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58 Research products, page 1 of 6

  • 2012-2021
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  • Closed Access English
    Authors: 
    Jespersen, Christian;
    Publisher: Syddansk Universitet. Det Samfundsvidenskabelige Fakultet
    Country: Denmark

    Afhandlingen analyserer i hvilket omfang Traktatfrihederne forpligter medlemsstaterne til at yde kompensation for underskud til koncerner og til selskaber med faste driftssteder. Afhandlingen er inddelt i otte kapitler. Afhandlingens kapitel 1 præsenterer emnet, problemformulering samt metode.Afhandlingens kapitel 2 introducerer emnet på medlemsstabsniveau. Dette kapitelintroducerer de udfordringer, som - på den ene side - den asymmetriske behandling af overskud og underskud og - på den anden side - de grundlæggende principper for beskatning skaber i relation til fradrag, som skaber et underskud. Herudover beskriver kapitlet de mest almindelige metoder, som anvendes for at yde underskudskompensation. Endelige beskriver kapitlet de udfordringer, som opstår i relation til underskudskompensation, når selskaber og koncerner udøver grænseoverskridende virksomhed. Afhandlingens kapitel 3-5 introducerer de fire friheder og redegør for, hvordan EU domstolen vurderer, om en national skattelovgivning er i uoverensstemmelse med en traktatfrihed. Kapitel 3 introducerer de fire traktatfriheder og redegør for traktatfrihedernes restriktionsbegreb, som dette fortolkes i relation til nationale regler på området for direkte beskatning. På grundlag af dette indledende kapitel uddyber kapitel 4 restriktionstesten, som består af henholdsvis ulempetesten of sammenlignelighedstesten, mens kapitel 5 uddyber justifikationstesten.Afhandlingens kapitel 6-7 analyserer EU-domstolens praksis vedrørende underskudskompensation. Kapitel 6 analyserer i hvilket omfang en medlemsstat er forpligtet til at yde kompensation for underskud lidt af koncerner i grænseoverskridende situationer. Dette afsnit analyserer således EU-domstolens praksis vedrørende horisontalekompensationsordninger samt underskudsanvendelse i forlængelse af en fusion. Kapitel 7 analyserer i hvilket omfang en medlemsstat er forpligtet til at yder kompensation for underskud lidt af et selskab med et fast driftssted. Dette afsnit analyserer EU-domstolens praksis vedrørende fradrag for underskud i det underskudsgivende indkomstår, fradrag for underskud i medfør af vertikale kompensationsordninger, genbeskatning af underskud som allerede er taget i betragtning og udskydelse af beskatning som følge af underskud. The thesis analyses to what extent the Treaty freedoms require the EU Member State to provide loss compensation to corporate groups and to companies with permanent establishments in the European Union. The thesis is divided into eight chapters. The first part of the thesis presents the subject, the research questions, the motivation for the choice of subject, delimitation and legal philosophy and methods.Chapter 2 introduces the subject on Member State-level. This chapter introduces the challenges that are caused by - on the one hand - the asymmetrical treatment of profits and loss and - on the other hand - the fundamental principles of taxation in respect of losses. This chapter further introduces the most common methods adopted in order to provide loss compensation. Finally, the chapter elaborates on the challenges that arise in relation to loss compensation when corporate groups and companies exercise cross-border activity.Chapter 3-5 introduces the four Treaty freedoms and explain how the European Court of justice examines whether a nation legislation on direct taxation violates a Treaty freedom. Chapter 3 introduces the four Treaty freedoms and explains how the European Court of Justice interprets the concept of restriction in respect of national legislation on direct taxation. On that basis, chapter 4 elaborates on the restriction test, which comprises the disadvantage test and the comparability test, while chapter 5 elaborates on the justification test.Chapters 6-7 analyses the case law of the European Court of Justice on loss compensation. Chapter 6 analyses to what extent the Treaty freedoms require a Member State to provide loss compensation to corporate groups in cross-border situations. This chapter analyses the case law on horizontal loss compensation schemes and national provisions providing for loss compensation in the context of a merger. Chapter 7 analyses to what extent a Member State is required to provide loss compensation to a company with a permanent establishment. This chapter analyses the case law concerning deductions of losses during the loss-making income year, deduction of losses by means of horizontal loss compensation schemes, reincorporation of losses previously deduction and the deferral of taxation as a consequence of losses.Chapter 8 contains the conclusion on the thesis. This chapter concludes to what extent the Treaty freedoms require the Member States to provide loss compensation to corporate groups in cross-border situations and to a company with a permanent establishment.

