The effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants : study protocol for a randomized controlled trial

Background: Although breast milk has numerous benefits for infants' development, with greater effects in those born preterm (at < 37 gestational weeks), mothers of preterm infants have shorter breastfeeding duration than mothers of term infants. One of the explanations proposed is the difficulties in the transition from a Neonatal Intensive Care Unit (NICU) to the home environment. A person-centred proactive telephone support intervention after discharge from NICU is expected to promote mothers' sense of trust in their own capacity and thereby facilitate breastfeeding. Methods/design: A multicentre randomized controlled trial has been designed to evaluate the effectiveness and cost-effectiveness of person-centred proactive telephone support on breastfeeding outcomes for mothers of preterm infants. Participating mothers will be randomized to either an intervention group or control group. In the intervention group person-centred proactive telephone support will be provided, in which the support team phones the mother daily for up to 14 days after hospital discharge. In the control group, mothers are offered a person-centred reactive support where mothers can phone the breastfeeding support team up to day 14 after hospital discharge. The intervention group will also be offered the same reactive telephone support as the control group. A stratified block randomization will be used; group allocation will be by high or low socioeconomic status and by NICU. Recruitment will be performed continuously until 1116 mothers (I: 558 C: 558) have been included. Primary outcome: proportion of mothers exclusively breastfeeding at eight weeks after discharge. Secondary outcomes: proportion of breastfeeding (exclusive, partial, none and method of feeding), mothers satisfaction with breastfeeding, attachment, stress and quality of life in mothers/partners at eight weeks after hospital discharge and at six months postnatal age. Data will be collected by researchers blind to group allocation for the primary outcome. A qualitative evaluation of experiences of receiving/providing the intervention will also be undertaken with mothers and staff. Discussion: This paper presents the rationale, study design and protocol for a RCT providing person-centred proactive telephone support to mothers of preterm infants. Furthermore, with a health economic evaluation, the cost-effectiveness of the intervention will be assessed. Trial registration: NCT01806480

MAPfastR : quantitative trait loci mapping in outbred line crosses

MAPfastR is a software package developed to analyze QTL data from inbred and outbred line-crosses. The package includes a number of modules for fast and accurate QTL analyses. It has been developed in the R language for fast and comprehensive analyses of large datasets. MAPfastR is freely available at: http://www.computationalgenetics.se/?page_id=7.

Thermal losses in sealed, gas-filled flat plate solar collectors

A sealed space between absorber and cover glass makes it possible reducing the influence of humidity condensate and dust at the same time as the enclosed space can be filled with a suitable gas for lowering the losses. This paper is about the size of the losses in these collectors. A calculating model of a gas-filled flat plate solar collector was built in Matlab with standard heat transfer formulas. It showed that the total loss can be reduced up to 20% when changing to an inert gas. It is also possible using a much shorter distance and still achieve low losses at the same time as the mechanical stresses in the material is reduce.

Are central bank independence reforms necessary for achieving low and stable inflation?

Using data on the occurence of central bank independence (CBI) reforms in 131 countries during 1980-2005, we test whether they were important in reducing inflation and maintaining price stability. CBI reforms are found to have reduced inflation on average 3.31% when countries with historically high inflation rates are included. But countries with lower inflation have reduced it without institutional reforms granting central banks more independence, undermining the theoretical time-inconsistency case for CBI. There is furthermore no evidence that CBI reforms have helped reduce inflation variability.

Determinants and effects of central bank independence reforms

This thesis consists of four empirically oriented papers on central bank independence (CBI) reforms.    Paper [1] is an investigation of why politicians around the world have chosen to give up power to independent central banks, thereby reducing their ability to control the economy. A new data-set, including the possible occurrence of CBI-reforms in 132 countries during 1980-2005, was collected. Politicians in non-OECD countries were more likely to delegate power to independent central banks if their country had been characterized by high variability in inflation and if they faced a high probability of being replaced. No such effects were found for OECD countries.    Paper [2], using a difference-in-difference approach, studies whether CBI reform matters for inflation performance. The analysis is based on a dataset including the possible occurrence of CBI-reforms in 132 countries during the period of 1980-2005. CBI reform is found to have contributed to bringing down inflation in high-inflation countries, but it seems unrelated to inflation performance in low-inflation countries.    Paper [3] investigates whether CBI-reforms are important in reducing inflation and maintaining price stability, using a random-effects random-coefficients model to account for heterogeneity in the effects of CBI-reforms on inflation. CBI-reforms are found to have reduced inflation on average by 3.31 percent, but the effect is only present when countries with historically high inflation rates are included in the sample. Countries with more modest inflation rates have achieved low inflation without institutional reforms that grant central banks more independence, thus undermining the time-inconsistency theory case for CBI. There is furthermore no evidence that CBI-reforms have contributed to lower inflation variability    Paper [4] studies the relationship between CBI and a suggested trade-off between price variability and output variability using data on CBI-levels, and data the on implementation dates of CBI-reforms. The results question the existence of such a trade-off, but indicate that there may still be potential gains in stabilization policy from CBI-reforms.

