Impact of extreme sea levels and waves in the bay of Lundåkra - present situation and future scenarios

This report is a study of the impacts of extreme sea levels and waves on the coastal area of the bay of Lundåkra. The bay is characterized by shallow sea bottoms and a flat topography, particularly in the north. Analyses have been based on historical data. To expand the analyses to apply for a future scenario a change in mean sea level has been considered. Based on general recommendations from the Swedish Meteorological and Hydrological Institute (SMHI) and recent research from the Arctic Monitoring and Assessment Program (AMAP) two future scenarios have been chosen, a sea level rise of 1 m and 1.6 m respectively, for the year of 2100. The bay of Lundåkra is a Natura 2000 area and also contains smaller areas of nature reserves. The bay area holds many conservation values. Some of the most important ones are found in an area of coastal meadows in the northernmost part close to the Saxån estuary. This site is important to many red listed birds. This area is particularly threatened since the highway E6 runs very close to the coast here. The bay area is also of great importance for fish and other animals. Bathymetry and topography data collected by a laser scan method have been obtained from the municipality of Landskrona and Kävlinge and combined with the New National Height Model (NNH) from Lantmäteriet. Modeled wave data (1994-2011) have been extracted for the bay from the company Denmark’s Hydrological Institute, DHI. Sea levels (1992-2012) have been obtained from SMHI and combined with a longer series extracted from a previous study by Karlsson Green and Martinsson (2010). Return periods have been estimated for sea levels and waves by fitting the data to Weibull and Gringorten distribution functions. For the extreme event of the November storm in 2011-11-27 the waves reached 2.2 m, which has the estimated return period of 32.5 years. The sea level reached at the same time 1.47m, with the estimated return period of 27.5 years. Applying the Bruun rule to the future scenarios a risk has been estimated of a coastline retreat of several hundreds of meters along the entire bay area. The northernmost part with the important coastal meadows will likely be flooded already at a sea level rise of 0.75 m. An analysis for calculating the wave runup levels indicate that the highway may be exposed to wave runup at extreme events in the future scenario of a 1 m sea level rise. The wave runup analysis further shows some indications that some sections of the coastline will be more exposed to wave erosion than others

Generation Y- en hållbar generation?

Corporate Social Responsibility (CSR) har under senare år fått stor uppmärksamhet i media och i företags strategier. Detta faktum innebär att kunder i olika grad allt mer kommer i kontakt med företags samhällsengagemang, inte minst inom resebranschen. Vilken betydelse har då denna kontakt för kundernas val av olika produkter och tjänster under konsumtionsprocessen? Ser kunderna en researrangörs CSR relaterade arbete som en kvalitetsskapande faktor eller väcker engagemanget istället misstankar om manipulation? Tidigare forskning behandlar faktorer som inverkar på kunders upplevda kvalité, dock saknas forskning på hur ett företags CSR arbete kan integreras bland de övriga varumärkesvärderingarna i den kvalitetsskapande processen för en specifik målgrupp. Intressant målgrupp för denna undersökning är den i teorin benämnda Generation Y, då denna generation anses komma ha en stor påverkan på resebranschen i framtiden

Early Probiotic Supplementation and the Risk of Celiac Disease in Children at Genetic Risk

AbstractProbiotics are linked to positive regulatory effects on the immune system. The aim of the study was to examine the association between the exposure of probiotics via dietary supplements or via infant formula by the age of 1 year and the development of celiac disease autoimmunity (CDA) and celiac disease among a cohort of 6520 genetically susceptible children. Use of probiotics during the first year of life was reported by 1460 children. Time-to-event analysis was used to examine the associations. Overall exposure of probiotics during the first year of life was not associated with either CDA (n = 1212) (HR 1.15; 95%CI 0.99, 1.35; p = 0.07) or celiac disease (n = 455) (HR 1.11; 95%CI 0.86, 1.43; p = 0.43) when adjusting for known risk factors. Intake of probiotic dietary supplements, however, was associated with a slightly increased risk of CDA (HR 1.18; 95%CI 1.00, 1.40; p = 0.043) compared to children who did not get probiotics. It was concluded that the overall exposure of probiotics during the first year of life was not associated with CDA or celiac disease in children at genetic risk.Abstract Probiotics are linked to positive regulatory effects on the immune system. The aim of the study was to examine the association between the exposure of probiotics via dietary supplements or via infant formula by the age of 1 year and the development of celiac disease autoimmunity (CDA) and celiac disease among a cohort of 6520 genetically susceptible children. Use of probiotics during the first year of life was reported by 1460 children. Time-to-event analysis was used to examine the associations. Overall exposure of probiotics during the first year of life was not associated with either CDA (n = 1212) (HR 1.15; 95%CI 0.99, 1.35; p = 0.07) or celiac disease (n = 455) (HR 1.11; 95%CI 0.86, 1.43; p = 0.43) when adjusting for known risk factors. Intake of probiotic dietary supplements, however, was associated with a slightly increased risk of CDA (HR 1.18; 95%CI 1.00, 1.40; p = 0.043) compared to children who did not get probiotics. It was concluded that the overall exposure of probiotics during the first year of life was not associated with CDA or celiac disease in children at genetic risk