  • Closed Access English
    Authors: 
    Steinsdóttir, Herdís Guðlaug;
    Publisher: Syddansk Universitet. Det Naturvidenskabelige Fakultet
    Country: Denmark

    Metan er en drivhusgas 28 gange stærkere end CO2. De seneste års udvikling i atmosfæriskemetankoncentrationer har udfordret vores forståelse af det globale metankredsløb ogunderstreget behovet for at forbedre vores estimater af metakilder og optag. Kystnære zoner erbåde den største og mest usikre kilde af marint metan til atmosfæren, og til trods for at iltfattigekystnære zoner indeholder høje koncentrationer af metan, vides det ikke hvilke konsekvenserdette har for metanudslip til atmosfæren. Teoretisk set, er disse iltfattige miljøer ideelle foranaerob metanoxidation, men dog er denne proces og dets rolle i metanudslip aldrig blevetundersøgt i disse systemer. Da målinger viser at disse områder globalt bliver mere udbredte,dannede denne manglende viden motivationsgrundlaget for den her afhandling.Denne afhandling undersøger dynamikken, reaktionsvejene, samt de regulerendefaktorer af anaerob metanoxidation i to modelsystemer: den iltfrie Mariager Fjord, Danmark,og den kystnære iltsvindszone i Golfo Dulce, Costa Rica. Manuskript I beskriver hvordan densæsonmæssige udvikling af iltsvind i Mariager Fjord påvirker aktiviteten og sammensætningenaf metan-oxiderende organismer. Iltsvind førte til en stigning i metankoncentrationen ibundvandet til 1.4 µM, men udslip af metan til overfladen var forhindret af effektivmetanoxidation nær den iltede-iltfrie grænseflade. Metanoxidation foregik både aerobt oganaerobt med samme effektivitet, og var tilsyneladende udført af Deep Sea-1 stammen afMethylococcales, som ellers tænkes at være aerobe. Manuscript II og III beskriverreaktionsveje og dynamik af anaerob metanoxidation i iltsvindzonen i Golfo Dulce. Et treårigstudie beskrevet i Manuscript II målte vedvarende høje metankoncentrationer (op til 1.7 µM)og effektiv anaerob metanoxidation, der omsatte markante mængder af metan. OPU3 og DeepSea-1 af Methylococcales stod tilsyneladende bag omsætningen. Det højeste relative antal afbegge stammer forekom altid i det iltfrie bundvand og derved virkede de tilpasset til det iltfriemiljø. Da deres kapacitet for anaerob omsætning ikke er undersøgt og reaktionsvejene stadigvar ukendt, benyttede Manuscript III sig af metagenomics og specifikke rate forsøg til atudforske disse spørgsmål. Forsøg viste at metanoxidation sandsynligvis var koblet tildenitrifikation. Desuden fandt vi en niche-fordeling af tre Methylococcales stammer iiltsvindszonen, og baseret på vores analyse, hypotiserer vi at forskelle i evnen fordenitrifikation, iltrespiration, og motilitet er faktorer der opretholder deres tilstedeværelse ogaktivitet på forskellige dybder i iltsvindzonen. Samlet set, så har denne afhandling vist, atiltfattige kystnære zoner er områder med effektiv metanomsætning, og på baggrund af voresestimater, så bidrager det metan der ophober