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1.
  • Abbasi, Maisam, et al. (författare)
  • Developing environmentally sustainable logistics. Exploring themes and challenges from a logistics service providers' perspective
  • 2016
  • Ingår i: Transportation Research. Part D: Transport & Environment. - Elsevier. - 1361-9209. ; 46, s. 273-283
  • Tidskriftsartikel (refereegranskat)abstract
    • The purpose of this paper is to explore themes and challenges in developing environmentally sustainable logistical activities. The approach is explorative with a cross sectional design that takes advantage of ten case studies out of selected logistics service providers (LSPs) operating primarily in the Scandinavian countries. The findings illustrate the major themes by analyzing current and future activities in developing environmentally sustainable logistical activities. In addition, four categories of challenges are identified: customer priorities, managerial complexity, network imbalance, and technological and legislative uncertainties. It is concluded that there is a great need for a holistic perspective where LSPs and product owners together analyze and design future logistical setups. The suggested holistic and integrative model, building on a three-dimensional concurrent engineering framework, provides new opportunities for research. Further research is needed to improve the interrelationship between LSPs and their customers in the development of sustainable logistical solutions.This paper puts forward recommendations for the sustainable development of logistics by combining the results from the case studies with a review of related literature. This will be beneficial for managers and policy makers when they approach sustainable logistical challenges. The emergence and synthesis of themes and challenges are critical for a sustainable society.
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2.
  • Abendstein, Helmut, et al. (författare)
  • Quality of Life and Head and Neck Cancer: A 5 Year Prospective Study.
  • 2005
  • Ingår i: Laryngoscope. - Lippincott Williams & Wilkins. - 1531-4995. ; 115:12, s. 2183-2192
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: Assessment of health-related quality of life (HRQL) in head and neck cancer patients from diagnosis to 5 years after start of treatment. STUDY DESIGN: A prospective, descriptive study METHODS: three hundred fifty-seven patients from Norway and Sweden filled in HRQL questionnaires, the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and the EORTC QLQ-H and N35, six times during the first year and then after 5 years. At 5 years, 167 (87%) of the 192 living patients filled in questionnaires. RESULTS: Group data: clinical significant improvements in HRQL were not found between 1 and 5 years. Problems with teeth, opening of the mouth, dryness in the mouth, and sticky saliva were persistent or worsening. Similar findings were found regardless of sex, age, stage, or site when clinical significant changes are considered. Patients who died between 1 and 5 years reported reduced HRQL on 15 of 28 scales at 1 year compared with the survivors. Individual data: 40% of patients reported improved global HRQL from diagnosis to 5 years after start of treatment. In addition, 11% had "top scores" at both assessment points. The pattern in global HRQL scores also applies for most of the other function and symptom scales. CONCLUSION: After the first year after treatment, recovery of the persisting side effects of treatment cannot be expected for the group as a whole. Patients must be prepared for this. Some individual patients experience improvement in global HRQL. HRQL assessments in daily clinical practice can identify patients who are in need of additional support and symptom relief.
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3.
  • Adelmann, Kent (författare)
  • Att lyssna till röster. Ett vidgat lyssnandebegrepp i ett didaktiskt perspektiv.
  • 2002
