| 1. |
- Westman, Anders, 1946-
(författare)
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Musculoskeletal pain in primary health care : a biopsychosocial perspective for assessment and treatment
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Long-term musculoskeletal pain is a large public health problem with serious consequences for both the individual and society. Psychosocial factors have been shown to be good predictors of long-term disability and play an important role in the transition from acute to chronic pain. Early identification and intervention of those that run the risk of developing long-term disability would offer a great opportunity for reducing costs and personal suffering. The overall aim of this thesis was to assess a biopsychosocial approach to the assessment and management of musculoskeletal pain patients in primary health care. To this end, biopsychosocial assessment and treatment methods were tested in two different populations of primary care patients suffering pain. Results indicated that improvements in quality of life and work capacity one year after early multimodal rehabilitation were basically maintained after five years. The most salient prognostic factors determining return to work were educational level and the individual’s perceived health (Study I). Psychosocial factors as measured by the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) were related to disability and perceived health three years after treatment for non-acute pain problems (Study II). The experimental group in the controlled multimodal pain rehabilitation programme had lower health care utilization and a reduced risk of using large amounts of medication after three years compared with the participants in the control group. However, there were no significant differences between the groups on variables such as work capacity, function, catastrophizing and pain (Study III). Distinct profiles of catastrophizing, fear-avoidance beliefs, and distress were extracted and meaningfully related to future sick leave and dysfunction (Study IV). Our findings provide support for the biopsychosocial model and highlight the importance of psychosocial factors in long-term outcome. The results underscore the need for early identification of patients at risk. Further, multimodal treatment that covers not only biological but also psychosocial factors seems to be a key to successful treatment, and ideally this intervention should be matched to the patients' needs.
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| 2. |
- Hult, Carl, 1953-, et al.
(författare)
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Timing of retirement and mortality : A cohort study of Swedish construction workers
- 2010
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Ingår i: Social Science and Medicine. - : Elsevier. - 0277-9536 .- 1873-5347. ; 70:10, s. 1480-1486
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Tidskriftsartikel (refereegranskat)abstract
- Recent studies indicate that early retirement per se may have a negative effect on health to such an extent that it increases mortality risk. One type of early retirement often referred to in these studies is retirement with disability pension/benefit. Given the overall objective of disability benefit programmes - to help the disabled live socially and economically satisfactory lives, freed from exposure to employment health hazards and thus avoid further declines in health - the finding is challenging. This paper examined the relationship between timing of retirement and mortality using a cohort of Swedish construction workers. The mortality risk of disability pensioners - excluding those with diagnoses normally connected to increased mortality - was compared with the risk of those continuing to work. Although initial indications were in line with earlier results, it became obvious that the increased mortality risk of disability pensioners did not depend on early retirement per se but on poor health before early retirement not explicitly recognized in the diagnosis on which the disability pension rested. The results indicate that there are no general differences in mortality depending on timing of retirement. Future studies of mortality differences arising from working or not working must sufficiently control for health selection effects into the studied retirement paths.
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| 3. |
- Sandström, Agneta, 1959-
(författare)
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Neurocognitive and endocrine dysfunction in women with exhaustion syndrome
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Stress has emerged as one of the most important factors to consider in psychiatric diagnoses and has become a common reason for long-term sick leave (LTSL). Roughly 50% of LTSL due to psychiatric diseases are thought to be associated with work-related stress. The demarcation towards major depression is disputed, and no international consensus exists for how to diagnose and rehabilitate these individuals. The Swedish National Board of Health has suggested the term “exhaustion syndrome” to integrate these individuals into stress-related disorders. Prominent features of this syndrome are fatigue, sleeping disorders, and cognitive dysfunction. The cognitive dysfunction may be due to an interaction between personality features, environmental factors, the biological effects of stress hormones, and dysfunction in key brain areas, notably the hippocampus and prefrontal cortex. A consistent feature of chronic stress is activation of the cortisol, or hypothalamic-pituitary-adrenal, axis, which may be linked to cognitive dysfunction. Increased glucocorticoid levels, mainly cortisol in humans, are known to impair memory performance. The aim of this thesis was to investigate whether patients with exhaustion syndrome exhibit specific alterations in an extensive set of biological, psychological and immunological variables. Patients in Study 1 had significant cognitive impairment for specific tasks assumed to tap frontal lobe functioning. In Study 2 anxiety prone, worrying, pessimistic individuals with low executive drive and a persistent personality type were more likely to develop exhaustion syndrome. Decreased reactivity was found on the pituitary level after corticotropin releasing hormone (CRH) in exhaustion syndrome patients. The cortisol/adrenocorticotropic hormone response to CRH was slightly higher in patients compared to controls, indicating increased sensitivity at the adrenal cortex level. No differences were found in hippocampal volume. In Study 3, functional imaging revealed a different pattern of brain activation in working memory tests in patients with exhaustion syndrome compared to healthy individuals and patients with depression. In summary, our data suggests an intimate link between personality and wellbeing, cognitive performance and neuroendocrine dysfunction, in exhaustion syndrome. We thus find similarities with major depression but also distinct differences between the exhaustion syndrome and major depression.