LEARNING STUDY: ROZVOJ ŠKOLY SKRZE KOLEGIÁLNÍ UČENÍ UČITELŮ : Learning study: school development through collegial learning of teachers

The aim of this article is to describe how the Learning Study method (LS) was implemented in a Swedish upper secondary school, as well as how the principals and the teachers involved perceived this to affect teaching at, and the development of, the school. It is an empirical study that was conducted as an action research project over a period of three years. The project to implement the LS method was based on the assumption that proper training is the result of collegial activity that occurs when teachers learn from each other. The teachers in this study were, in general, positive about using the LS method. It created opportunities to meet and talk about teaching skills, developed better professional relationships between colleagues, and offered a systematic method for planning, implementing and monitoring teaching. However, working together requires that time be set aside to allow for implementation of the LS method. This is crucial, as the LS method is a rather expensive way to make school development work. This places heavy demands on principals to create the necessary conditions for the implementation of the LS method.

Familjemedlem till person med psykossjukdom : bemötande och utanförskap i psykiatrisk vård

This thesis focused on the situation of family members of persons with psychotic illness, particular on their experience of the approach of the healthcare professionals and of their feelings of alienation regarding the professional care of their family member. A further aim was to explore how siblings who have participated in a support group for siblings experienced their situation. A questionnaire was developed that enabled the aims of this thesis to be investigated (I). Seventy family members from various parts of Sweden participated, and data were collected via the questionnaire developed in study I (II-III). Thirteen siblings who previously had participated in a support group participated in follow-up focus groups interviews (IV). The questionnaire developed was shown to be reliable and valid in these studies (I). In many cases, the participants had experienced an approach from professionals that indicated that they did not experience openness, confirmation and cooperation, and that they felt powerless and socially isolated in relation to the care. There was also found to be a certain degree of association between how the participants experienced the approach and whether they felt alienation (II). The majority of the participants considered openness, confirmation, and cooperation to be important aspects of professional’s approach. The result also identified a low level of agreement between the participants’ experience and what they considered to be significant in the professional’s approach (III). The findings revealed the complexity of being a sibling of an individual with psychotic illness. Participating in a support group for siblings can be of importance in gaining knowledge and minimizing feelings of being alone (IV). Although the psychiatric care services in Sweden have been aware of the importance of cooperating with family members, the results indicated that there is a need for further research in this area.

The Key Role of the School Principal’s Leadership in the Schooling of Newly Arrived Immigrant Pupils in Sweden : Experiences from an Interactive Action Research Project

When newly immigrated children and young people begin school in Sweden, certain challengesarise. These may result from weak Swedish-language skills and different schooling backgrounds,as well as organizational and pedagogical limitations in the schools. This generates demands onschool leaders to lead and develop the organization and teachers competences to meet these pupils’needs. This situation was behind the initiation of the project “New Immigrants and Learning—Competence Development for Teachers and School Principals.” The project ran in schools infour Swedish municipalities, its aim was to develop leadership, organizational and pedagogicalskills that would facilitate the schooling and integration of newly arrived pupils. This article aimsto describe and discuss a Participant Action Research (PAR) based on a think tank and researchcircles, drawing special attention to the role of the school leaders. It will also examine whether theresearch circles and the project overall served to develop educational and intercultural leadership,organizational conditions, collegial learning, pedagogical methods and competence in terms ofschooling for this pupil group.

