INTRODUCTION:Multiple sclerosis (MS) is a chronic autoimmune disease with a substantial impact on quality of life and functional capability. The prognosis of MS has changed over time due to the development of increasingly effective therapies. As the knowledge and perceptions of persons living with chronic conditions increasingly have been acknowledged, it has become important to understand lived experiences with a focus on everyday events and experiences as a way of knowing and interpreting the world. Exploring context-specific lived experiences as a source of knowledge about the disease and care may contribute to more precision in designing care services. The aim of this study was to explore the lived experience of persons living with MS in a Swedish context.MATERIALS AND METHODS:A qualitative interview study was conducted with both purposeful and random sampling strategies, resulting in 10 interviews. Data were analyzed using inductive thematic content analysis.RESULTS:The analysis generated 4 overarching themes with 12 subthemes, the 4 themes were: perspectives on life and health, influence on everyday life, relations with healthcare, and shared healthcare processes. The themes are concerned with the patients' own perspectives and context as well as medical and healthcare-related perspectives. Patterns of shared experiences were found, for example, in the diagnosis confirmation, future perspectives, and planning and coordination. More diverse experiences appeared concerning relations with others, one's individual requirements, symptoms and consequences, and knowledge building.CONCLUSION:The findings suggest a need for a more diverse and coproduced development of healthcare services to meet diverse needs in the population with greater acknowledgement of the person's lived experience, including consideration of the complexity of the disease, personal integrity, and different ways of knowing. Findings from this study will be further explored together with other quantitative and qualitative data.

BACKGROUND:The burden of disease for persons with multiple sclerosis (MS) and society is changing due to new treatments. Knowledge about the total need for care is necessary in relation to changing needs and new service models.OBJECTIVE:The aim of this study was to describe the contact patterns for MS patients, calculate costs in health care, and create meaningful subgroups to analyze contact patterns.METHODS:All patients diagnosed with MS at Ryhov Hospital were included. All contacts in the region from January 1, 2018, until September 30, 2019, were retrieved from the hospital administrative system. Data about age, sex, contacts, and diagnosis were registered. The cost was calculated using case costing, and costs for prescriptions were calculated from medical files.RESULTS:During the 21-month period, patients (n = 305) had 9628 contacts and 7471 physical visits, with a total cost of $7,766,109. Seventeen percent of the patients accounted for 48% of the visits. The median annual cost was $7386 in the group with 10 or fewer visits, compared to $22,491 in patients with more than 50 visits.CONCLUSION:There are considerable differences in the utilization of care and cost between patients with MS in an unselected population, meaning that the care needs to be better customized to each patient's demands.

Abstract Background Pursuing the vision ‘for a good life in an attractive region,’ the Region Jönköping County (RJC) in Sweden oversees public health and health-care services for its 360 000 residents. For more than three decades, RJC has applied ‘quality as strategy,’ which has included increasing involvement of patients, family and friends and citizens. This practice has evolved, coinciding with the growing recognition of co-production as a fundamental feature in health-care services. This study views co-production as an umbrella term including different methods, initiatives and organizational levels. When learning about co-production in health-care services, it can be helpful to approach it as a dynamic and reflective process. Objective This study aims to describe the examples of key developmental steps toward co-production as a system property and to highlight ‘lessons learned’ from a Swedish health system’s journey. Method This qualitative descriptive study draws on interviews with key stakeholders and on documents, such as local policy documents, project reports, meeting protocols and presentations. Co-production initiatives were defined as strategies, projects, quality improvement (QI) programs or other efforts, which included persons with patient experience and/or their next of kin (PPE). We used directed manifest content analysis to identify initiatives, timelines and methods and inductive conventional content analysis to capture lessons learned over time. Results The directed content analyses identified 22 co-production initiatives from 1997 until today. Methods and approaches to facilitate co-production included development of personas, storytelling, person-centered care approaches, various co-design methods, QI interventions, harnessing of PPEs in different staff roles, and PPE-driven improvement and networks. The lessons learned included the following aspects of co-production: relations and structure; micro-, meso- and macro-level approaches; attitudes and roles; drivers for development; diversity; facilitating change; new perspectives on current work; consequences; uncertainties; theories and outcomes; and regulations and frames. Conclusions Co-production evolved as an increasingly significant aspect of services in the RJC health system. The initiatives examined in this study provide a broad overview and understanding of some of the RJC co-production journey, illustrating a health system’s approach to co-production within a context of long-standing application of QI and microsystem theories. The main lessons include the constancy of direction, the strategy for improvement, engaged leaders, continuous learning and development from practical experience, and the importance of relationships with national and international experts in the pursuit of system-wide health-care co-production.