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| 4. |
- Lytsy, Per, et al.
(författare)
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Views on Treatment Necessity, Harm, and Benefits in Patients Using Statins
- 2010
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Ingår i: Medical decision making. - 0272-989X .- 1552-681X. ; 30:5, s. 594-609
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUNDPatients with dyslipidemia and high overall risk of ischemic heart disease are those most likely to benefit from treatment with statins. The objective of this study was to investigate patients' views of the necessity, harm, and expected benefits of their statin treatment, as well as factors associated with these treatment beliefs. One main objective was to investigate whether cardiovascular risk level and previous coronary heart disease affect the way patients view these different aspects of their medication.METHODSA total of 829 statin users were recruited while visiting a pharmacy to collect their statin medication (response rate, 69.4%). Patients returned a questionnaire assessing their medical history, concurrent risk status, social demographic factors, as well as their views and expectations regarding their statin treatment. RESULTS: Previous ischemic heart disease, or high risk of such disease, was not associated with a more favorable notion on statin treatment. Having an internal health locus of control as well as being satisfied with the physician's treatment explanation were factors associated with more positive views on expected treatment effect. The views on necessity, harm, and treatment benefit were closely associated with each other.CONCLUSIONThe main findings in this study suggest that cardiovascular risk level and previous coronary heart disease are not associated with the way patients value potential benefits of statin treatment. Patients' views of the treatment's necessity, harm, and benefits do not seem to be independent dimensions of patient beliefs but rather represent one overall question: is this good for me?
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| 5. |
- Brun Sundblad, Gunilla, et al.
(författare)
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Orka hela vägen : Upplevd hälsa, idrotts- och träningsbakgrund bland studenter på en fysiskt inriktad yrkesutbildning. Lärarstudenter GIH 2008 delrapport 1: 2009
- 2010
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Sammanfattning Ett sammanfattande porträtt av den nyantagna lärarstudenten vid GIH med utgångspunkt från enkätsvaren ger vid handen en bild av en person, som är ca 21 år gammal, född i Sverige och uppvuxen i en medelstor stad i Mellansverige. Studenten trivdes mycket bra i skolan och var som elev något över medel med MVG i idrott och hälsa. Valet av yrkesutbildning grundade sig på ett stort intresse för idrott, samt en önskan att få jobba med barn och ungdom. Studievalet hade för många påverkats av en tidigare idrotts-lärare, kompisar och familj. En bra lärare i idrott och hälsa är enligt studenten positiv, engagerad, rättvis, bestämd och kunnig. Lärarstudenten ser sig behärska bollspel väl. Störst kunskap och färdighet uppges i fot-boll och alpin skidåkning. Minst kunskap och färdighet skattades i softboll, baseboll, bergsklättring, långfärdsskridskoåkning och i konsten att kunna valla skidor. Många ser sig ha god kunskap om sambandet mellan hälsa, livsstil och miljö, men mindre god om hur en idrottsaktivitet har betydelse för kulturarvet, samband mellan miljö och männi-skans hälsa i ett historiskt och nutidsperspektiv samt i ergonomi. På sin fritid går lärarstudenten ofta på idrottsevenemang, café, tittar på TV och video eller umgås med vänner och familj. Lärarstudenten går sällan på bio och nästan aldrig på tea-ter, museum eller vernissager. "Vad är vernissage?" undrar en student. Hälsan, både fysiskt och psykiskt, skattas som tillfredsställande och man känner ofta hopp, glädje och meningsfullhet. Emellertid finner man sig även ofta stressad på grund av tidsbrist och alla krav. Många kvinnliga studenter (41%) rapporterade ryggont och många, både kvinnor och män, beskrev att de har besvär från en skadad fotled eller knä. De flesta lärarstudenterna är regelbundet fysiskt aktiva och de finner att mängden motion delvis är tillfredsställande. Förväntningarna är höga på utbildningen både att den är mångsidig och kommer att ge ökad kunskap inom olika områden. Under studietiden förväntar man sig att utvecklas och förbättra sin egen fysiska status och hälsa. En student uttrycker det med orden: "Mitt nya liv startar idag". Den sammanfattande bilden av lärarstudenten på GIH liknar den som tidigare har redovisats av Meckbach och Wedman i en liknande studie från maj 2005. Deras studie genomfördes på studenter efter ett års studier på GIH (Meckbach & Wed-man, 2007).