DEN KOMMUNALA FÖRVALTNINGENSOM RATIONALISTISKT IDEAL- en fallstudie om styrning och handlingsutrymme inom skola,barnomsorg och miljö- och hälsoskydd

DEN KOMMUNALA FÖRVALTNINGEN SOM RATIONALISTISKT IDEAL - en fallstudie om styrning och handlingsutrymme inom skola, barnomsorg och miljö- och hälsoskydd.(The municipal authority as a rationalist ideal - a case-study on steering and scope for initiative within child-care, education and environmental departments.)A municipal authority is a considerable producer of services in the local community and iscommonly perceived as an important sector of the Swedish welfare system. One aspect of awell-functioning municipal organisation is that its administrative organs function efficiently.This study examines how activities in municipal administration are steered. The focus is on how different methods are used within a vertical hierarchical perspective to influence the actions of the participants and how the latter try to create space for action. To analyse the problem an ideal-type steering model is used.The study consists of three sections. In the first the research problem and the aims of the study are introduced as well as the methodological and theoretical approach. The result of the study is presented in the second section and in the third conclusions are drawn and discussed.The study shows that the perceptions of the participants involved regarding the possibilities of steering the everyday activities with the support of the methods studied differ on a number of points depending on the sector studied. When control of the various steering methods is distributed in different organisational units in the municipality a number of steering mechanisms operate side-by-side, sometimes in harmony and sometimes independently or in pure conflict with their goals. Steering leads to clear restrictions but there is clearlyroom for initiative, a ‘free-zone’ where the individual has room to act independently. Is it possible based on this study to state whether the ideal-type model functions in the way intended? On many accounts it would seem doubtful whether the effects of steering lead to beneficial effects for the activity. Rather it would seem that the effects of steeringsometimes function more or less randomly because the administration exists in a complexcontext in which the staff can be expected to have its own expectations and act in accordancewith them.

W-dalaprojektet - Vinnande partnerskap mellan näringsliv och högskola

Samverkan mellan företag, stat, kommuner, landsting o.s.v. och högskolor representerar tillsammans den plattform vilken ofta benämns som Triple Helix. Denna typ av samverkan utgår från antagandet att de inblandade aktörerna kan få belöningar som överstiger de bidrag som de själva sätter in. En sådan samverkan antas också ge företag och den region de befinner sig i konkurrensfördelar och möjligheter att växa och utvecklas. Syftet med Wdalaprojektet, som startade våren 2005 och som skulle avslutas i och med utgången av 2006, var att bygga upp en sådan varaktig samverkan. Den frågan som är i fokus är hur framgångsrikt W-dalaprojektet varit i dessa avseenden? Den här studien försöker:a) beskriva hur projektet initierats och implementeratsb) värdera i vilken utsträckning projektets mål har uppnåtts samtc) identifiera och värdera funktionaliteten hos den samverkansmodellsom använtsErfarenheterna från projektet kan sammanfattas i sex punkter för vad som kan antas vara väsentligt för en långsiktig samverkan att fungera.1. Det behövs fora för kontinuerliga möten och en formaliserad organisation2. ”Kontaktpunkter” för att koordinera samarbetet spelar en viktig roll3. Högskolans ”leveransförmåga” måste förbättras4. ”Kulturkrockar” och en bristande ömsesidig tilltro5. Förmågan att definiera behov av samverkan behöver förbättras6. Långsiktig hållbar ekonomi

Projektet W-Dala Plus - metodutveckling i samverkan mellannäringsliv och högskola

Projektet W-dala Plus - metodutveckling i samverkan mellan näringsliv och högskola är en fortsättning på det s.k. W-dalaprojektet (W-Dala – vinnande partnerskap mellan näringsliv och högskola) som startade våren 2005 och som, något försenat, avslutades under våren 2007. Syftet med det inledande projektet var att bygga upp en varaktig och innovativ samverkan mellan regionens näringsliv, den offentliga sektorns organisationer ochden högre utbildningen, för att skapa en ”triple helix-anda”. Sådan samverkan kan ske både formaliserat och genom att informella nätverk byggs upp. Denna samverkan avsågs att ”kunna bli självbärande genom att företagarna själva betalar för sitt behov av fortbildning och uppdragsforskning” (Projektplanen, W-Dala). Syftet var också att det arbete som inleddes skulle kunna öka företagens konkurrenskraft och därmed bidratill regional tillväxt.Syftet med studien är att belysa, tolka och analysera hur W-Dalaprojektet vidareutvecklats genom att projektet W-Dala Plus - metodutveckling i samverkan mellan näringsliv och högskola genomförts samt vilka erfarenheter som är möjliga att dra från detta. Resultatet kan i sin tur ge indikationer mot vilka områden fortsatta insatser kan vara lämpliga att riktas.

