Publikationer från Uppsala Universitet
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Breaking the cycle : Systematic review of perinatal interventions for parents at risk of child removal
No full textThis systematic review examined the effectiveness of perinatal interventions aimed at preventing infant removals, with attention to service features, implementation barriers, and enablers. We searched six electronic databases and 15 relevant websites for peer reviewed studies published between 2014 and 2024. Eligible studies evaluated interventions targeting pregnant parents at risk of having another child removed and reported on infant removal outcomes. Independent reviewers screened studies using Covidence. A total of 256 records were obtained, of which six peer reviewed studies covering eight interventions, involving 3,254 pregnant women and 20 professionals met the inclusion criteria. Three studies included comparison groups, including only one randomized controlled trial. Five studies assessed program-level interventions, and one study evaluated a policy change. Risk of bias was assessed using the Mixed Methods Appraisal Tool (MMAT). Two of the three comparative studies indicated that targeted interventions may help reduce infant removals. Four of the six studies highlighted that trauma-informed, relationship-based, and multidisciplinary approaches delivered during pregnancy were associated with reductions in infant removals and improvements in maternal wellbeing, housing stability, substance use, and service engagement. Facilitators of successful implementation included continuity of care, culturally safe and non-judgmental support, and flexible services tailored to family needs. Common barriers were late referrals, limited intervention timelines, mistrust of services particularly among families with prior removals and insecure funding that constrained scale and sustainability. Despite generally positive outcomes, the evidence base remains weak due to small samples, limited diversity, lack of comparison groups, and short follow-up periods. This first systematic review of perinatal interventions for preventing infant removals highlights the need for long term, inclusive, comparative research. It underscores the importance of embedding early, holistic support in routine services and offers valuable insights for policy and practice on supporting parents with complex needs within the child protection system
Hälsofrämjande omvårdnad i primärvården : Vuxna personers upplevelser vid kronisk sjukdom – en litteraturstudie
No full textBakgrund: Personer med kroniska sjukdomar ökar bland befolkningen globalt och i Sverige. Primärvården har ett uppdrag att erbjuda hälsofrämjande och förebyggande insatser. Distriktssköterskan har en central roll att stärka patienternas egenvård och stödja dem till hälsofrämjande beteendeförändringar genom personcentrerade arbetssätt. Denna vård begränsas av brister på organisatorisk nivå, behovet av kompetensutveckling samt låg patientmotivation. Det saknas kunskap om hur patienterna upplever den hälsofrämjande omvårdnad som primärvården ger. Syfte: Syftet var att beskriva hur vuxna personer med kroniska sjukdomar upplever hälsofrämjande omvårdnad i primärvården. Metod: Studien hade en deskriptiv och systematisk ansats och genomfördes som en allmän kvalitativ litteraturstudie. Analysen genomfördes tematisk enligt Bettany-Saltikov och McSherrys (2016) nio steg, där rådata kondenserades och kodades in i subteman och teman. Resultat: Analysen identifierades till två teman och fyra subteman. Tema ett: Stöd och lärande i utvecklingen av egenvårdsförmåga med subteman Behov av motivation och stöd och Tillägnande och tillämpning av kunskap. Tema två: Relationer och vårdorganisationen som grund för hälsofrämjande omvårdnad med subteman Bemötande i vårdrelationen och Tillgänglighet och samordning. Resultatet visade att patienternas upplevelser av hälsofrämjande omvårdnad präglades av att personcentrerat stöd och individanpassad information, vilket stärkte motivation, delaktighet och egenvårdsförmågan. Respektfullt bemötande och kontinuitet från vårdpersonal var avgörande för att patienterna skulle uppleva tillit till vården. Slutsats: Hälsofrämjande omvårdnad upplevs som mest meningsfull om den ges med stöd, respekt och kontinuitet. Distriktssköterskans personcentrerade arbete stärker patienternas motivation och egenvård, förutsatt ett ledningsstöd som möjliggör tid, kompetens och samverkan.Title: Health-promoting nursing in primary care. Adults’ experiences of living with chronic illness – a literature review. Background: The number of people living with chronic diseases is increasing globally and in Sweden. Primary health care is responsible for providing health-promoting and preventive interventions. The district nurse has a central role in strengthening patients’ self-care and supporting health-promoting behavioral changes through person-centered approaches. However, this care is limited by organizational barriers, the need for continuous professional development, and low patient motivation. Limited knowledge exists regarding how patients perceive health-promoting nursing in primary care. Aim: The aim was to describe how adult patients with chronic illnesses experience health-promoting nursing in primary health care. Method: The study had a descriptive and systematic approach and was conducted as a general qualitative literature review. The analysis was carried out thematically according to Bettany-Saltikov and McSherry’s (2016) nine-step process, in which the raw data were condensed and coded into subthemes and themes. Results: