar 80% kvinnor, och 38% av alla kvinnliga arbetstagare hittas i arbeten inom den offentliga sektorn. Kommunens skyldighet att trygga dessa kvinnors lika villkor inom kommunorganisationen ingår både som en del i arbetsgivaransvaret, men även som del i statens demokratiska utövande genom myndighetsansvaret. De tre planer som ingår i mitt material innehåller en kartläggning av jämställdhetsområdet i olika omfattning, definierade mål och åtgärder och ingen av planerna har följts upp efter att de godkänts. Planerna varierar både i utformning och omfattning men också i ansvarsspecificering och åtgärdernas konkretisering, vilken ger en varierande kvalitet och därmed även varierande förutsättning att genomdrivas och därmed uppfylla lagens ålägganden. Två av kommunerna har eller har haft en jämställdhetskommitté. I de 26 inkomna svarsformulär görs en närläsning av hur begreppet jämställdhet används och hur jämställdhetslagen tolkas och orsakerna till frånvaron av jämställdhetsåtgärder. På frågan om varför jämställdhetsarbetet inte genomförts helt eller delvis utkristalliserade sig sex olika argumentationsteman: 1. Myten om den jämställda kommunen, innebär en hänvisning till att det inte förekommit några problem med jämställdheten. 2. Den naturligt integrerade jämställdheten, är kommunens policy och sker utan planer, men en liten kritik av problematiken med frånvaron av planer framförs av några kommuner. 3. Könens komplettering, utgår jämställdhetsbegreppet ifrån i några kommuner. 4. Den matematiska jämställdheten, är argument där man genom hänvisningar till kvinnor på olika högre positioner visar på att jämställdheten är uppnådd. 5.En fråga om resurser, används som ett argument till jämställdhetsarbetets frånvaro i kommunen. 6. Avsaknad av intresse, hos personalen och allmänheten är ett annat argument för ogenomförda jämställdhetsåtgärder. Det framkommer tydligt i materialet att kommunerna anser sig följa jämställdhetslagen, samtidigt som det blir tydligt att det råder en oklarhet om vad jämställdhetslagen från 1995 egentligen innehåller. En tydlig sammanblandning mellan den lagstadgade kvoteringen och skyldigheten att aktivt främja jämställdhet träder fram i materialet. Det ofullständiga jämställdhetsarbetet strandar på olika punkter, men en avgörande anser punkt är oförståelsen inför begreppet jämställdhet och därmed också lagens syfte och innehåll. Avhandlingens slutsats är att frånvaron av en könsmaktanalys försvårar förståelsen av ojämställdhetens komplexhet, dvs. dess orsaker, mångskiftande funktion och olika uttryck i organisationens strukturer och i de handlande aktörerna.

Conceptual and statistical modelling of environmental effects in population dynamics

Population dynamics are generally viewed as the result of intrinsic (purely density dependent) and extrinsic (environmental) processes. Both components, and potential interactions between those two, have to be modelled in order to understand and predict dynamics of natural populations; a topic that is of great importance in population management and conservation. This thesis focuses on modelling environmental effects in population dynamics and how effects of potentially relevant environmental variables can be statistically identified and quantified from time series data. Chapter I presents some useful models of multiplicative environmental effects for unstructured density dependent populations. The presented models can be written as standard multiple regression models that are easy to fit to data. Chapters II IV constitute empirical studies that statistically model environmental effects on population dynamics of several migratory bird species with different life history characteristics and migration strategies. In Chapter II, spruce cone crops are found to have a strong positive effect on the population growth of the great spotted woodpecker (Dendrocopos major), while cone crops of pine another important food resource for the species do not effectively explain population growth. The study compares rate- and ratio-dependent effects of cone availability, using state-space models that distinguish between process and observation error in the time series data. Chapter III shows how drought, in combination with settling behaviour during migration, produces asymmetric spatially synchronous patterns of population dynamics in North American ducks (genus Anas). Chapter IV investigates the dynamics of a Finnish population of skylark (Alauda arvensis), and point out effects of rainfall and habitat quality on population growth. Because the skylark time series and some of the environmental variables included show strong positive autocorrelation, the statistical significances are calculated using a Monte Carlo method, where random autocorrelated time series are generated. Chapter V is a simulation-based study, showing that ignoring observation error in analyses of population time series data can bias the estimated effects and measures of uncertainty, if the environmental variables are autocorrelated. It is concluded that the use of state-space models is an effective way to reach more accurate results. In summary, there are several biological assumptions and methodological issues that can affect the inferential outcome when estimating environmental effects from time series data, and that therefore need special attention. The functional form of the environmental effects and potential interactions between environment and population density are important to deal with. Other issues that should be considered are assumptions about density dependent regulation, modelling potential observation error, and when needed, accounting for spatial and/or temporal autocorrelation.