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| 6. |
- Sandström, Agneta, 1959-, et al.
(författare)
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Cognitive deficits in relation to personality type and hypothalamic-pituitary-adrenal (HPA) axis dysfunction in women with stress-related exhaustion
- 2011
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Ingår i: Scandinavian Journal of Psychology. - Oxford : Wiley-Blackwell. - 0036-5564 .- 1467-9450. ; 52:1, s. 71-82
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Tidskriftsartikel (refereegranskat)abstract
- Exhaustion caused by long-term work-related stress may cause cognitive dysfunction. We explored factors that may link chronic stress and cognitive impairment. Personality, psychiatric screening, and behavior were assessed by self-reporting measures in 20 female patients (mean age 39.3 years; range 26–53) with a preliminary diagnosis of stress-related exhaustion and in 16 healthy matched controls. Cognitive performance was investigated with a detailed neuropsychological test battery. Cortisol axis function was assessed by urinary and saliva collections of cortisol, dexamethasone suppression, Synacthen response, and corticotropin-releasing hormone (CRH) tests. Proinflammatory cytokines were measured. Hippocampal volumes were estimated by magnetic resonance imaging. Multivariate and univariate statistical methods were used to explore putative differences between groups and factors linked to cognitive impairment. Cognitive function clearly differed between groups, with decreased attention and visuospatial memory in the patient group, suggesting frontal cortex/medial temporal cortex-network dysfunction. Increased harm avoidance and persistence was present among patients, with lowered self-directedness linked to lower quality of life, increased anxious and depressive tendencies, and experiences of psychosocial stress. Attention was decreased with concomitantly impaired visuospatial memory. The pituitary (adrenocorticotropic hormone, ACTH) response to CRH was decreased in patients, with an increased cortisol/ACTH response to CRH. However, cortisol production rates, diurnal or dexamethasone-suppressed saliva cortisol levels, and the cortisol response to Synacthen were unaltered. Hippocampal volumes did not differ between groups. These findings suggest that cognitive dysfunction in stress-related exhaustion is linked to distinct personality traits, low quality of life, and a decreased ACTH response to CRH.
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| 7. |
- Ahlgren, Christina, et al.
(författare)
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Struggle for time to teach. Teachers experiences of their work situation.
- 2011
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Ingår i: Work. - 1051-9815 .- 1875-9270. ; 40:Suppl 1, s. 111-118
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The objective of this study was to from a gender perspective, explore elementary school teacher' experiences of their work situation, and identify conditions that could be health risks. Participants: Eighteen female teachers who work in an elementary school in Northern Sweden. Method: Thematic interviews were conducted using an interview guide. The interviews were tape-recorded and transcribed verbatim. Qualitative content analysis was used to analyse the transcribed text and interpretations were made within gender theory. Results: Four categories emerged: "Squeezed between dream and reality", "Effort to keep up with demands", "We can make it together" and "The school needs men's qualities". The categories were linked together with the theme "A struggle for time to teach". The theme describes the conflict between the teachers' ambitions to teach and create a stimulating learning environment versus the increased need for behaviour control that took time from classroom work. Beside work at the school, the teachers carried a large burden of domestic work.Conclusions: Teachers' work includes both endless demands and great joy. Their work is structured within the schools gender system in which caring duties are subordinated despite a growing demand for behaviour control. Traditional gender roles affect their domestic work load.
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| 8. |
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| 9. |
- Björkman, Ingeborg, et al.