sig i disse zoner ikke betydelig til regionensmetanudslip til atmosfæren. Contemporary dynamics in atmospheric concentrations of methane – a major regulator of global climate – have challenged our understanding of the global methane cycle, stressing the need for refining global methane sources and sinks. Coastal and shelf waters constitute the largest and most uncertain term in the marine methane emission budget, and while oxygen-depleted coastal waters contain particularly high concentrations of methane, little is known about their effect on emissions. In theory, these anoxic methane-rich waters also constitute ideal niches for anaerobic methane oxidation, yet this process and its potential role in flux mitigation has still not been explored in these systems, which in light of their predicted expansion is the knowledge gap motivating this thesis.This thesis studies the dynamics, pathways, and controls of anaerobic methane oxidation in two model systems: the seasonally anoxic Mariager Fjord, Denmark, and the coastal oxygen minimum zone (OMZ) of Golfo Dulce, Costa Rica. Manuscript I describes how the seasonal development of anoxia in Mariager Fjord influences the activity and community composition of methanotrophs. Methane accumulated to as much as 1.4 µM in anoxic bottom waters, yet its flux to surface waters was mitigated by efficient methane oxidation near the oxic-anoxic interface. This activity could be conducted both aerobically and anaerobically with near equal efficiency and was most likely mediated by the putatively aerobic Methylococcales of the Deep Sea-1 clade. Manuscript II and III describe pathways and long-term dynamics of anaerobic methane oxidation in the Golfo Dulce OMZ. In Manuscript II, a three-year study found stable, high concentrations of methane (up to 1.7 µM) and efficient anaerobic methane oxidation in the OMZ core, the latter constituting a substantial methane sink. Here, OPU3 and Deep Sea-1 clades of the Methylococcales were the most likely conveyors. Both clades always peaked in relative abundance in the OMZ core, indicating an adaptation to the anoxic environment. With their potential for an anaerobic metabolism unexplored and the methane oxidation pathway still elusive, Manuscript III used metagenomics and targeted rate and inhibitor experiments to address these knowledge gaps. Here, we showed that anaerobic methane oxidation was likely linked to denitrification. In addition, we resolved a niche partitioning of three Methylococcales lineages (ecotypes) in the OMZ, and based on functional analysis, we hypothesize that differences in capacity for denitrification, oxygen respiration, and motility sustain their presence and activity at different depths in the OMZ. Overall, this thesis has shown that oxygen-depleted coastal waters are environments with efficient methane turnover, and based on our estimates, the methane accumulating there does not influence regional atmospheric methane emissions.