The analysis resulted in two themes and four subthemes. Theme one: Support and learning in the development of self-care, with the subthemes Need for motivation and support and Gaining and using knowledge. Theme two: Relationships and the health care organization as a foundation for health-promoting nursing, with the subthemes Approach in the care relationship and Accessibility and coordination. The results showed that patients’ experiences of health-promoting nursing were characterized by person-centered support and individualized information, which strengthened motivation, participation, and self-care ability. Respectful encounters and continuity of care were essential for patients’ trust in the healthcare system. Conclusion: Health-promoting nursing is perceived as most meaningful when characterized by support, respect, and continuity. The district nurse’s person-centered approach enhances patients’ motivation and self-care when organizational support allows time, knowledge development, and teamwork
Negotiating stance expressions in research writing with GenAI : A three-step prompt approach for ChatGPT
No full textRecent studies have started to examine differences in the use of stance expressions between human and GenAI writing, e.g. comparing student essays to those generated by LLMs. In professional research writing, stance expressions not only reflect authors' attitudes and assessments but also function as manifestations of researcher's positionality. However, to our knowledge, the impact of GenAI on the linguistic expression of researcher positionality, and stance in particular, has not received attention in the literature. To address this gap, our study zooms in on how ChatGPT-4 adopts and adapts stance with regard to knowledge claims in applied linguistics and pragmatics. We have systematically tested three kinds of prompting techniques in order to assess the model's flexibility in generating stance expressions: a) zero-shot prompting with minimal input; b) few-shot prompting technique; c) role enactment prompting. Our analysis of ChatGPT-4 output in response to our prompts suggests that, overall, the model displays a rather rigid understanding of stance. The outputs are more acceptable for epistemic rather than attitudinal stance. Our results suggest that interactional prompting is the most effective strategy, as the model is guided to treat texts holistically and consider a range of nuanced elements, producing an output that better mimics genuine engagement with the text
KoF24 Quality and Renewal 2024 (Q&R24) : A research evaluation at Uppsala University
No full textOncological Outcome for 83 Consecutive Patients With Malignant Peripheral Nerve Sheath Tumors Treated at a Tertiary Referral Centre
No full textBackground: Malignant peripheral nerve sheath tumors (MPNSTs) are rare soft tissue sarcomas with a high risk of recurrence and a poor prognosis, and there is a lack of knowledge regarding long-term follow-up and response to oncological treatment.Aims The aim of this study was to investigate what treatment the patients received and to examine the outcome for patients with MPNST. Methods and Results: This is a retrospective study of patients treated for MPNST at Karolinska University Hospital between 2003 and 2022. Data regarding surgical and oncological treatment and follow-up were collected. Eighty-three patients were identified and included in the study. Tumor grade is available for 72 patients, of which 64 had high-grade tumors. Seventy-nine patients were primarily operated on. Twelve patients presented with distant metastases at diagnosis. Another 37 patients developed local recurrence or distant metastases during follow-up; the median time from surgery to recurrence was 10.5 months (1-95 months, n = 36). The overall mortality rate during the study period was 44% (n = 82). Twenty-seven patients received palliative systemic treatment. The most used therapy for first-line palliative systemic treatment was doxorubicin and ifosfamide. The disease control rate for first-line treatment was 33% (n = 21). The mean overall survival for the cohort was 132 months (95% CI 107-157 months). Conclusion: Forty-five percent of the patients in this material were diagnosed with recurrent disease and most patients treated with palliative systemic therapy experienced brief disease control following treatment. Among patients with MPNST treated with first-line palliative oncological treatment, doxorubicin and ifosfamide have the highest disease control rates. The study also identified a few patients with long-term treatment responses, with four patients alive more than 2 years after starting palliative oncological treatment
Heat event risk perception and care adaptation among pregnant women in Nepal : baseline assessment of a longitudinal concurrent cohort