Short- and long-term consequences of food resources on Ural owl Strix uralensis reproduction

Life-history theory states that although natural selection would favour a maximisation of both reproductive output and life-span, such a combination can not be achieved in any living organism. According to life-history theory the reason for the fact that not all traits can be maximised simultaneously is that different traits compete with each other for resources. These relationships between traits that constrain the simultaneous evolution of two or more traits are called trade-offs. Therefore, during different life-stages an individual needs to optimise its allocation of resources to life-history components such as growth, reproduction and survival. Resource limitation acts on these traits and therefore investment in one trait, e.g. reproduction, reduces the resources available for investment in another trait, e.g. residual reproduction or survival. In this thesis I study how food resources during different stages of the breeding event affect reproductive decisions in the Ural owl (Strix uralensis) and the consequences of these decisions on parents and offspring. The Ural owl is a suitable study species for such studies in natural populations since they are long-lived, site-tenacious, and feed on voles. The vole populations in Fennoscandia fluctuate in three- to four-year cycles, which create a variable food environment for the Ural owls to cope with. The thesis gives new insight in reproductive costs and their consequences in natural animal populations with emphasis on underlying physiological mechanisms. I found that supplementary fed Ural owl parents invest supplemented food resources during breeding in own self-maintenance instead of allocating those resources to offspring growth. This investment in own maintenance instead of improving current reproduction had carry-over effects to the following year in terms of increased reproductive output. Therefore, I found evidence that reduced reproductive costs improves future reproductive performance. Furthermore, I found evidence for the underlying mechanism behind this carry-over effect of supplementary food on fecundity. The supplementary-fed parents reduced their feeding investment in the offspring compared to controls, which enabled the fed female parents to invest the surplus resources in parasite resistance. Fed female parents had lower blood parasite loads than control females and this effect lasted until the following year when also reproductive output was increased. Hence, increased investment in parasite resistance when resources are plentiful has the potential to mediate positive carry-over effects on future reproduction. I further found that this carry-over effect was only present when potentials for future reproduction were good. The thesis also provides new knowledge on resource limitation on maternal effects. I found that increased resources prior to egg laying improve the condition and health of Ural owl females and enable them to allocate more resources to reproduction than control females. These additional resources are not allocated to increase the number of offspring, but instead to improve the quality of each offspring. Fed Ural owl females increased the size of their eggs and allocated more health improving immunological components into the eggs. Furthermore, the increased egg size had long-lasting effects on offspring growth, as offspring from larger eggs were heavier at fledging. Limiting resources can have different short- and long-term consequences on reproductive decisions that affect both offspring number and quality. In long-lived organisms, such as the Ural owl, it appears to be beneficial in terms of fitness to invest in long breeding life-span instead of additional investment in current reproduction. In Ural owls, females can influence the phenotypic quality of the offspring by transferring additional resources to the eggs that can have long-lasting effects on growth.

