Publikationer från Örebro universitet
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Do the early social environment and persistent peripartum depressive symptoms shape toddlers' expressive language?
No full textBackground: Extensive research suggests that peripartum depression is a risk factor for children's early language development. Yet, previous research on this association shows mixed results, often lacking information on the persistence of depression and the social context. This population-based cohort study addresses this gap by investigating the longitudinal influence of peripartum depressive symptoms on toddlers' expressive language. Specifically, we systematically examined the influences of timing, severity, and persistence of depressive symptoms during pregnancy and the first 6 months postpartum on child expressive language development, while accounting for important social and environmental factors. Methods: This study is part of a prospective, population-based investigation conducted within the follow-up Uppsala Birth Cohort study in Uppsala, Sweden. The final analysis included 2176 mother-infant dyads (1122 boys, mean age = 18.3 months, SD = 0.7). Perinatal depressive symptoms were assessed at gestational weeks 17 and 32 and at postpartum six weeks and six months, using the Edinburgh Postnatal Depression Scale (cut-off >12). At 6 months postpartum, mothers were also invited to fill out the Postnatal Bonding Difficulty Questionnaire. At 18 months postpartum, mothers completed the Language Development Survey, which assessed expressive vocabulary and word combinations. Multivariable linear regression models were applied to examine the associations between peripartum depressive symptoms and child language development. Adjusted models incorporated background and social context variables to account for potential confounding factors. Results: Depressive symptoms during prenatal and postnatal periods were not significantly associated with language outcomes. Our final model identified negative associations with second-born status, family history of late talkers, countryside residence, and maternal age at childbirth. Positive correlations were found for sex (girl) and pregnancy length. The final model explained 8.4% of the variance (F(22, 1566) = 6.525, p < 0.001). Furthermore, we found that persistent depressive symptoms were not significantly related to language outcomes (Kruskal-Wallis test: H = 2.227, df = 2, p = 0.21). Conclusions: Our findings found no negative link between peripartum depressive symptoms and expressive language in toddlers, even after considering timing, severity, and persistence. While no immediate direct negative influence of peripartum depressive symptoms was observed, the long-term cumulative effects later in life remain unclear.The project is supported by the Uppsala Region (ALF‐965886; ALF‐965905), the Göran Gustafsson Foundation (Nr. 1551A‐2015), the Swedish Research Council (523‐2014‐07605), the Swedish Medical Association, and the Swedish Brain Foundation to Alkistis Skalkidou as well as the Gillbergska Foundation to Emma Fransson and Hsing‐Fen Tu.</p
Leading guideline implementation : from the view of first-line nursing and rehabilitation managers in orthopaedic healthcare
No full textBackground Annually, many persons undergo hip surgery, where urinary retention (UR) is a common complication. A gap exists between clinical practice guidelines (CPGs) and performed care regarding the prevention of UR, highlighting the need for implementation interventions to support uptake of the CPGs. As implementation leaders, first-line managers (FLMs) are key to bridging the knowledge-practice gap and could be included in implementation strategies. Aim To explore guideline implementation in orthopaedic healthcare with a focus on first-line managers’ implementation leadership. Method A cluster-randomised hybrid effectiveness/implementation study involving 17 orthopaedic units performing hip surgery at hospitals located in Sweden. Intervention units formed multi-professional internal facilitating (IF) teams (each including at least one FLM) for a 12-month education and support programme to implement bladder monitoring CPGs. Data was collected via interviews (study I, II, IV), medical record reviews (study III), patient surveys (study III), and registry data (study III), and it was analysed using qualitative content analysis (study I) and thematic analysis (study II), statistical analysis (study III), and realist evaluation (study IV). Results FLMs viewed guideline implementation as a balancing act between organisational structures and unit-level realities (study I). They adapted leadership strategies based on context, often translating guidelines to fit local conditions (study I,II). During COVID-19, implementation was smoother due to unified goals, but it faced barriers such as unclear evidence and rapid changes (study II). The intervention deepened participants’ understanding of both clinical guidelines and implementation science (study IV), though without any statistically significant differences in adherence to bladder monitoring CPGs between intervention and control (study III). Managers played a crucial role in anchoring decisions but stepped back to empower teams (study IV). Conclusion Although FLMs have a clear vision of beneficial leadership in relation to change and use implementation leadership behaviours in CPG implementation, a support and education programme regarding implementation processes could build on their prior knowledge. Still, leadership actions can be influenced by contextual factors, and the FLMs sometimes have to adjust accordingly. Health organisations could support first-line managers in their important role in reinforcing an evidence-based practice by scrutinising the organisational context and creating processes that support implementation leadership