  • Other research product . Other ORP type . 2021
    Closed Access English
    Authors: 
    Rotbain, Emelie;
    Publisher: Syddansk Universitet. Det Sundhedsvidenskabelige Fakultet
    Country: Denmark

    Kronisk lymfatisk leukæmi (CLL) er en kræftsygdom i blod, lymfeknuder, milt og knoglemarv. Omkring 450 personer får stillet diagnosen CLL årligt i Danmark. De fleste har ikke symptomer på sygdom ved diagnosen og har derfor ikke behov for behandling. Mange for dog behandlingsbehov i løbet af de efterfølgende år. Der findes flere former for behandling for CLL: kemoterapi, immunterapi og nye målrettede behandlinger. Valg af behandling afhænger af patientens alder, andre kroniske sygdomme (komorbiditeter), prognostiske faktorer, patientens eget ønske og tidligere behandling. I denne afhandling præsenteres fire studier, der undersøger behandling, overlevelse, brug af sundhedsydelser og komorbiditet hos patienter med CLL. Studierne er baseret på information fra danske nationale register og journaloplysninger.I studie I undersøgtes overlevelse og behov for fornyet behandling for patienter med CLL henholdsvis med og uden somatiske hypermutationer i immunglobulingenets tunge kæde (IGHVstatus), og afhængig af type af behandling. Studiet viste at det gik bedre for patienter, der havde muteret IGHV-status og at patienter, der fik intensiv behandling med kemoimmunterapi, havde en god overlevelse.Studie II omhandlede betydningen og hyppigheden af 11 forskellige komorbiditeter hos patienter med CLL. Over en tredjedel af patienterne havde en eller flere komorbiditeter, når de fik stillet CLL diagnosen. Alle komorbiditeter i studiet var forbundne med en dårligere overlevelse.I studie III undersøgte vi en ny metode for at evaluere betydningen af komorbiditet: CLL komorbiditetsindeks. Patienter blev kategoriseret som havende lav, mellem og høj risiko baseret på tilstedeværelsen af: sygdomme i den øvre del af mave-tarmsystemet, karsygdomme og endokrinologiske sygdomme. Studiet viste at scoren i CLL komorbiditetsindeks var associeret med overlevelse og med behov for behandling.Brug af sundhedssystemet blev undersøgt i studie IV, hvor vi fandt at patienters forbrug af sundhedsydelser steg, efter at de fik stillet CLL diagnosen. Sundhedsydelserne inkluderede besøg på hospital og anvendelse af receptpligtig medicin. Patienter med komorbiditeter, havde et større forbrug af sundhedsydelser end patienter uden. Chronic lymphocytic leukemia (CLL) is a cancer of the blood, secondary lymphoid tissue (lymph nodes, spleen) and bone marrow. Approximately 450 individuals are diagnosed with CLL yearly in Denmark. Most newly diagnosed CLL patients do not have any symptoms, and therefore do not need treatment at the time of diagnosis. However, many patients with CLL require therapy during the following years. There are several types of treatment for CLL including chemotherapy, immunotherapy, and targeted agents, and the choice of treatment depends on age, other chronic conditions (comorbidities), prognostic factors, patient preferences, and previous treatment.This thesis includes four studies of different aspects of treatment, survival, use of the healthcare system, and comorbidity for patients with CLL. All studies are based on data from Danish nationwide registers and some also include data from patient records.In study I, variation in survival and need for renewed treatment in patients by the prognostic factor immunoglobulin variable heavy chain (IGHV) mutational status and by type of treatment was studied. The results showed that patients receiving intensive chemoimmunotherapy generally had a long survival and that patients with mutated IGHV had a superior prognosis. Next, in study II, the importance of 11 different comorbidities in CLL was examined. Over a third of all patients with CLL had one or more comorbidity at diagnosis of CLL and all comorbid conditions were associated with a shorter survival. In study III, using the new CLL comorbidity index, patients were categorized as low, intermediate, or high risk based on the presence or absence of three types of comorbidities: upper gastrointestinal disease, vascular disease, and endocrinological disease. The results showed that the CLL comorbidity index was associated with survival and treatment outcomes in patients both at diagnosis and at first treatment.Finally, in study IV, use of the healthcare system was studied in terms of hospital and emergency room admissions, out-patient clinic visits, and use of prescription drugs. The study showed that patients had an increased healthcare utilization after diagnosis of CLL and that patients with comorbid conditions used the healthcare system more than patients without comorbidities.