No full textBackground: Heat events have detrimental effects on maternal and neonatal health, increasing the risk for maternal complications, preterm birth, and neonatal mortality. There is an urgent need to explore pregnant women's heat risk perceptions and adaptive measures. This study uses the Health Belief Model (HBM) to investigate pregnant women's perception of heat risks and related prevention and mitigation strategies and identifies barriers to the adoption of such behaviours. Methods: Using a concurrent cohort design, a baseline assessment was conducted through semi-structured interviews with 745 pregnant women in a heat prone district in Nepal. The interviews collected socio-demographic information and assessed the five HBM constructs of heat event risk perception using a Likert scale. Heat maps were created to visualise perceptions, and Principal Component Analysis was undertaken to create a nominal scale score for each construct. Crude and adjusted linear regressions were performed to assess associations of socio-demographic characteristics and HBM constructs. Results: Among the pregnant women, 68% perceived dehydration due to heat as a risk to their pregnancy, and 37% perceived sunburn as a risk to foetal health. In terms of perceived benefit, 34% agreed that staying in an air-conditioned environment could reduce their chances of suffering during a heat event. Adjusted linear regression showed that wealthier women perceived higher susceptibility (adj. beta = 0.14, 95% CI: 0.07, 0.21; p < 0.001) and severity (adj.beta = 0.16, 95% CI: 0.08, 0.23; p < 0.001), and reported more barriers (adj. beta = 0.16, 95%CI: 0.08, 0.23; p < 0.001). Conversely, urban residents had significantly lower perceived susceptibility (adjusted beta = -0.32, 95% CI: -0.41, -0.24; p < 0.001) and severity (adj. beta = -0.34, 95%CI: -0.42, -0.25; p < 0.001), fewer barriers (adj. beta = -0.34, 95%CI: -0.42,-0.25; p < 0.001) towards heat events, and perceived more benefits (adj. beta = 0.31, 95%CI: 0.22, 0.39; p < 0.001) from heat stress prevention and mitigation strategies compared to their rural counterparts. Conclusion: To promote adaptive behaviours in this vulnerable population and strengthen maternal and foetal resilience against the growing threat of heat, we recommend focusing on closing knowledge, availability, and accessibility gaps. Maternal health considerations should be integrated into national climate change adaptation strategies to ensure that pregnant women are prioritised in policies and interventions. Statistics IBM SPSS statistic software for Windows version 26 and Stata/SE 18.0 were used for this study. Highlights This study provides novel evidence on how pregnant women in a low-resource and heat-affected setting perceive and respond to extreme heat events. In this concurrent cohort study, we examined the pregnant women's perception of heat risks, barriers to adaptation, and barriers to mitigation strategies. We found that more than one in three women perceive heat as risk to pregnancy and stayed in an air-conditioned environment during a heat event. Women who are poor and reside in urban area have lower risk to heat risk perception and adaptation
Direct observation of the on-site oxygen 2p two-hole Coulomb energy in La2CuO4
No full textElectron correlation in functional materials has remained a challenge with strong deviations of electronic structure from mean field approaches. In high temperature superconductors the electron-electron and hole-hole interaction energies are essential in the underlying pairing mechanisms. For cuprates, oxygen holes have been considered of central importance for superconductivity. In La2CuO4 the site specific oxygen 2p hole-hole Coulomb energy has been determined by Auger photoelectron coincidence spectroscopy. This experimental approach allows to separate the different oxygen sites, i.e. the lattice oxygen, and distinguish from otherwise overlapping signal from surface oxygen. Values of 6.3±0.2 eV for oxygen in the Cu-O planes and an upper limit of 9.2±0.2 eV for apical oxygen are found to be on the high energy side of reported computational values and narrows the range of experimentally reported values. Additionally, a much reduced hybridization in La2CuO4 as compared to CuO is found in O 2p hybridization strengths
Navigating Interdependencies In Collaborative Innovation : A Data-Driven Dematel Framework
No full textCollaborative innovation is vital for organisational competitiveness, yet the literature still offers an incomplete picture of how its numerous drivers interact. This study advances that understanding by consolidating 34 factors from a content-centric review of recent research and distilling them to eight core variables: market dynamics, knowledge creation and acquisition, technological learning, trust, innovation culture, organisational learning, innovation capabilities and governance. We engage a ten-member panel of academics and industry experts and employ the Decision-Making Trial and Evaluation Laboratory (DEMATEL) method - an innovative multi-criteria decision-making approach - to quantify the causal structure among these factors. The resulting network relationship map shows that trust, innovation culture and organisational learning form the principal engine of collaborative innovation, exerting the strongest net positive influence on the system. Knowledge creation and technological learning surface mainly as outcomes of this relational engine, while market dynamics and governance assume balanced, context-sensitive positions. Innovation capability emerges as a hinge factor, receiving almost as much influence as it delivers, thereby converting relational gains into competitive advantage. By integrating DEMATEL with network visualisation, the study provides one of the first data-driven blueprints for managing the dynamics of collaborative and open innovation. The reference model guides managers in prioritising actions-cultivating trust, fostering an experimentation-friendly culture, institutionalising learning routines and aligning governance with environmental turbulence - across both firm and network levels. Future research should examine the temporal evolution of these interactions and explore how emerging technologies such as AI, digital twins and blockchain further reshape collaborative innovation ecosystems
The Cost of Healthcare for Undocumented Migrants : Comparing Accessibility in the Netherlands and Spain
