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| 2. |
- Andersson, H. Ingemar, 1950-
(author)
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Chronic pain : epidemiological studies in a general population
- 1998
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Doctoral thesis (other academic/artistic)abstract
- The aim was to study the epidemiology of chronic pain (> 3 months duration) and factors associated to pain prevalence, prognosis, health care and medication in a general population. A cross-sectional mailed survey to a random population sample (n = 1806) was followed by a clinical examination and a prospective study of three selected groups. Pain related diagnoses from primary health care was monitored and compared with pain prevalence. The most important findings were: - a high total prevalence of chronic pain, 55.2%, without gender difference but varying by age and socioeconomic level. About one fourth (12.8%) reported high pain intensity and functional impairments. Women experienced pain at more locations and with higher intensity. - in a multivariate analysis increasing age, female gender, low education, high work strain, depression and insomnia were associated with chronic pain. - widespread pain showed a worse 2- year prognosis compared with neck shoulder pain. - musculoskeletal location of pain dominated, myalgia and myofascial pain being the most common symptom descriptions. - co-morbidity with chronic pain was common. More hypertensives and an increased level of serum uric acid associated to widepread pain indicated possible metabolic connections to pain. - smoking (current and previous) was associated with low-back and widespread pain. - chronic pain had a substantial influence of primary health care-seeking and medication; high pain intensity being the most important predictor of care and medication. - pain related diagnoses in primary health care increased between 1987 and 1996. Chronic pain, mainly with musculoskeletal location, is a community health problem. A multi-factorial approach in prevention and treatment on the basis of present knowledge is necessary.
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| 3. |
- Sollerhed, Ann-Christin, 1954-
(author)
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Young today - adult tomorrow! : studies on physical status, physical activity, attitudes, and self-perception in children and adolescents
- 2006
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Doctoral thesis (other academic/artistic)abstract
- The aim was to gain knowledge of young people's physical status and physical activity, and to further the understanding of the role of school physical education in a salutogenic public health perspective. Two studies were performed in southern Sweden. Study 1 was performed in 1996 among 301 adolescents aged 16-19 in upper secondary school. It comprised three parts: a questionnaire, seven physical tests, anthropometrical measures and information on every student's grades. Study 2, with a longitudinal design and annual measurements, was performed in 2000-2003 (n=205- 275) among children aged 6-12 in two primary schools, one intervention school with expanded physical education lessons, and one norm school which followed the stipulated curricular time. The study comprised a questionnaire, eleven physical tests and anthropometrical measures. In Study 1, students in practical education for occupations such as industrial and building workers, mechanics, assistant nurses and hairdressers, all of which are occupations involving physical effort, had lower physical capacity than students in theoretical education among both boys and girls. A correlation was found between physical capacity and grades. An interrelation between Sense of Coherence (SOC) and attitudes to physical education was found, indicating that past experiences of physical activity and physical education could contribute to the development of SOC, and actual levels of SOC could influence the persistent attitudes to physical education and be important for lifelong physical activity. Study 2 showed high self perceived competence in physical education among children to be associated with high physical performance, male gender, low age, living with both parents, high self perceived physical fitness and enjoying physical education. Children who followed an expanded physical education programme during the three-year follow up showed positive changes in physical performance compared to children in the norm school. The number of children with increasing body mass index (BMI) rose in both schools, but a lower increase in BMI could be seen in the intervention school. In both Study 1 and 2, the highest physical capacity was found among children and adolescents who reported a high level of physical activity in leisure time. This thesis shows it is possible to achieve improvement in physical status among young people with an increase of physical education lessons in school. Differences in physical capacity between prospective blue-collar and white-collar workers already in adolescence during education emphasize the need for early interventions to increase physical activity and capacity in young people. Physical education in the school setting could be seen as an important arena for improving physical capacity, positive self-perceptions and positive attitudes to physical activity, which could be important for public health.