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • Popular Abstract in Swedish Detta är en avhandling om hur en del av vårt meningsskapande går till, sedd genom åtta studenters användning av sina kontextuella resurser. Den handlar om hur vi lyssnar till auditiva, visuella och upplevda röster, och hur vi talar med stöd av dessa röster när vi skapar och utvecklar vår egen röst. Detta kallar jag för rapporterat lyssnande, d.v.s. dessa yttranden visar att ett tidigare lyssnande ägt rum. I den empiriska undersökningen använder jag två metoder för att besvara klassrumsfrågan och visa vilka kontextuella resurser som utnyttjas och vilken funktion de får i den nya kontexten. När det gäller de rapporterade rösternas förekomst använder jag manifest intertextualitet som metod och redovisar resultaten i form av en lyssnarrepertoar och olika lyssnartyper. När det gäller de rapporterade rösternas funktion använder jag retorik som metod och redovisar resultaten i form av en lyssnarprofil och olika lyssnarpositioner. I det förra fallet pekar responsen bakåt och synliggör studenternas röstrespons, alltså med vilka röster de för en dialog. I det senare fallet pekar responsen framåt och synliggör studenternas röstanvändning, alltså för vilka syften de för dialogen vidare. Med ett vidgat lyssnandebegrepp och Bakhtins röstbegrepp syftar jag till en integrerande och helhetsorienterande ansats som gestaltar undervisningsdiskursens mångstämmighet och där studenternas samspel med olika slags röster i tid och rum hörs i den aktuella interaktionen. I avhandlingstexten lyssnar läsaren på samma sätt till många andra röster än författarens (framvuxna) stämma. En del röster citeras eller refereras uttryckligen, i enlighet med den skriftliga genren och vetenskapliga traditionen, medan andra röster mera står att läsa mellan raderna eller ekar från en fond av gemensamma kulturerfarenheter. Oavsett vilket gestaltar denna polyfoni av röster för ett ögonblick ett nätverk av ständigt pågående röstmöten och röstsamspel som väntar på sin röstrespons, vars röstanvändare rekontextualiserar yttrandet och använder det för nya ändamål i nya sammanhang i talkommunikationens språkliga och kontextuella rymd. Men den här avhandlingen handlar inte om ett etablerat svenskt forskningsfält med en bekant forskningsbakgrund, kända definitioner och välbeprövade teorier och metoder. Genom undersökningen av aspekten Lyssna i modersmålets utbildningsdokument och introduktionen av det internationella lyssnarfältet har jag istället pekat på ”en nästan vit fläck på kartan”. Vidare har jag försökt fylla denna tomhet med en begreppsutredning som visar på en vid begreppsdomän för begreppet ’lyssna’ i svenska språket, där begreppsbestämningen innehåller såväl en social och dynamisk som holistisk dimension. När det gäller synen på såväl det snävare perspektivet med aspekten Lyssna som det vidare perspektivet med det vidgade lyssnandebegreppet, blir konsekvenserna av avhandlingen en strävan efter ett helhetsperspektiv som pekar på upplösningen av traditionella gränser. För aspekten Lyssna handlar det om upplösningen av uppdelningen mellan reception och expression, där de traditionella in- och uttrycksformerna i svenskämnet kompletteras, likställs och dialogiseras med en alternativ aspektmodell i en språklig rymd som omfattar olika former för språklig mediering inom alla ämnesområden. För det vidgade lyssnandebegreppet gäller upplösningen synen på innehållet och den betydelse som traditionellt tillmäts olika ämnen och medium, vilka istället likställs genom att olika ämnesstoff får kvalificera sig och att alla erfarenheter, oavsett hur de medieras, ges en röst i rapporterat lyssnande. Den här avhandlingen handlar främst om lyssnande i ett didaktiskt perspektiv. Undersökningen synliggör undervisningsdiskursens polyfona karaktär, uppmärksammar det dialogiska samspelet mellan olika kontextuella resurser, och understryker betydelsen av att de studerande aktiverar dessa kontextuella resurser i ett språkutvecklande syfte. Rapporterat lyssnande beskriver klassrummets mångstämmighet ur ett lyssnarperspektiv. Av lyssnarrepertoaren framgår till vilka erfarenheter i tid och rum som de studerande riktar sin uppmärksamhet under handledningsprocessen. Lyssnarprofilen visar hur de använder dessa röster under gruppinteraktionen. Detta pekar på såväl lyssnandets betydelse i läroprocessen som responsens betydelse för förståelse och gruppens betydelse för lärande. Rapporterat lyssnande är slutligen också en didaktisk ingång till ett språkutvecklande arbete med utgångspunkt i den studerandes individuella rösterfarenheter och röstupplevelser. Att lyssna till röster kan då vara att utvecklas språkligt tillsammans genom att lyssna uppmärksamt till andras röster på olika sätt, att rikta sitt lyssnande i tid och rum via olika former av språklig mediering, och att vara lyhörd för såväl den egna inre rösten som hur den egna skapade och skapande rösten växer och utvecklas som en konstant röstförändring. Att lyssna till röster kan vara att lyssna till det totala röstsamspelet i den lyssnande människans dialogiska existens.
4.