No full textUndocumented migrants’ (UMs) access to healthcare varies widely across EU member states, and a trend towards more restrictive legislation has emerged. In most cases, they are only entitled to emergency care. The Netherlands and Spain provide broader access, yet UMs still face significant barriers to care. The Netherlands operates a Social Health Insurance (SHI) system, whereas Spain has a tax-funded National Health Service (TF-NHS). Both the Dutch Linking Act (1998) and the Spanish Royal Decree-Law 16/2012 (2012–2018) are national manifestations of this restrictive trend, tying entitlements to legal status and hindering healthcare accessibility. This qualitative, comparative case study, based on policy reports, peer-reviewed articles, and six semi-structured interviews, examined how legal frameworks and financing systems in both countries influence UMs’ ability to access healthcare. Findings suggest that financing systems influence the level of health coverage UMs receive by shaping both entitlement narratives and healthcare providers’ behaviour. In Spain’s TF-NHS, indirect tax contributions by UMs justify entitlement to use publicly funded care, whereas in the Netherlands, the exclusion of UMs from obtaining insurance precludes such logic. In the Netherlands, both the SHI model and unfamiliarity with a reimbursement mechanism appear to prompt financial reservations among practitioners about providing care to uninsured UMs due to a perceived risk of financial loss. Spain’s TF-NHS does not bring such reservations. These findings have relevance for Universal Health Coverage (UHC) debates, showing how financing models can widen or narrow coverage for UMs
Investigating Ionospheric Scintillations Using Swarm and GNSS Measurements
No full textSolar activity variations, including solar flares and coronal mass ejections, drive geomagnetic storms that inject energy into the magnetosphere–iono-\\sphere system, producing field-aligned currents (FACs), auroral phenomena, and plasma density irregularities. These irregularities cause rapid fluctuations in Global Navigation Satellite System (GNSS) signal amplitude and phase, known as scintillations, which degrade navigation and communication accuracy. This study combines data from the ESA Swarm satellite mission—providing measurements of electron density and FACs—with ground-based GNSS scintillation receivers that record S4 (amplitude) and σϕ (phase) indices. Geomagnetically active days were selected using the Kp, Dst, and Hp30 indices. Results show that during major storms, FACs of up to ±108 μA/m² were observed near 67° AACGM latitude, expanding equatorward at storm onset. The electron drift velocity in the ionosphere increased from about 600 m/s on quiet days to nearly 20,000 m/s under storm conditions. Ground stations recorded strong scintillations (S4 > 0.4, up to 1.4) at equatorial latitudes, coinciding with Swarm detections of plasma bubbles. Correlation analysis revealed a link between electron density irregularities and scintillation intensity (Pearson r > 0.7 for Swarm A and C). Overall, the findings confirm that space weather–driven ionospheric disturbances impact GNSS signal stability, particularly during geomagnetic storms at high and equatorial latitudes. These results highlight the importance of integrating satellite and ground-based observations to improve space weather monitoring and the reliability of global navigation systems.Solen påverkar ständigt vår planet, och när den blir särskilt aktiv, till exempel vid solutbrott eller stora eruptioner, kan den störa rymden runt jorden. Dessa störningar, som kallas geomagnetiska stormar, skickar energi till den övre atmosfären och skapar glödande norrsken samt osynliga förändringar i jonosfären, ett område fyllt med laddade partiklar. Dessa förändringar är viktiga eftersom de kan störa radiosignalerna som används av navigationssystem som GPS och Galileo. När jonosfären blir ojämn eller ”klumpig” börjar signalerna från satelliterna att flimra och fluktuera, ett fenomen som kallas scintillation. Detta kan minska noggrannheten hos de navigations- och kommunikationssystem som vi förlitar oss på varje dag. I detta projekt kombinerade jag två typer av mätningar för att bättre förstå dessa effekter. Först använde jag data från ESA:s Swarm-satelliter, som kretsar kring jorden och mäter saker som elektrontäthet och elektriska strömmar som flödar längs magnetfältlinjer. För det andra inkluderade jag observationer från markbaserade mottagare som övervakar hur starkt GPS-signalerna störs. Genom att fokusera på perioder med stark geomagnetisk aktivitet fann jag att intensiva elektriska strömmar bildades över norra breddgrader och rörde sig mot lägre breddgrader när stormarna började. Elektronernas rörelse i jonosfären ökade också kraftigt under stormar, från normala hastigheter på några hundra meter per sekund till tiotusentals meter per sekund. Samtidigt upptäckte markstationer nära ekvatorn starka störningar i GPS-signalerna, vilket stämde överens med de ”plasma-bubblor” som satelliterna observerade. Genom att jämföra alla datamängder fann jag ett samband mellan oregelbundenheter i jonosfären och signalstörningarnas svårighetsgrad. Detta visar att rymdväderhändelser kan påverka GPS-prestandan i både polära och ekvatoriella regioner. Sammantaget understryker dessa resultat hur viktigt det är att kombinera satellit- och markmätningar vid övervakning av rymdväder. En bättre förståelse av dessa störningar kan bidra till att skydda och förbättra tillförlitligheten hos de globala navigationssystem som det moderna samhället är beroende av