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| 4. |
- Samarasinghe, Kerstin, 1950-
(author)
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Facilitating a healthy transition for involuntary migrant families within primary health care
- 2007
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Doctoral thesis (other academic/artistic)abstract
- The refugee families face a complex transition due to the nature of the migration. This exposes them to vulnerability in cohesion and family function. Primary Health Care Nurses (PHCN) and Interpreters in Primary Health Care (PHC) play a vital role in their promotion of health because migrant health care is mainly carried out within PHC. The overall aim of this thesis was to reach a comprehensive understanding of involuntary migrant family health in order to facilitate a healthy transition for the aforementioned families in Sweden from a systems perspective. These findings are based on interviews representing 16 members from ten families from the Balkans, Kurdistan and Africa (study I), 34 PHCNs (study II & III) and ten Interpreters working within PHC and originating from the same countries as the families (study IV). This study was carried out in two municipalities in Sweden. Contextual analysis with reference to phenomenography was used in interpreting the data in studies I-III. A qualitative method and contextual analysis was used in study IV. The Neuman Systems Model was used to unravel environmental influences in all the four studies. The findings of study I & II illustrate the families’ transition experience through four different family profiles respectively describing the families’ wellbeing: A distressed family living under prolonged tension; a contented family who leads a satisfactory life; a frustrated family who cannot lead a fully satisfactory life and a dejected family who feels deserted (study I). Further, a mentally distressed family within the asylum-seeking process; an insecure family with immigrant status; a family with internal instability and being segregated from society; and a stable and well functioning family integrated in society (study II). Stress factors such as living in uncertainty, having traumas, change in family roles, frequent negative attitudes of the host country and social segregation was detrimental to the wellbeing of the family. In promoting their health, PHCNs approached the families through: an ethnocentric approach, an empathic and culturally relative approach, and a holistic approach enabling families to function well in their everyday life (study III). From the Interpreters’ perspective, promoting health was to improve psychological wellbeing by: promoting positive thoughts of a future, promoting consideration of one’s worth and promoting stability of the family unit. Social interactions within the host country together with the recognition and appreciation of the families’ cultural values and beliefs, and competence and proper and elucidative information regarding the functioning of the host country, was considered necessary. Facilitating a healthy transition is possible within PHC. This can be done through cooperation of the family, with other health professionals, community and ethnic organisations. A model was developed in order to help the aforementioned. Competence in intercultural communication and family focused nursing is required. Adequate skills ought to be included in the education of nurses.
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| 5. |
- Sepp, Hanna, 1968-
(author)
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Pre-school children's food habits and meal situation : factors influencing the dietary intake at pre-school in a Swedish municipality
- 2002
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Doctoral thesis (other academic/artistic)abstract
- A pre-school-based dietary survey, using seven-day records, focus group interviews and semi-structured interviews, was carried out in a suburban area of Stockholm. The overall objective was to investigate the individual food and nutrient intake of pre-school children at all meals during the day, as well as factors that might influence children’s intake. The average energy and nutrient intake per day for the whole week was satisfactory for the 109 pre-school children, but the temporal distribution throughout the day was skewed. The energy and nutrient intakes of food at the pre-school were lower than recommended. This was, however, compensated for by meals eaten at home. The children had a more varied food intake during weekdays than weekend days. This study has not provided any evidence to support the selection of water versus milk as a preferable lunch beverage in terms of pre-school children's total milk consumption and general dietary quality. However, the dietary analyses showed that there could be a reason to limit pre-school children’s daily milk and fermented milk intake to half a litre, according to the existing guidelines. The children associated food and eating with rules and norms. They did not categorise food as good or bad, as adults often do, but as "food" and "non-food"; for example, sweets were not food. The method used in this study, the focus group interview, was judged to be a useful tool for exploring how children think about and jointly reflect upon food. The role of the teacher had changed over the past years and they had not yet found a solid ground for integrating food and meals into their everyday work.
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- Badache, Andreea, 1991-
(author)
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Beyond the Years : Exploring the role of sensory functions and cognitive abilities in shaping the patterns of old age disabilities and successful aging in an aging population in Sweden and Denmark: An epidemiological perspective of disability
- 2023
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Doctoral thesis (other academic/artistic)abstract
- AIMS: This research project aims to review the lay perspectives of older adults 75 and above regarding successful aging, as well as estimate the prevalence of sensory difficulties by different subgroups, explore the role of cognition and sensory function in explaining decreasing disability trends over time in Sweden and Denmark and, lastly, longitudinally examine the sensory-cognitive relation in older adults. METHODS: For Study I, a systematic review was conducted, while for Study II the prevalence of sensory functions was estimated. For Study III, the Karlson Holm Breen method was used, whereas Study IV applied a cross-lagged panel model. RESULTS: This research indicates that younger and older adults have different definitions of successful aging, with themes of life, death, and environmental/system influences being important for those aged 75 and above (Study I). Study II shows that the prevalence of sensory difficulties in old age varies among subgroups, and Study III reveals a decreasing prevalence of disability in Sweden and Denmark, attributed to cognitive function, education, reading ability, and hearing ability. Finally, Study IV highlights a reciprocal relationship between sensory functions and cognition among older adults, with better cognitive function associated with better hearing and vision scores over time. DISCUSSION: This research underlines the need for policymakers to cater to the diverse needs of different generations based on gender differences, environmental factors, and access to healthcare and social services. Study II reveals a higher prevalence of sensory difficulties among certain subgroups, which could be targeted by specific interventions. Study III and IV indicate that preserving good sensory functions may mitigate cognitive decline, with interventions including vision and hearing aids and surgeries potentially delaying cognitive decline.