  • Other research product . Other ORP type . 2021
    Closed Access English
    Authors: 
    Thomasen, Rikke Scheel;
    Publisher: Syddansk Universitet. Det Naturvidenskabelige Fakultet
    Country: Denmark

    Der er en stigende interesse for alternativ behandling af patogene infektioner i både i forskningsverdenen og i samfundet grundet antibiotika resistensudviklingen samt mangel på effektiv behandling mod nogle bakterielle infektioner. I årtier har frie fedtsyrer (FFS) været kendt for at have antimikrobiel aktivitet mod adskillige bakterier. For nyligt blev det opdaget at FFS kan have en anti-virulent aktivitet mod nogle bakterier, hvilket har øget interessen forat undersøge FFS som anti-virulente agenter mod bakterielle infektioner.Her undersøger vi hvordan FFS genererer et antimikrobielt og anti-virulent respons i patogene bakterier, mere specifikt den fødevare bårne bakterie Listeria monocytogenes, som er kendt for at have en høj døds rate på trods af antibiotika behandling. Tidligere blev det vist at FFS med antimikrobiel aktivitet mod L. monocytogenes kan inhibere aktiviteten af virulensregulatoren PrfA. Den hæmmende effekt på PrfA’s aktivitet reducerer ekspressionen virulensgener og medfører dermed et anti-virulent respons i bakterien. Eftersom vi indtil videre kun havde detekteret FFS med begge eller ingen af de to effekter, begyndte vi atspekulere på der kunne være en kobling imellem de to aktiviteter. Vi undersøgte derfor om der er et link imellem de to aktiviteter, samt de underliggende mekanismer for den antimikrobielleog anti-virulente effekt. Vores data indikerer klart at der ikke er nogen kobling imellem FFS´ antimikrobielle og anti-virulente effekt. Endvidere detekterede vi FFS med kun anti-virulentaktivitet, hvilket understøtter at der ikke er noget link imellem to effekter. I forhold til det antimikrobielle respons mod FFS, så viser vores data at både transskriptionsregulatoren Catabolite control protein A (CcpA) og N-acetylglucosamin (GlcNAc) glykosylering afteikoidsyrer i cellevæggen bidrager til sensitivitet mod FFS. Under konstant påvirkning af to forskellige antimikrobielle FFS opstod der mutationer i enten ccpA eller det gen som er involveret i GlcNAc glykosylering, hvilket resulterede i øget FFS tolerance. Tolerancen opstod på baggrund af en mere hydrofil overflade, hvilket fremmer at FFS frastødes den bakterielle overflade. For den anti-virulente aktivitet så vi at de anti-virulente FFS kunne binde direkte til PrfA in vitro og hæmme PrfAs aktivitet. Denne hæmning reducerer ekspressionen af virulensgenerne in vivo. Eftersom der ikke er et link imellem den antimikrobielle og antivirulente effekt, viste vi at til trods for resistens udvikling imod det antimikrobielle aktivitet vil bakterierne forblive sensitive overfor det anti-virulente effekt. Dette indikerer at FFS kunnevære et godt bud på en behandlings metode til trods for resistens udvikling. An increased interest for alternative treatment options against bacterial infections is arising in both research and society due to antibiotic resistance development and lack of sufficient treatment against some bacterial infections. Free fatty acids (FFAs) have been known for decades to have antimicrobial properties against multiple bacterial pathogens. Recently, it was discovered that FFAs could have anti-virulent properties against some pathogens, which increased the interest for studying FFAs as potential anti-virulent agents against bacterial infections. Here we examine how FFAs can cause an antimicrobial and anti-virulent response in pathogens, more specifically the foodborne pathogen Listeria monocytogenes, which presents a high fatality rate despite antibiotic treatment. Previously, it was observed that FFAs with antimicrobial properties against L. monocytogenes could inhibit the activity of the major virulence regulator PrfA. The inhibition of PrfA activity reduces virulence gene expression andresults in an anti-virulent effect. Since only FFAs with both or neither of the effects have been detected so far, we speculated if the antimicrobial and anti-virulent activities of the FFAs couldbe linked. We specifically investigated a link between the two activities and the underlying mechanisms of the antimicrobial and anti-virulent effect. Our data clearly indicate that there isno obvious link or connection between the antimicrobial and anti-virulent effect of FFAs on L. monocytogenes. Additionally, FFAs with only anti-virulent properties were detected, supporting that the two activities are not linked. For the antimicrobial response to FFAs, our data reveal that both the transcriptional regulator Catabolite control protein A (CcpA) and Nacetylglucosamine (GlcNAc) glycosylation of wall teichoic acids confer sensitivity towards antimicrobial FFAs. Upon constant exposure to two different antimicrobial FFAs, mutations occurred in ccpA or the gene coding for GlcNAc glycosylation, which led to FFA tolerance. The tolerance occurred based on a more hydrophilic surface, which repulsed the FFAs from the bacterial surface. For the anti-virulent activity of the FFAs, we showed that anti-virulent FFAscould bind directly to PrfA in vitro and inhibit PrfA activity. This inhibition reduces the virulence gene expression in vivo. Altogether, since the antimicrobial and anti-virulent effects of the FFAs are not linked, we show that despite resistance development towards the antimicrobial effect of the FFAs strains stay sensitive towards the anti-virulent activity of the FFAs. This indicatesthat FFAs could be potent treatment compounds despite resistance development.