Looking under the Hood of Digital Government : A Digital Index Framework for Assessing Digitalisation of Core Processes in Government Agencies
No full textThis thesis addresses the question: How can a Digital Index Framework (DIF) provide an assessment of digitalisation of core processes in government agencies? It aims to understand how digitalisation can be assessed in the context of public administration and core processes. The research is grounded in the multi-disciplinary field of digital government and applies mixed methods: literature review, design science and case studies. The thesis finds that benchmarking digital government faces recurring criticism regarding how assessments are conducted and what they measure. By examining the design of a DIF, the thesis proposes design principles for assessing digitalisation, focusing on how digital technologies support administrative processes. This includes a process view highlighting interaction with society, internal case handling and data exchange. Examining digitalisation through a DIF highlights core processes and contributes to scholarly discussions on linking public administration with digitalisation. Focusing on core processes, the thesis presents a classification of eight types, which can support both assessing digitalisation and studying phenomena such as artificial intelligence and digital services. The thesis also contains results concerning the influences from the practical implementation of the DIF among practitioners in government agencies. The engagement with the DIF fostered skill development, deeper reflections on cross-government processes and led to policy learning and change
Beyond Causal Accuracy : Evaluating Representation Quality in Deep Treatment Effect Estimation
No full textRecent advances in treatment effect estimation (TEE) leverage deep neural networks to learn latent representations that balance treatment and control groups. However, despite their empirical success, we know remarkably little about the learned representations themselves—what structure they capture, why they lead to improved performance, and how far we can trust them. Existing evaluations focus almost exclusively on causal outcome metrics such as PEHE or ATE bias, leaving the representational mechanisms largely unexplored. This lack of understanding limits our ability to explain why models perform well, to identify when they fail, and to design more interpretable or trustworthy causal systems. In this work, we present a comprehensive analysis for representation-level evaluation of TEE methods. We benchmark CFR, DRCFR, TEDVAE and modern disentanglement-driven models using a unified suite of quantitative and graphical measures. Quantitatively, we assess AUC(T | Z) for confounding separability, Mutual Information (MI) retention for informativeness, MMD2 and SW1 for balance, CH-ratio for compactness, and Participation Ratio (PR) for effective dimensionality. Graphically, we analyze bias removal through embedding visualizations, kNN-mixing histograms, covariance heatmaps, and outcome-smoothness histograms—providing an interpretable view of latent geometry. Our analysis shows that modern VAE-based disentangling models yield more structured, balanced, and informative representations, which also correlate strongly with causal reliability. We provide a practical way to see inside TEE representations—revealing hidden biases, interpreting latent behavior, and understanding when conventional embedding properties (such as neighborhood preservation) may actually hinder bias mitigation. Overall, our findings emphasize that evaluating how models learn is essential to understanding why they perform well, paving the way toward more interpretable and trustworthy causal inference
The rise of law in education - exploring three drivers of juridification in the context of a changing welfare state
No full textThis article takes as its starting point that governments in different countries increasingly tend to use legal means to solve societal problems and argues that this tendency reflects broader changes in the welfare state. While previous critical studies of education policy have contributed important knowledge on governance changes, the impact of the legal system has, however, until recently remained an outlier. By synthesising links between different theoretical and empirical contributions, the purpose of this article is to identify and explore key historical drivers for the development of juridification. The guiding research question is: Why juridification of education now - and how? To approach it, three interrelated and interwoven international trends are outlined: marketisation, accountability and human rights. The article contributes knowledge on how these three drivers have created contextual opportunities for juridification to develop, and invites further examination by the growing community of researchers dedicated to exploring juridification of and in education
Teachers as linguistic role models : Language teaching in multilingual ECEC settings