The initial aim of the roll out of smart electricity meters in Sweden was to allow remote readings of the households’ monthly electricity consumption for billing purposes. Since then the transition towards a smart grid has become a more prioritized matter. In the roll out of next generation smart meters more attention is therefore given to how the Distribution System Operator (DSO) can benefit from the meter through different smart grid applications. This study uses a qualitative research method to identify three general fields of application and 15 specific concepts corresponding to ways in which the DSO can create added value from the information provided by the smart meter. The benefits of one of these concepts, the so-called “last gasp” and “first breath” functionality, are assessed in a business case. The study concludes that the three main areas of smart meter applications are operating the grid, planning the grid and utility in the customers’ household. The study also shows that the outcomes of the business case on the “last gasp” and “first breath” functionality are highly dependent on the cost of the functionality, however the investment can still be motivated through increased customer satisfaction andimproved outage management. The general conclusion is that the smart meter will play an essential role in providing the control and information needed in the transition to a smarter grid.

The implementation of electronic patient records has over the years become an international issue, as is the challenge to reduce the number of medical errors. The use of electronic patient records ...

During the past decades, Geographic Information Systems (GIS) have been developed as a tool for managing spatial data. Under the right conditions, GIS can be a useful tool in the field of crisis management where private and public actors need to manage extensive flows of information. This master thesis aims to study how GIS is used in different parts of the risk and vulnerability analysis process. Specifically, the use of GIS and maps as support for decision making in operational crisis management is studied. The project also aims to study the prerequisites for the implementation and use of GIS in an organization for this purpose. The results partly show that technical challenges related to hard- and software are relatively simple to solve in comparison to those that are related to the organization and the staff.

Global exploration and production of minerals is increasingly located in areas populated by indigenous people. Conflicts that arise between multinational corporations and local activists and/or indigenous people are widespread while the understanding of such issues are still lacking. The Swedish government encouraging an expanding mining industry have caused great resistance, particularly due to the environmental and social implications, and above all with regards to the effects on Saami reindeer husbandry. The resistance to a mine in Kallak is based on the belief that the right to decide about the land historically fall on Saami people and the right to use the land is detrimental for the survival of Sami culture and the practice of reindeer husbandry. Even though the conflict might at first glance be perceived as a conflict concerning access to natural resources, I argue in this thesis that the perceived environmental conflict can be seen as part of a larger struggle over social status and recognition. This research combines insights from a number of different stakeholders in order to highlight how the establishment of a mine in Kallak is perceived by different stakeholders. Data have been collected using methods of observations, interviews and documents and then interpreted using coding and discourse analysis. The data have been analyzed using a meta-theoretical framework of justice as recognition and stakeholder analysis, using a typology of relations of power. The results of this thesis suggest that relations of power constitute some categories of social actors as normative and others as deficient. This can be shown particularly prominent in the way that more dominant stakeholders such as the government, the company and media have ‘more’ power, ‘different’ kinds of power and/or power ‘over’ other subordinated stakeholders such as the Saami population. Saami people are being misrecognized in a number of ways by other more dominant stakeholders. The struggle over a mine in Kallak can be understood as a struggle to overcome parity-impeding cultural norms. The findings in this thesis suggest that further investigation needs to be directed towards understanding the implications that the mining industry has on misrecognition of Saami stakeholders with a focus on making informed and suitable remedies. A more informed understanding of the politics of recognition can serve to broaden, concretizes and deepen the questing of the mining industry into a questioning of misrecognition of the Saami population.