  • Agardh, Anette, et al. (författare)
  • Health Risks in Same-Sex Attracted Ugandan University Students: Evidence from Two Cross-Sectional Studies
  • 2016
  • Ingår i: PLoS ONE. - Public Library of Science. ; 11:3
  • Tidskriftsartikel (refereegranskat)abstract
    • Widespread discrimination across much of sub-Saharan Africa against persons with same-sex sexuality, including recent attempts in Uganda to extend criminal sanctions against same-sex behavior, are likely to have profound effects on this group’s health, health care access, and well-being. Yet knowledge of the prevalence of same-sex sexuality in this region is scarce. This study aimed to systematically examine prevalence of same-sex sexuality and related health risks in young Ugandan adults. We conducted two cross-sectional survey studies in south-western Uganda targeting student samples (n = 980, n = 1954) representing 80% and 72% of the entire undergraduate classes attending a university in 2005 and 2010, respectively. A questionnaire assessed items concerning same-sex sexuality (same-sex attraction/fantasies, same-sex sexual relations), mental health, substance use, experience of violence, risky sexual behavior, and sexual health counseling needs. Our findings showed that same-sex sexual attraction/fantasies and behavior were common among male and female students, with 10–25% reporting having sexual attraction/fantasies regarding persons of the same-sex, and 6–16% reporting same-sex sexual relations. Experiences of same-sex sexuality were associated with health risks, e.g. poor mental health (2010, AOR = 1.5; 95% CI: 1.0–2.3), sexual coercion (2010, AOR 2.9; CI: 1.9–4.6), and unmet sexual health counseling needs (2010, AOR 2.2; CI: 1.4–3.3). This first study of young adults in Uganda with same-sex sexuality found high levels of health needs but poor access to health care. Effective response is likely to require major shifts in current policy, efforts to reduce stigmatization, and reorientation of health services to better meet the needs of this vulnerable group of young people.
5.
  • Ahlgren, Camilla, et al. (författare)
  • Contact Allergy to Gold in Patients with Oral Lichen Lesions.
  • 2012
  • Ingår i: Acta Dermato-Venereologica. - Medical Journals Limited. - 1651-2057. ; 92:2, s. 138-143
  • Tidskriftsartikel (refereegranskat)abstract
    • The aetiology of oral lichen lesions is obscure. In this study the frequency of contact allergy to gold in 83 patients with oral lichen lesions was compared with that in two control groups, comprising 319 age- and gender-matched patients with dermatitis selected from files and 83 clinically examined dermatitis patients. All patients were tested epicutaneously with gold sodium thiosulphate. The two control groups tested were under examination for a tentative diagnosis of allergic dermatitis not related to oral problems. The frequency of contact allergy to gold was 28.9% in the patients with oral lichen lesions, 18.2% in patients selected from files, and 22.9% in the clinically examined control patients. The difference in frequency between patients with oral lichen lesions and those taken from files was statistically significant.
6.
  • Ahlner Elmqvist, Marianne, et al. (författare)
  • Characteristics and implications of attrition in health-related quality of life studies in palliative care.
  • 2009
  • Ingår i: Palliative Medicine. - SAGE Publications. - 1477-030X. ; 23, s. 432-440
  • Tidskriftsartikel (refereegranskat)abstract
    • In a longitudinal study of 297 palliative care patients, 280 patients were followed from inclusion to death. Characteristics and health-related quality of life (HRQL) of the participants and those who later dropped out were compared at inclusion, and 3 and 2 months before their death. At inclusion, the dropouts were older (P = 0.001), had reduced Karnofsky performance score (P < 0.001), received more help from the local authority (P = 0.004) and had reduced HRQL compared with patients who continued in the study and completed the next questionnaire. There were no differences in any of the HRQL parameters between participants and dropouts 3 months before death. Two months before death, differences in HRQL were found, but in favour of the dropouts. Data from patients close to death may be representative of a larger group of patients, whereas initial dropouts may lead to a positive bias of reported HRQL.
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7.
  • Ahlner Elmqvist, Marianne, et al. (författare)
  • Characteristics and Quality of Life of Patients Who Choose Home Care at the End of Life.
  • 2008
  • Ingår i: Journal of Pain and Symptom Management. - Elsevier. - 1873-6513. ; 36, s. 217-227
  • Tidskriftsartikel (refereegranskat)abstract
    • Cancer patients with advanced disease and short-survival expectancy were given hospital-based advanced home care (AHC) or conventional care (CC), according to their preference. The two groups were compared at baseline to investigate whether there were differences between the AHC and the CC patients that may help explain their choice of care. The patients were consecutively recruited over 2(1/2) years. Sociodemographic and medical data, and the health-related quality of life (HRQL) of the two groups were compared. HRQL was assessed using a self-reporting questionnaire, including the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30), the Impact of Event Scale (IES), five questions about social support, and two items concerning general well-being. The AHC group showed significantly poorer functioning on all the EORTC QLQ-C30 scales and an overall higher symptom burden than the CC patients. Fewer of the AHC patients were receiving cancer treatment. The AHC patients had lived longer with their cancer diagnosis, had a significantly shorter survival after study enrollment, and a significantly poorer performance status. The major differences between the two groups seemed to be related to being at different stages in their disease. The results indicate that patients are reluctant to accept home care until absolutely necessary due to severity of functioning impairments and symptom burden. These findings should be taken into consideration in planning palliative care services.
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8.