  • Other research product . Other ORP type . 2021
    Closed Access English
    Authors: 
    Mellupe, Renata;
    Publisher: Syddansk Universitet. Det Samfundsvidenskabelige Fakultet
    Country: Denmark

    Forskning i, hvordan stressfaktorer i forbindelse med udfordringer og hindringer påvirker performance, er vokset stærkt frem i litteraturen om organisatorisk stress. Vores forståelse af de mekanismer, som kan forklare disse effekter, er dog stadig begrænset. Denne artikelbaserede afhandling, som tager afsæt i udfordrings-/hindrings stressmodellen og transaktionsteori omkring stress, behandler i tre forskningsartikler spørgsmålet om, hvordan stressfaktorer påvirker performance ved at undersøge underliggende kognitive mekanismer og faktorer, som er relateret til disse effekter. Den første artikel har fokus på, hvordan udfordrings- og hindringsvurdering bidrager til vores forståelse af sammenhængen mellem stressfaktorer og performance. Artiklen præsenterer en oversigt over empiriske resultater, og stiller de studier, som måler vurderinger og de studier, der ikke tager vurderinger med i betragtning op overfor hinanden. Den konkluderer, at måling af vurderinger giver et mere detaljeret billede af sammenhængene mellem stressfaktorer og performancerelaterede resultater. Den anden artikel beskriver et præregistreret eksperimentelt studie, som har undersøgt virkningen af stressfaktorens styrke (opgavesværhedsgrad) på udfordrings-/hindringsvurderinger og performance af en krævende kognitiv opgave. Studiet fandt en ikke-lineære effekt af opgavesværhedsgrad på udfordringsvurderinger, mens effekten på hindringsvurderinger var lineær. Samtidig bekræfter det hindringsvurderingens medierende rolle i sammenhængen mellem opgavesværhedsgrad og performance. Den tredje artikel beskriver to studier. Studie 1 er et præregistreret eksperiment, som udforsker, hvilken rolle tidligere erfaringer og feedback spiller i det dynamiske stressforløb. Artiklen fokuserer især på, hvordan opgaveperformance, vist som en sideløbende performance feedback (dvs. simultan præsentation af opadgående social sammenligning og objektiv feedback) medierer ændringer i udfordrings- og hindringsvurderinger. Studie 1 underbygger delvist dets hypoteser om indirekte effekter. Studie 2 bygger på Studie 1 og anvender derudover eye-tracking til at undersøge sammenhængene mellem udfordrings-/hindringsvurderinger og opmærksomhed på de to nævnte aspekter af sideløbende feedback for at kaste lys på hvilke opmærksomhedsprocesser, der ligger bag de effekter, der blev fundet i Studie 1. Studie 2 er i øjeblikket i gang med dataindsamling og er ikke afsluttet på grund af COVID-19-inducerede restriktioner på laboratoriet. Denne afhandlings overordnede resultater anbefaler en gentænkning af den nuværende forståelsesramme for udfordrings-/hindrings stressmodellen ved at åbne for en mere kompleks konceptualisering af sammenhængen mellem stressfaktorer og performance i organisationer. Research on the effects of challenge and hindrance stressors on performance is burgeoning in organizational stress literature. Nevertheless, our understanding of the mechanisms explaining these effects is still limited. Grounded in the challenge-hindrance stressor framework and the transactional theory of stress, this article-based dissertation addresses the question of how stressors produce their effects on performance by investigating the underlying cognitive mechanisms and factors associated with these effects in three research papers. Specifically, to understand how challenge and hindrance appraisals contribute to our understanding of the stressor-performance link, the first paper presents a review of the empirical findings that contrasts the studies that measure appraisals with those that do not consider appraisals. It finds that measurement of appraisals offers more refined picture of the relationships between the stressors and performance-related outcomes. The second paper conducts a pre-registered experimental study to investigate the effects of the magnitude of a stressor (task difficulty) on challenge and hindrance appraisals and performance in a demanding cognitive task. It finds the non-linear effects of task difficulty on challenge appraisals, while the effects on hindrance appraisals were linear. In addition, it provides support for the mediating role of the hindrance appraisals in the task difficulty-performance relationships. The third paper consists of two studies. Study 1 carries out a pre-registered experiment to explore the role of prior experience and feedback in the dynamic stress process. Specifically, it examines how task performance, provided as in-task concurrent feedback, i.e., simultaneous presentation of upward social comparison and objective feedback, mediates change in challenge and hindrance appraisals. Study 1 finds partial support for the hypothesized effects. Study 2 examines the underlying effects found in Study 1 and employs eye-tracking to explore the associations between challenge and hindrance appraisals and attentional focus on the two elements of the in-task concurrent feedback to shed light on attentional processes. Study 2 is currently in the process of data collection and is not completed due to COVID-19 induced restrictions on the laboratory. The overall results of this dissertation encourage rethinking the existing state of the challenge-hindrance stressor framework by inviting a more complex conceptualization of the stressor-performance association in organizations.

  • Other research product . Other ORP type . 2021
    Closed Access English
    Authors: 
    Radl-Karimi, Christina Mathilde;
    Publisher: Syddansk Universitet. Det Sundhedsvidenskabelige Fakultet
    Country: Denmark