Impact of disease and treatment on body weight and eating in patients with head and neck cancer : experiences from a multicenter study

Background Nutritional deterioration in patients with head and neck cancer (HNC) has a multifactorial etiology mainly associated with tumor and treatment related factors. The objective of the present thesis was to investigate the impact of the disease and treatment on body weight and eating in patients with HNC treated with radiation therapy (RT) as the single modality treatment or as preoperative RT by analyzing body weight and body mass index (BMI) over time, predictive factors for weight loss and BMI, weight loss and BMI as prognostic factors for survival, and by studying the patients’ own experience of food and eating. Methods ARTSCAN is a randomized prospective multicenter trial conducted between the years of 1998 - 2006. Data were collected during and after RT with a total follow-up time of five years. Nutritional data from the whole study cohort (n = 712), from patients with oropharyngeal cancer (n = 232) and from two of the participating treatment centers (n = 101) were retrospectively analyzed in the present thesis. In addition, interviews (n = 13) were conducted nine months after the termination of RT as part of a care development project. Results On a group level, the patients lost weight during and after RT with a nadir at five months after the termination of RT. Factors related to a higher weight loss were oropharyngeal cancer, a high BMI at the start of RT, post-treatment aspiration, no tube feeding at the start of RT, and larger treated volumes. Furthermore, a high BMI at the start of RT was shown to be significantly related to a better five-year overall survival in patients with oropharyngeal cancer, whereas weight loss was not. The patients’ own narratives showed that all aspects of food, eating and meals were affected by the remaining sequelae, and that the patients found ways to accept and cope with the changes that had to be done to facilitate eating. Conclusions and clinical implications The disease and treatment gave persistent effects on the HNC patients’ weight and BMI which calls for a prolonged nutritional follow-up. The predictive factors found for weight loss can be used during patient history to find patients at risk for nutritional deterioration. In oropharyngeal cancer, patients with a high BMI at the start of RT had the best survival. This finding indicates that patients with a low BMI should be encouraged to gain weight before RT start. All aspects of food, eating and meals were affected during and after RT, and therefore the nutritional treatment should be given with a holistic approach to meet the multifaceted need patients with HNC experience

Impact of disease and treatment on body weight and eating in patients with head and neck cancer : experiences from a multicenter study

Background Nutritional deterioration in patients with head and neck cancer (HNC) has a multifactorial etiology mainly associated with tumor and treatment related factors. The objective of the present thesis was to investigate the impact of the disease and treatment on body weight and eating in patients with HNC treated with radiation therapy (RT) as the single modality treatment or as preoperative RT by analyzing body weight and body mass index (BMI) over time, predictive factors for weight loss and BMI, weight loss and BMI as prognostic factors for survival, and by studying the patients’ own experience of food and eating. Methods ARTSCAN is a randomized prospective multicenter trial conducted between the years of 1998 - 2006. Data were collected during and after RT with a total follow-up time of five years. Nutritional data from the whole study cohort (n = 712), from patients with oropharyngeal cancer (n = 232) and from two of the participating treatment centers (n = 101) were retrospectively analyzed in the present thesis. In addition, interviews (n = 13) were conducted nine months after the termination of RT as part of a care development project. Results On a group level, the patients lost weight during and after RT with a nadir at five months after the termination of RT. Factors related to a higher weight loss were oropharyngeal cancer, a high BMI at the start of RT, post-treatment aspiration, no tube feeding at the start of RT, and larger treated volumes. Furthermore, a high BMI at the start of RT was shown to be significantly related to a better five-year overall survival in patients with oropharyngeal cancer, whereas weight loss was not. The patients’ own narratives showed that all aspects of food, eating and meals were affected by the remaining sequelae, and that the patients found ways to accept and cope with the changes that had to be done to facilitate eating. Conclusions and clinical implications The disease and treatment gave persistent effects on the HNC patients’ weight and BMI which calls for a prolonged nutritional follow-up. The predictive factors found for weight loss can be used during patient history to find patients at risk for nutritional deterioration. In oropharyngeal cancer, patients with a high BMI at the start of RT had the best survival. This finding indicates that patients with a low BMI should be encouraged to gain weight before RT start. All aspects of food, eating and meals were affected during and after RT, and therefore the nutritional treatment should be given with a holistic approach to meet the multifaceted need patients with HNC experience