No full textThis article examines ECEC teachers' beliefs about being linguistic role models and how these beliefs relate to their language teaching for multilingual children. Due to the increased language diversity in Finland, the demands on teachers have increased. Teachers are expected to be linguistic role models and create multilingual learning opportunities for all children. This study uses quantitative methods to examine the relationships between teachers as linguistic role models and language teaching for multilingual children. A questionnaire was answered by 42 ECEC teachers in Swedish-medium settings in Finland. Data was analyzed using chi-square tests to depict relationships between variables. Results show that teachers largely agree to be linguistic role models. This correlates with seeing adult-led play as important for language development and using dialogic reading as a teaching strategy. Play with peers was highly valued as a language development activity but not related to being a linguistic role model. Although planning reading activities was considered important, it was not related to being a linguistic role model. The latter may indicate that teachers need more knowledge on how these daily activities can become high-quality language teaching situations, especially when developing children’s academic language skills
Nivåläsning ur ett läsförståelseperspektiv : En läromedelsanalys av Diamantjakten
No full textThis study investigates how the educational book series ABC-klubben: Diamantjakten offers possibilities for students to develop their reading comprehension abilities. The purpose is to analyse how the three different versions of the same text (easy- moderate and hard) differ in means of sentence structure, multimodality and reading comprehension strategies and how these differences influence students’ possibilities to reach the knowledge requirements in the curriculum for Swedish. The study is based on a manifest content analysis of a selection of chapters from each version, using the Swedish Readability index (LIX), the relation between text and illustrations as well as the four strategies of the method Reciprocal teaching: summarise, ask questions, clarify and make predictions. The results show that the easy-to-read version is generally simpler in means of sentence structure and visual support, though risking the readers’ possibility to make inferences while reading due to knowledge gaps in the text. The moderate- and hard-to-read versions offer more possibilities to use reading comprehension strategies but also impose higher demands on the cognitive abilities of the reader, e.g. vocabulary and memory capacity
Inkluderande matematikundervisning : En litteraturstudie om strategier som möter klassrummets olikheter
No full textForskning visar att salamancadeklarationens mål om en skola för alla har varit svåra att uppnå och att begreppet inkludering blivit alltför abstrakt. Samtidigt visar internationella undersökningar att spridningen av elevers matematikresultat har ökat. Syftet med den systematiska litteraturstudien är att sammanställa undervisningsstrategier som möter klassrummets olikheter. Resultatet visar att flera undervisningsstrategier bör kombineras eftersom en enskild inte är tillräcklig för att möta elevers olika sätt att lära. Undervisningsstrategierna som framträder genom resultatet är: stöd- och språkstruktur, representationer och uttrycksformer, individ- och gruppbaserad matematikundervisning samt elevnära matematikundervisning. Studien poängterar även vikten av att lärare medvetet skapar en relation mellan elev och innehåll.Research shows that the goals of the salamanca declaration to achieve education for all have been difficult to implement, and that the concept of inclusion has become abstract. At the same time, international comparisons indicate a growing variation in student’s mathematics performance. The aim of this systematic literature review is to compile the teaching strategies that address classroom diversity. The result show that multiple strategies need to be combined as no single approach is sufficient to meet all student´s ways of learning. The identified strategies are support, representations, individual- and group-based teaching and student-centered teaching. The study also highlights the importance of teacher´s conscious approach to create a meaningful relationship between the student and the content
What Drives Girlfriends' Bedtimes? Experimental Effects of Social Technology Use and the Role of Friendship and Personality
No full textTechnology use is often implicated in adolescent sleep difficulties, yet experimental evidence confirming its impact on bedtime is critically lacking. This study tested whether online socialising with friends delays bedtime compared to non-social online media use, while also considering the roles of friendship quality and personality. Seventeen pairs of female friends (N = 34; ages 16–18 years) spent two nights in a sleep laboratory: one night online socialising with their friend in another room (WhatsApp + Netflix), and one night watching Netflix alone without socialising. Condition order was counterbalanced across pairs. Bedtime was behaviorally observed using infrared cameras. The following morning, participants reported who initiated sleep and their reasons for going to bed. They also completed questionnaires on friendship quality, co-rumination, self-control, bedtime procrastination, and a sleep diary. Multilevel models accounted for the nested structure of repeated assessments within individuals within dyads. On average, participants went to bed later during online socialising than during non-social online use, although this difference was not statistically significant. However, higher friendship quality significantly predicted longer bedtime delays during online socialising, with delays up to 72 min. Feeling sleepy was the primary reason for sleep onset, rather than social motivations. Additionally, there were clear associations between self-reported sleep initiation and bedtime procrastination and behavioural observations of earlier and later bedtimes, respectively. These experimental findings suggest that online socialising may delay adolescent bedtimes, particularly among those with high-quality friendships. These results underscore the importance of addressing peer dynamics and individual differences in supporting healthy adolescent sleep.Ungdomars sömn, kompisar och sociala medier: En multimetodstudi