    Samskabelse er et lovende koncept for meningsfulde og autentiske partnerskaber mellem patienter og sundhedsprofessionelle. Samskabelse er et alternativ til markedsproduktion af offentlige ydelser og argumenterer for, at velfærd altid skabes i et fællesskab af borgere og offentligt ansatte. I forbindelse med sundhedsvæsenet betyder det, at sundhedsydelser altid er et resultat af et samarbejde mellempatienten og sundhedspersonalet. Konceptet har stor betydning for patienter med minoritetsbaggrund, som oplever begrænset adgang til sundhedsydelser og begrænset inddragelse i egen sundhed, og dermed risikerer at modtage behandling af lavere kvalitet. Der er begrænset viden, om disse patienter bedre kan bidrage med deres egne erfaringer og ressourcer i deres forløb. Denne afhandling præsenterer anvendelig viden om, hvordan patienter med minoritetsbaggrund og sundhedsprofessionelle kan samskabe patientens sundhedstiltag og derved forbedre patientens sundhed. Studie I er et systematisk scoping review der afdækker facilitatorer for samskabelse med patienter med minoritetsbaggrund. Studiet viser, at patienterne er værdifulde informanter og kompetente partnere i deres eget behandlingsforløb, når sundhedsvæsenet og de sundhedsprofessionelle er ”klædt” på til dette. I to kvalitative studier undersøgte vi sundhedspersonalets (studie II) ogpatienternes oplevelser (studie III) af samskabelse i en tværfaglig indvandrermedicinsk klinik. Studie II bygger på deltagerobservationer, interviews og fokusgrupper med sundhedspersonalet, og viser, at fleksibilitet og tværfaglig sparring gør det muligt for personalet at finde løsninger, der giver mening for patienten. Kommunikationsværktøjer, tilpasset patienters behov, gør, at sundhedspersonale lytter og skaber et trygt rum baseret på tillid og empati. Denne tryghed er en nødvendighed for fælles beslutningstagen. Relationel kontinuitet i sundhedsforløbet styrker samskabelse, men indebærer ogsåen risiko for at patienter bliver følelsesmæssigt afhængige af personalet. Studie III, baseret på kvalitative interviews viste, at patienter, der føler sig trygge, er mere tilbøjelige til at åbne op ogindtage en mere aktiv rolle i deres behandlingsforløb. En stærk relation støtter patienter i at tage ansvar for deres egen sundhed.Set fra et samskabelsesperspektiv blev det tydligt, hvor meget en vellykket sundhedsydelse afhænger af samarbejdet og tid mellem patient og sundhedspersonale. Når begge bidrager med deres ressourcer i form af levet erfaring og faglig ekspertise skabes der værdi for patienten. Vores resultater understreger behovet for organisatorisk fleksibilitet i daglig praksis, hvor medfølelse og venlighed 14 over for forskellige patientpopulationer er afgørende. Ligeledes er det vigtigt at kunne acceptere densårbarhed, der opstår ved at møde kompleksitet og tvetydighed i den kliniske hverdag. For at fremme samskabelse bør fremtidig forskning undersøge validiteten af vores fund i forskellige sundhedsfaglige kontekster og med forskellige grupper af patienter og fagfolk. Ydermere bør det undersøges, hvilke langsigtede effekter samskabelse har på patienter med minoritetsbaggrund og deres sundhed og trivsel. Endelig kan disse patienter med deres livsoplevelser bidrage til forbedring og co-design initiativer for yderligere at forbedre patienters og fagpersoners oplevelser. The concept of coproduction holds great promise for meaningful and genuine partnerships between patients and health professionals. According to coproduction, services are, unlike goods, always coproduced by a user and a public service provider. Coproduction is especially important for immigrants, who experience limited access and involvement in their healthcare and are at risk of receiving lower quality of care. However, research on how immigrants can use their own experience and expertise to participate in the coproduction of health is scarce. This thesis provides practical insights into how health professionals and immigrant patients can coproduce to create better health from healthcare services.The systematic scoping review on facilitators for coproduction (Study I) showed that immigrant patients can be a valuable source of information and powerful coproducers of their own health if the healthcare organization and frontline health professionals prepare for it. In the two qualitative studies, we explored health professionals’ (Study II) and immigrant patients’ (Study III) experiences with coproduction at an interdisciplinary outpatient clinic for immigrants and refugees. Study II, from participant observations, interviews, and focus groups, showed that leadership-supported flexibility and interdisciplinary support enabled health professionals to find sensible solutions for each patient. Communication tools designed around patient needs guided health professionals in listening and creating a safe space built on trust and empathy. This safe space was essential for shared decisions about care. Relational continuity strengthened coproduction but also bore risks of emotional dependency. Study III, based on qualitative interviews with immigrant patients, showed that mutual trust and feeling safe encouraged immigrant patients to open up and take a more active role in the coproduction of their health. A strong therapeutic relationship enabled them to become agents of their own health.Using a coproduction lens, we recognized that creation of a service requires time and that the patient and the health professional to work together. They contribute their resources of lived experience and professional expertise in coproducing healthcare services and thus value for the patient. Our findingshighlight the need for flexibility in daily practice, for compassion and kindness for diverse patient populations, and for accepting vulnerability arising from the complexity and ambiguity of clinicalpractice and of life.To move coproduction forward, future research should investigate the validity of our findings in different settings with different groups of patients and professionals. Further, long-term effects of healthcare coproduction on immigrant patients’ health and well-being should be studied. Finally, immigrant patients can contribute with their lived experiences to improvement and codesign initiatives to further improve the experiences of care for patients and professionals.