Hälsosamtal i tidig graviditet : En kvalitativ intervjustudie med barnmorskor.

Bakgrund: Socialstyrelsens nationella riktlinjer ger rekommendationer om metoder för att förebygga sjukdom genom att stödja människors förändring av sina levnadsvanor. Alla kvinnor ska erbjudas ett tidigt hälsosamtal vilket är av stor vikt för att identifiera ohälsosamma levnadsvanor. I arbetet med att motivera patienten till förändring är motiverande samtal (MI) en beprövad samtalsmetod som barnmorskan kan använda i samtalet med den gravida kvinnan. Effekterna av motiverande samtal har visat sig ha en gynnsam verkan på flera hälsorelaterade beteenden såsom bruk av alkohol, tobak och andra droger, kost och fysisk aktivitet. Syfte: Syftet med studien var att undersöka barnmorskors erfarenheter av och inställning till hälsosamtal i tidig graviditet. Metod: Studien var empirisk och har en kvalitativ ansats och bygger på åtta enskilda intervjuer. Datamaterialet analyserades med innehållsanalys enligt Graneheim och Lundman (2004). Resultat: I resultatet framkom sex kategorier som besvarade studiens syfte.  Kategorierna heter; tidig flexibel handläggning, intresserade och positiva till hälsosamtal, tidigt hälsosamtal är en vinst, barnmorskorna hade olika åsiketer om behov av utbildning, stor variation i genomförande av hälsosamtal och resurstillgång påverkar hälsosamtalets kvalitet. Slutsats: Det som framkom av studien var att tidsbristen är en avgörande faktor för  arbetet med hälsosamtal. Barnmorskorna hade delade uppfattningar om utbildningen som gavs var tillräcklig eller inte. En stor vinst sågs med tidigt hälsosamtal för både barnmorskan och den gravida kvinnan. Mer specifika riktlinjer och utbildningar bör därför finnas eftersom övervikt är ett växande hälsoproblem idag.Background: The guidelines of the National Board of Health and Welfare provides recommendations on methods on how to prevent illness by supporting people to change their lifestyles. All women should be offered an early health dialogue which is of great importance to identify unhealthy habits. Motivational interviewing is a proven method that the midwife can use in the effort to motivate the pregnant woman. The effects of motivational interviewing has been shown to have a beneficial effect on several health-related behaviors such as use of alcohol, tobacco and other drugs, diet and physical activity. Objective: The aim of this study was to explore midwives' experiences of and attitudes towards health interviews in early pregnancy. Method: The study was empirical and has a qualitative approach and is based on eight single interviews. The data were analyzed by content analysis according Graneheim and Lundman (2004). Results: The results revealed six categories that answered the purpose of the study. The categories are called: early flexible handling, interested and supportive of health interviews, early health consultation is a benefit, the midwives had different opinions about the need for training, considerable variation in the implementation of health consultations and resource availability affects the quality of health discussions. Conclusion: The findings of the study was that lack of time is a crucial factor in the work of health consultations. The midwives had different views on the training given was adequate or not. A large gain was seen with early health consultations for both the midwife and the pregnant woman. More specific guidelines and training should therefore be implemented because obesity is a growing health problem today

Personalvetarstudenter, var ni verkligen redo? : En kvalitativ studie om före detta personal- och arbetslivsstudenters förhållningssätt till övergången från studier till arbetsliv