  • Ahlner Elmqvist, Marianne, et al. (författare)
  • Health-related quality of life during the last three months of life in patients with advanced cancer
  • 2009
  • Ingår i: Supportive Care in Cancer. - Springer. - 0941-4355. ; 17:2, s. 191-198
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of the study was to explore the development of functioning impairments and symptom occurrence during the last months of life of advanced cancer patients. Self-reported data from 116 patients who all completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) at 3, 2 and 1 month before death were analysed. All functioning aspects deteriorated. For physical, cognitive and social function, the most marked changes occurred between 2 and 1 month before death. The proportion reporting serious difficulties with self-care activities increased from 14% to 43%. The most seriously affected activity could not be distinguished from the EORTC QLQ-C30 scores. Levels of fatigue, dyspnoea and appetite loss increased significantly. More than 50% of the patients had severe pain at all assessments, and only a minor number (8%) reported any improvement. The findings have implications for the planning of care and indicate that further research is required to improve assessment, treatment and follow-up procedures. Adequate pain treatment seems still to be a challenge. Anorexia, fatigue as well as dyspnoea are all symptoms that need further focus.
9.
  • Ahlner Elmqvist, Marianne, et al. (författare)
  • Place of death: hospital-based advanced home care versus conventional care. A prospective study in palliative cancer care.
  • 2004
  • Ingår i: Palliative Medicine. - SAGE Publications. - 1477-030X. ; 18:7, s. 585-593
  • Tidskriftsartikel (refereegranskat)abstract
    • The purpose of this prospective nonrandomized study was to evaluate time spent at home, place of death and differences in sociodemographic and medical characteristics of patients, with cancer in palliative stage, receiving either hospital-based advanced home care (AHC), including 24-hour service by a multidisciplinary palliative care team or conventional hospital care (CC). Recruitment to the AHC group and to the study was a two-step procedure. The patients were assigned to either hospital-based AHC or CC according to their preferences. Following this, the patients were asked to participate in the study. Patients were eligible for the study if they had malignant disease, were older than 18 years and had a survival expectancy of 2-12 months. A total of 297 patients entered the study and 280 died during the study period of two and a half years, 117 in the AHC group and 163 in the CC group. Significantly more patients died at home in the AHC group (45%) compared with the CC group (10%). Preference for and referral to hospital-based AHC were not related to sociodemographic or medical characteristics. However, death at home was associated with living together with someone. Advanced hospital-based home care targeting seriously ill cancer patients with a wish to remain at home enable a substantial number of patients to die in the place they desire.
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10.
  • Ahlner Elmqvist, Marianne (författare)
  • The Impact of Advanced Home Care on Health-related Quality of Life Reports in the end of life from palliative care patients with cancer
  • 2008
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • ABSTRACT The aim of the present work was to compare patients with advanced cancer receiving specialized palliative home care with those receiving conventional care. A hospital-based advanced home care programme was initiated, in order to enable patients to remain at home for a longer period and to choose to die at home. The allocation to advanced home care (AHC) or conventional care (CC) was performed according to the patients’ preferences. This intervention offered an opportunity to investigate the effect of AHC and to describe the HRQL of patients with a progressive, life-threatening disease. A prospective longitudinal comparative study was performed. The two groups of patients (AHC and CC) were compared and the main outcome variables were place of death, time spent in institution or at home, and the patients’ HRQL. The latter was assessed monthly by using self-reported questionnaires, including the European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30), the Impact of Event Scale (IES), five questions about social support and two items concerning general well-being. The AHC patients spent more time outside the hospital and more died at home compared with patients in the CC group. Compared with the CC patients, patients who chose the AHC programme had lived longer with their cancer diagnosis, had a shorter survival period after study enrolment, and had poorer performance status. A marked, but gradual deterioration was seen during the patients’ last three months of life. A more rapid increase in problems was observed between two and one month before death regarding Physical, Cognitive and Social function, as well as Fatigue. The mean scores for Pain, Nausea/Vomiting, Sleeping problems, Diarrhoea and Financial impact were stable over time. Patients who dropped out of the study after filling in the first questionnaire after inclusion had a less favourable prognosis, with regard to both clinical variables and HRQL data. This pattern was not found from patients dropping out of the study during the last two months before death. The palliative intervention with AHC proved successful. Dying at home is strongly associated with the patients’ preference to do so. The results indicate that patients are reluctant to accept home care until necessary due to the severity of functioning impairments and symptom burden. It is important to be aware of the high level of symptoms in the patients’ last three months of life. Symptom assessment using standardised questionnaires may enhance the focus on symptom management. Results from HRQL studies must be interpreted with care due to non-random attrition. This is less evident close to death.
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