Swedish Audiologists’ Attitudes Toward Continuing Professional Development: A Follow-Up Study
No full textBakgrund: Audionomprofessionen har genomgått en betydande förändring från en assisterande roll till ett självständigt yrke, därför ställs höga krav på audionomens kompetensutveckling. Kompetensutveckling inom vården innebär att yrkesverksamma förbättrar sina kunskaper och färdigheter för att säkerställa hög vårdkvalitet. I länder som USA, Storbritannien, Australien och Sydafrika är kompetensutveckling obligatorisk och regleras genom ett poängsystem. För att behålla sin yrkeslegitimation krävs att audionomer kontinuerligt deltar i kompetensutvecklande aktiviteter. I Sverige är deltagande i kompetensutveckling frivilligt och audionomer ansvarar själva för att hålla sig uppdaterade om nya metoder och tekniker inom deras yrkesområde. Syftet: Syftet med studien är att undersöka om svenska audionomers inställning till kompetensutveckling i allmänhet samt deras intresse att ta del av formaliserade kompetensutvecklingsprogram. Metod: En kvantitativ webbenkätstudie genomfördes för att nå ut till legitimerade audionomer i Sverige. Data analyserades med deskriptiv statistik och Chi-två-test. Sammanlagt deltog 107 audionomer i denna studie. Resultat: Studiens resultat visar att majoriteten (60,7%) av respondenterna är positivt inställda till ett obligatoriskt program liknande USA eller Storbritannien. Trots det positiva engagemanget upplever många att hög arbetsbelastning och tidsbrist försvårar deltagande, och nästan hälften anser att ett poängsystem inte skulle öka deras motivation. Samtidigt framkommer att audionomer ser kontinuerlig kompetensutveckling som en viktig del av sitt yrkesutövande. Det fanns inte ett statistiskt samband mellan utbildningens längd eller arbetsbelastning och inställning till obligatorisk kompetensutveckling. Jämfört med tidigare forskning (Andersson & Fredriksson, 2013), där audionomer främst föredrog det frivilliga systemet för kompetensutveckling, visar vår studie att en större andel nu är positivt inställda till ett obligatoriskt program. Detta kan tyda på en möjlig attitydförändring, även om skillnader i urval, metod och tidsaspekt bör tas i beaktande. Slutsats: Resultaten tyder på en attitydförändring jämfört med tidigare forskning där fler audionomer idag är positiva till ett obligatoriskt kompetensutvecklingssystem. För att detta ska bli effektivt krävs organisatoriskt stöd, tydlig struktur och resurser från arbetsgivare.Background: The audiology profession has undergone a significant transformation from an assisting role to an independent profession, which places high demands on the audiologist’s professional development. Continuing professional development in healthcare refers to professionals improving their knowledge and skills to ensure high-quality care. In countries such as USA, UK, Australia, and South Africa continuing professional development is mandatory and regulated through a creditbased system. To maintain their professional license, audiologists are required to continuously participate in professional development activities. In Sweden, participation in continuing professional development is optional, and audiologists are individually responsible for staying up to date with new methods and techniques within their field. Aim: The aim of this study is to investigate Swedish audiologists’ attitudes toward continued professional development in general, as well as their interest in participating in formalized development programs. Method: A quantitative web-based survey was conducted to reach licensed audiologists in Sweden. Data were analyzed using descriptive statistics and the Chi-square test. A total of 107 audiologists participated in this study. Results: The results show that the majority (60,7%) of respondents have a positive attitude towards a mandatory program similar to those in USA or UK. Despite this positive engagement many experience that high workload and lack of time make participation difficult, and nearly half believe that a credit-based system would not increase their motivation. At the same time, it is evident that audiologists view continuous professional development as an important part of their professional practice. There was no statistically significant association found between the length of education or workload and attitudes toward mandatory professional development. Compared to previous research (Andersson & Fredriksson, 2013), where audiologists primarily preferred the non-mandatory system for professional development, our study shows that a larger proportion are now positively inclined toward a mandatory program. This may indicate a possible shift in attitudes, although differences in sample, methodology, and time frame should be taken into consideration. Conclusion: The results suggest a change in attitudes compared to earlier research, with more audiologists today being in favour of a mandatory continuous professional development system. For such a system to be effective, organizational support, a clear structure and resources from employers are required