Personal- och arbetslivsprogrammet är en akademisk utbildning som på senare tid har diskuterats som en utbildning i gränslandet mellan akademi och yrkesliv. Utbildningen får ofta utstå kritik i samhällsdebatten då de nyexaminerade akademikerna, trots flerårig utbildning saknar praktiska arbetsrelaterade färdigheter och kunskaper. Programmet finns på många olika orter i Sverige, men med olika utbildningsupplägg. I denna studie undersöks personal- och arbetslivsprogram vid två universitet i Sverige. Syftet med studien är att undersöka hur tidigare studenter från personal- och arbetslivsprogram upplever att utbildningen har förberett dem för arbetslivet. De frågeställningar som vi ämnar besvara i och med uppsatsen är följande: Vilka attityder finns hos informanterna gentemot utbildningen vad gäller de erfarenheter och kunskaper som genererats? Vilka likheter och/eller skillnader finns hos informanterna från de olika utbildningsprogrammen vad gäller upplevelser om i vilken mån utbildningen varit förberedande för yrkeslivet? Hur kan dessa förklaras i relation till olika sätt att förhålla sig till sin utbildning generellt? För att besvara våra frågeställningar har vi genomfört åtta intervjuer med före detta studenter från personal- och arbetslivsprogram. Som ett komplement till detta har även två telefonintervjuer genomförts med programansvarig på respektive universitet som valts ut för studien. De teoretiska utgångspunkter som använts i undersökningen är dels Granbergs (2009) olika kunskapstyper, Olofssons (2012) teori om utbildningskontraktet, Lindbergs (2009) modell för olika perspektiv på utbildningar samt Dimenäs (2012) begreppsdefinition av begreppet ”beprövad erfarenhet”. Vårt resultat visar på att de före detta studenterna generellt sett är nöjda med sin utbildning, majoriteten förespråkar dock fler inslag av praktiska moment kopplat till yrkeslivet. Informanterna upplever i dagsläget inte utbildningen som särskilt yrkesförberedande. Det finns en skillnad i hur de två programansvariga vid respektive universitet förhåller sig till utbildningen. Vi finner även vissa skillnader mellan de före detta studenterna rörande i vilken mån utbildningen varit förberedande för yrkeslivet beroende på vilket universitet de tillhört. Avslutningsvis lyfter vi de aspekter som hade kunnat göras annorlunda, samt ger ett förslag till vidare forskning.

Barnet i fokus : En allmän litteraturöversikt om sjuksköterskors erfarenheter av att anpassa omvårdnaden till barn som genomgår cancerbehandling inom slutenvård

Bakgrund: Sjuksköterskors främsta kompetens är omvårdnad. Sjuksköterskor har det främsta ansvaret kring att anpassa omvårdnaden till varje specifikt barn. Att anpassa omvårdnaden utefter behov, ålder, mognad och utveckling kan ses som en utmaning. Sjuksköterskor ansvarar för att erbjuda barnet en vårdande kommunikation samt en holistisk och personcentrerad vård. Tidigare forskning beskriver att barn som genomgår cancerbehandling inte känner sig delaktiga i sin egen vård och omvårdnad. En genomgång av de senaste årens studier av sjuksköterskors anpassning av omvårdnad till barn med cancer kan bidra med kunskap utifrån sjuksköterskors perspektiv. Syfte: Studiens syfte var att belysa sjuksköterskors erfarenheter av att anpassa omvårdnaden till barn som genomgår cancerbehandling inom slutenvård. Metod: En allmän litteraturöversikt med en induktiv ansats där analysmetoden utgick från metodförfattaren Fribergs (2017) beskrivning. Översikten baserades på åtta utvalda vetenskapliga artiklar. Resultat: I resultatet identifierades tre huvudkategorier; egen förberedelse, delaktighet och barnens behov. Omvårdnaden anpassades till barnen genom kommunikation, lek, se barnens symtom samt att inkludera familjen i barnens vård och omvårdnad. Slutsats: Om sjuksköterskor anpassar omvårdnaden genom egen förberedelse, delaktighet och utifrån barnens individuella behov erbjuds barnen en vårdande kommunikation samt en personcentrerad och holistisk omvårdnad med barnen i fokus