(författare)
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Perceptions among Swedish hospital physicians on prescribing of antibiotics and antibiotic resistance
- 2010
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Ingår i: Quality and Safety in Healthcare. - : BMJ. - 1475-3898 .- 1470-7934 .- 1475-3901. ; 19:6, s. e8-
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore and describe perceptions of antibiotic prescribing among Swedish hospital physicians, with special reference to whether the perceptions included awareness of antibiotic resistance (AR). Design: A phenomenographic approach was used and data were collected in face-to-face interviews. Setting: Hospitals in seven different counties in central Sweden. Participants A strategic sample of 20 hospital physicians specialising in internal medicine, surgery or urology. Main outcome The variation of perceptions of antibiotic prescribing. Results: Five qualitative different perceptions were found. AR was considered in two of the perceptions. Reasons for not considering AR included a dominating focus on the care of the patient combined with lack of focus on restrictive antibiotic use, or uncertainty about how to manage infectious diseases or the pressure from the healthcare organisation. Parallels between the five perceptions and the stages in the transtheoretical model of health behaviour change were seen. Conclusions: In three of the perceptions, AR was not considered when antibiotics were prescribed. Physicians who primarily express these three perceptions do not seem to be prepared to change to restrictive prescribing. Our findings can be useful in designing activities that encourage AR prevention. Organisational changes are also needed.
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| 10. |
- Edvardsson, Kristina, 1973-
(författare)
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Health promotion in pregnancy and early parenthood : the challenge of innovation, implementation and change within the Salut Programme
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: In 2005, the Västerbotten County Council launched a child health promotion programme, “the Salut Programme”, in response to an alarming prevalence of overweight and obesity, and trends of increased dental caries, among young county citizens. The programme, initially developed in four pilot areas, is built on multidisciplinary and cross-sectoral collaboration and aims to support and strengthen health promotion activities in health care, social services and school settings. It targets children and adolescents (0-18 years of age) and their parents, and starts during pregnancy. This thesis focuses on interventions provided by antenatal care, child health care, dental services, and open pre-schools, directed to expectant parents and families with children aged 0-1 ½ years. Within the programme context, the aim was to explore socio-demographic patterns of overweight and obesity in expectant parents (Paper I), firsttime parents’ experiences of health promotion and lifestyle change during pregnancy and early parenthood (Paper II), professionals’ experiences of factors influencing programme implementation and sustainability (Paper III and IV), and early programme outcomes on professionals’ health promotion practices and collaboration following countywide dissemination and implementation (Paper IV). Methods and results: A population based cross-sectional study among expectant parents showed overweight and obesity in 29% of women (pre-pregnancy) and in 53% of men (n=4,352♀, 3,949♂). The likelihood for obesity was higher in expectant parents with lower levels of education, among those unemployed or on sick leave, and those living in rural areas. In 62% of couples, at least one of the partners was overweight or obese; a positive partner correlation was also found for BMI (I). An interview study with 24 first-time parents (n=12♀, 12♂) revealed that they primarily undertook lifestyle changes to secure the health of the fetus in pregnancy, and to provide a healthy environment in childhood. Parents described themselves as highly receptive to information about how their lifestyle could influence fetal health, and they frequently discussed pregnancy risks related to tobacco and alcohol, as well as toxins and infectious agents in foods. However, parents did not seem inclined to make lifestyle changes primarily to promote their own health. The antenatal and child health care services were perceived as being mainly directed towards women, and parents described a lack of a holistic view of the family which included experiences of fathers being treated as less important (II). An interview study undertaken with professionals (n=23) in the Salut Programme pilot areas indicated programme sustainability at most sites, two years after implementation, although less adherence was described within child health care. Factors influencing programme sustainability, as described by professionals, were identified at multiple organisational levels (III). A before-and-after survey among professionals (n=144) measured outcomes of the county-wide implementation of the Salut Programme in 13 out of 15 county municipalities. Results showed significant improvements in professionals’ health promotion practices and collaboration across sectors. A number of important implementation facilitators and barriers, acting at different organizational levels, were also identified via a survey comprised of open-ended questions (IV). Conclusion: The Salut Programme, developed with high involvement of professionals, and strongly integrated in existing organisational structures and practices, shows potential for improving health promotion practices and cross-sectoral collaboration. The findings can inform further development of the Salut Programme.as well as new health promotion initiatives, and inform policy practice and future research. These aspects include approaches in health promotion and prevention, father involvement during pregnancy and early parenthood, and factors influencing implementation and sustainability of cross-sectoral health promotion programmes.
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