  • Closed Access English
    Authors: 
    Thise Pedersen, Jette; Thomsen, Gitte;
    Country: Denmark
  • Other research product . Other ORP type . 2021
    Closed Access English
    Authors: 
    Rasmussen, Torben Valdbjørn; Hessing-Olsen, Torben;
    Publisher: BARK
    Country: Denmark

    Bygtropolis er en tværfaglig podcast med og til bygeriet omhandlende branchens fælles spørgsmål - og svar!Er damspærrer lavet af genbrugsplast lige så effektive som dem, der laves konventionelt af ren jomfruelig plast? Det satte seniorforsker Torben Valdbjørn Rasmussen sig for at undersøge - for tænk på potentialet, hvis vi kan lave holdbare byggematerialer af al den plast, der ellers forurener vores omgivelser. Efter indkøb af utallige ruller af de allermest anvendte dampspærrer i Danmark, efter kemiske forsøg på Nationalmuseet og mekaniske test på Teknologisk Institut når seniorforskerne frem til et meget overraskende resultat... Faktisk så overraskende, at det må overbringes til DI Dansk Byggeri for at få en kommentar fra branchen selv.

  • Other research product . Other ORP type . 2021
    Closed Access English
    Authors: 
    Dokkedahl, Sarah Bøgelund;
    Publisher: Syddansk Universitet. Det Sundhedsvidenskabelige Fakultet
    Country: Denmark

    Partnervold er et folkesundhedsproblem, som kan have alvorlige psykiske konsekvenser. Vi har som samfund et ansvar for at forebygge denne vold og beskytte dens ofre. I et forsøg på at bidrage med ny viden fokuserer denne afhandling på psykisk vold og hvordan denne undertype af vold skal forstås ud fra et traumeperspektiv. Afhandlingen fokuserer også på kvindekrisecentre, og på hvordan vi kan evaluere sådanne interventioner ud fra et mentalt helbredsperspektiv.To sideløbende undersøgelser blev gennemført. Den første undersøgelse benyttede et prospektivt design og undersøgte 150 kvinder fra fire danske kvindekrisecentre. Den anden undersøgelse var et systematisk litteraturstudie, som benyttede sig af metaanalyser for at studere sammenhængen mellem psykisk vold og en række psykiske konsekvenser, fx posttraumatisk stressforstyrrelse (PTSD), depression og angst. Den metodiske fremgangsmåde og resultaterne diskuteres i relation til hinanden og til den nuværende viden, som vi har på området.Resultaterne demonstrerer alvoren ved psykisk vold og indikerer, at denne form for partnervold bør ankerkendes som en traumatisk begivenhed på lige fod med fysisk og seksuel vold. Forskning i psykisk vold er dog generelt kendetegnet ved adskillige metodiske mangler, og man bør derfor have begrænset tiltro til resultaterne. Evalueringen af disse resultater peger på, at der er behov for mere forskning, før vi kan drage en endelig konklusion.Kvinderne på de fire danske krisecentre udviste et højt niveau af PTSD og Kompleks PTSD ved indskrivning. Der blev rapporteret et højt antal af nye episoder af vold under opholdet og kvinderne havde generelt meget lange ophold. Selvom at der blev rapporteret et signifikant fald i symptomer ved opfølgning, så var der en undergruppe af kvinder, der stadig udviste traumesymptomer ved opfølgning. Den følgende afhandling vil diskutere de kliniske implikationer af disse fund. Intimate partner violence (IPV) is a public health problem that can have severe mental health consequences. As a society, we have a responsibility to prevent and protect victims from this type of abuse. To contribute to the current state of knowledge, this dissertation focuses on psychological violence and how we should understand this type of IPV from a trauma perspective. A second focus is the women’s shelter intervention and how we can evaluate this type of intervention from a mental health perspective.Two simultaneous studies were conducted; A prospective study with 150 women taking residence at four Danish women’s shelters; and a systematic review with meta-analyses addressing the association between psychological violence and a variety of mental health problems, e.g., Posttraumatic Stress Disorder (PTSD), depression and anxiety. The applied methodology and the results are presented here and discussed in relation to each other and the current state of knowledge.Findings demonstrate the gravity of psychological violence and suggest that this type of violence should be considered a traumatic event, equal to physical and sexual IPV. However, research on psychological violence is often characterized by numerous methodological shortcomings, which limits our confidence in the results. The evaluation of these results indicate that more research is needed before we can draw any final conclusions.The women in the four Danish women’s shelters exhibited a high level of PTSD and Complex PTSD symptoms at enrolment. Revictimization was high during residency and the women stayed at the shelters for a prolonged period of time. Although the women reported a significant symptom decline at follow-up, a substantial subgroup of the women continued to exhibit trauma symptoms. The following dissertation will discuss the clinical implications of these findings.

  • Other research product . Other ORP type . 2021
    Closed Access English
    Authors: 
    Christensen, Steffan Wittrup McPhee; Jull, Gwendolen; Palsson, Thorvaldur;
    Publisher: IASP Press
    Country: Denmark
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