Spatial ecology of a specialist insect herbivore : the leaf-mining moth Tischeria ekebladella on the pedunculate oak Quercus robur

Herbivorous insects comprise a major part of terrestrial biodiversity, and their interactions with their host plants and natural enemies are of vast ecological importance. A large body of research demonstrates that the ecology and evolution of these insects may be affected by trophic interactions, by abiotic influences, and by intraspecific processes, but so far research on these individual aspects has rarely been combined. This thesis uses the leaf-mining moth Tischeria ekebladella and the pedunculate oak (Quercus robur) as a case study to assess how spatial variation in trophic interactions and the physical distribution of host trees jointly affect the distribution, dynamics and evolution of a host-specific herbivore. With respect to habitat quality, Tischeria ekebladella experiences abundant variation at several spatial scales. Most of this variation occurs at small scales notably among leaves and shoots within individual trees. While hypothetically this could cause moths to evolve an ability to select leaves and shoots of high quality, I did not find any coupling between female preference and offspring performance. Based on my studies on temporal variation in resource quality I therefore propose that unpredictable temporal changes in the relative rankings of individual resource units may render it difficult for females to predict the fate of their developing offspring. With respect to intraspecific processes, my results suggest that limited moth dispersal in relation to the spatial distribution of oak trees plays a key role in determining the regional distribution of Tischeria ekebladella. The distribution of the moth is aggregated at the landscape level, where local leaf miner populations are less likely to be present where oaks are scarce. A modelling exercise based on empirical dispersal estimates revealed that the moth population on Wattkast an island in south-western Finland is spatially structured overall, but that the relative importance of local and regional processes on tree-specific moth dynamics varies drastically across the landscape. To conclude, my work in the oak-Tischeria ekebladella system demonstrates that the local abundance and regional distribution of a herbivore may be more strongly influenced by the spatial location of host trees than by their relative quality. Hence, it reveals the importance of considering spatial context in the study of herbivorous insects, and forms a bridge between the classical fields of plant-insect interactions and spatial ecology.

The influence of eutrophication on sexual selection in sticklebacks

Jordens ekologiska system undergår för tillfället stora förändringar pga. människans aktiviteter. Ett växande antal studier visar att dessa förändringar påverkar naturliga och sexuella urvalet och därmed evolutiva processer. Målet med detta arbete var att undersöka effekterna av omgivningsförändringar på sexuella urvalet genom att använda den ökade övergödningen inom storpiggen Gasterosteus aculeatus lekområden som modell system. Sexuella urvalet är en viktig evolutiv kraft med följder på populations- och artnivå (Kapitel 1). Avhandlingens olika delar fokuserar på övergödningens effekter på upptäckandet av partners, användningen av visuella- och doftsignaler i partnersval, och fördelningen av parningsframgången mellan bobyggande hanar. I Kapitel II och III simuleras hur grumlighet orsakad av fytoplankton påverkar hastigheten med vilken potentiella partners påträffas, genom effekter på synligheten. Resultaten visar att normala algblomningar i Östersjön har en måttlig effekt på finnandet av potentiella partners. Detta tyder på att algblomningarna troligen inte kommer att minska på selektiva parningen pga. ökade sökkostnader. I Kapitel IV visas att storspiggen ändrar relativa användningen av olika signaler när vattnets grumlighet ökar; visuella signaler minskar i betydelse medan doftsignaler ökar i betydelse. Samtidigt underlättas användandet av doftsignaler av ändringar i vattnets kemiska sammansättning då fotosyntesen intensifieras (Kapitel V). Lek i övergödda vatten kan ändå vara kostsamt både på individ- och populationsnivån, då parasiterade hanar, som troligen är dåligt genetiskt anpassade till sin miljö, lyckas få mer ägg i sina bon än friskare hanar som troligen är av högre genetisk kvalitet (Kapitel VI). Övergödningen påverkar således partnersval och konkurrensen om partners genom att påverka upptäckandet av potentiella partners, evalueringen av partners och fördelningen av partners inom lekområdena. De följder detta kan ha för evolutionen av sexuellt selekterad egenskaper och för populationers dynamik och livskraft är dock oklara. Avhandlingen visar på svårigheten att förutse följderna av omgivningsförändringar för sexuella urvalet och effekterna på individ och populationsnivå.