Arbete åt alla - En utvärderande studie av ett projekt för långtidssjukskrivna

Projektet Arbete åt alla genomfördes under perioden under 2007 i regi av Lärcentrum i Vansbro kommun. Verksamheten riktade sig till personer mellan 18-64 år som antingen var arbetslösa, sjukskrivna eller sjukskrivna från ett arbete med det långsiktiga ”målet att överbrygga klyftan mellan individen och arbete.” (Projektplanen) Projektet skulle också stärka deltagarnas möjligheter att förbättra sin kompetens för att öka deras möjligheter att komma tillbaka i arbete och därigenom klara sin egen försörjning. Deltagarna planerades att rekryteras vid ett och samma tillfälle samt att det skulle vara frivilligt att delta. Stor vikt skulle läggas vid att skapa individuella lösningar. Studien syftar till att beskriva och analysera de resultat och de erfarenheter som projektet Arbete åt alla har gett upphov till. Resultatet tolkas och bedöms i relation till uppsatta mål, men också till andra upplevda effekter, positiva såväl som negativa. Det övergripande syftet är att stidera hur ett arbetsmarknadspolitiskt projekt kan stödja arbetslösa långtidssjukskrivna personer för att kunna ta sig in på arbetsmarknaden. Ser vi till utfallet i fråga om deltagarna kunde göra ett inträde på arbetsmarknaden blev resultatet ”magert”. Av de 15 deltagarna var det endast en som lyckades få en lönebidragsanställning. Om resultatet istället relateras till de båda ”nyckelfaktorerna” individens status och tillgången på arbetstillfällen på den lokala arbetsmarkanden är utfallet begripligt. Det fanns helt enkelt inga möjligheter att deltagarna skulle kunna vare sig få, eller ta ett arbete om ett sådant erbjudits, därtill var deltagarnas förutsättningar för att klara detta alltför begränsade. Värderar vi vad projektet har betytt för de enskilda deltagarna kan utfallet ändå ses om positivt ur flera aspekter då deras sociala situation hade stärkts.

Steget - En utvärderande studie av ett projekt för att skapa möjligheter för arbetslösa ungdomar att ta sig in på arbetsmarknaden

Projektet Steget pågick under perioden 2007-01-02 – 2007-12-31 och riktade sig till ungdomar som upplever sig vara eller riskerar att hamna i ett utanförskap och att stötta de ungas ambitioner utifrån individuella förutsättningar och samtidigt skapa en förståelse för de värderingar som i dag styr arbetsmarknaden. Målgruppen definierades som arbetslösa ungdomar i åldern 20-30 år, vilka var eller riskerade att bli långtidsarbetslösa eller långtidssjukskrivna och som uppbar sjukpenning eller sjukersättning. En annan målgrupp var ungdomar som stod långt från arbetsmarknaden och var beroende av bistånd från Socialförvaltningen. Resultatet visar att verksamheten i flera fall har haft påvisbara positiva effekter som går bortom de rent arbetsmarknadspolitiska, d.v.s. det har på ett direkt och påtagligt sätt påverkat de involverade aktörerna i deras vardagliga liv. De fick ”närvaroplikt” och samtidigt livet ”inrutat”. De fick lov att ”bekänna färg” genom sina kontinuerliga möten med ledarna och övriga projektdeltagare. För många konfronterades deras livssituation på ett sätt som kunde uppfattas som påfrestande och som för en del upplevdes som ett tvång. För några kan detta vara en vändpunkt i livet. Vad som kan vara ett realistiskt resultat för ett arbetsmarknadsprojekt av den här karaktären är att skapa en beredskap hos deltagarna att förbättra sina förutsättningar för att kunna konkurrera på arbetsmarknaden. Att verksamheten i de flesta fall radikalt skulle öka deltagarnas konkurrensförmåga på arbetsmarknaden är dock ett alltför optimistiskt antagande.