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| 7. |
- Beck, Ingela, 1965-
(author)
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Att fokusera på "varandet" i en värld av görande : stöd till personalen i ett palliativt förhållningssätt vid vård- och omsorgsboende för äldre
- 2013
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Doctoral thesis (other academic/artistic)abstract
- The aim of this thesis was to study nurse assistants’ experience of palliative care and to investigate how an intervention with a focus on a palliative care approach in residential care facilities influenced the nurse assistants and their work situation. The thesis is based on two qualitative and two quantitative studies, focusing on nurse assistants working at residential care facilities for older people. The qualitative studies were based on focus-group interviews before the intervention (I) and individual interviews after the intervention (IV). The quantitative studies (II, III) were based on a questionnaire, including several measurements, that was answered pre-, and post- intervention. The intervention consisted of study circles with nurse assistants, and workshops together with their leaders, focusing on improvement work. A total of 75 nurse assistants participated in the intervention and answered the questionnaire at baseline and at two follow-ups, in comparison with 110 nurse assistants who served as controls. The results show that the nurse assistants experienced that it was difficult to focus on “being”, i.e. on relationship aspects in their work, since the main discourse in residential care focused on “doing”, i.e. on task oriented aspects. Palliative care was described as something that was only applied during a short and defined phase, namely the very last days of the residents’ life. The results also show that nurse assistants experienced difficulties facing emotional and existential issues with regards to both the residents and their relatives (I). The results of study I were, in turn, used as a basis for the development of the intervention. The evaluation of the intervention showed that the nurse assistants, after the intervention, had increased their focus on the residents’ situation and to a greater extent stated that they focused on the residents’ life stories and on aspects that brought meaning to their lives (III). The nurse assistants also stated that they experienced less criticism from their superiors as well as from the residents after the intervention (II). However, the evaluation also showed that the nurse assistants had a more negative view of the leadership (II), were more critical to the medical and the nursing care (III), and that their job satisfaction had decreased (II) after the intervention. Interviews after the intervention showed that they, as a result of the intervention, had not only gained increased insight into their own significance in their encounter with residents and their relatives, but also an increased awareness of the needs of the residents and their relatives. The intervention also contributed to an increased openness in the workgroup. However, the nurse assistants also expressed frustration over barriers, primarily in the form of a lack of resources and limited leadership (IV), standing in the way of the implementation of changes. The results indicate that the nurse assistants, through discussions and reflections over praxis in their ordinary work group, developed an increased awareness about, and focus on “being”, i.e. on relationship aspects. However, it would seem that essential prerequisites, such as support from the leaders and sufficient resources for working in line with a palliative care approach, were not provided. When implementing a palliative care approach in residential care facilities, more focus on support to the leaders is needed in order to maintain sustainable changes.
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| 8. |
- Clausson, Eva K., 1952-
(author)
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School health nursing : perceiving, recording and improving schoolchildren's health
- 2008
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Doctoral thesis (other academic/artistic)abstract
- Aim: The overall aim of this thesis is to explore School health nursing through school nurses’ descriptions of school children’s health and to analyse factors influencing the recording of schoolchildren’s health in the School Health Record (SHR). An additional aim is to evaluate family nursing interventions as a tool for the school nurses in the School Health Service (SHS).Methods: The thesis comprises four papers. A combination of qualitative and quantitative methods was used through individual interviews with a strategic sample of school nurses (n=12) (PI), a national survey to a representative sample of school nurses (n=129) (PII, III) and the implementation of family nursing models developed in Canada with girls in their early adolescence with recurrent health complaints and their families (n=4) in co-operation with their school nurses (n=2) (PIV). The Strengths and Difficulties Questionnaire (SDQ) was used as pre and post test. Evaluation interviews were conducted with the families and the nurses separately. Qualitative content analyses were used to analyze the interview text with the school nurses and the families. Manifest content analysis was used to analyze the free text answers of the survey and the evaluation interview with the school nurses. Descriptive statistical analyses were used to describe demographic data in all four papers. The SDQ was hand-scored statistically.Findings: The findings showed that nurses judged the schoolchildren’s mental health as deteriorated, especially in socially disadvantaged areas and more generally among girls expressed as psychosomatic symptoms. Individual factors related to lifestyle affected the schoolchildren’s physical health, and the mental health was, to a large extent, affected by the school environment and family relations. The latter seemed to be the most important factor affecting schoolchildren’s mental health. The basis for the school nurses judgement of the physical health was health check-ups and the health dialogues. Spontaneous visits were more commonly used to judge the mental health. Recording schoolchildren’s mental health was a challenge for school nurses. Difficulties were related to ethical considerations, tradition, lack of time and the improper structure of the SHR. Fears of marking the schoolchild for life related to the schoolchild itself, the parents or to other authorities/successive caregivers were brought up as hinders for recording mental and social health. Family sessions may be useful within the profession when handling recurrent health complaints among adolescence girls. The girls and their families experienced relief, they felt confirmed and that their feelings and reactions were normal in that situation. The families became aware of their own strengths and possibilities and this was supported by the SDQ which showed an increased well-being. The school nurses valued this way of working and meant that the sessions seemed to start a changing process within the families.Conclusions: The results indicate that school nurses have a deep knowledge about schoolchildren’s health which is not used to its full potential in a public health perspective. However, the experienced difficulties recording schoolchildren’s mental health seem obvious, which would demand developing the SHR for the needs of today. Family sessions in SHS with the school nurse as a collaborator with the family seemed useful and may be transferable to other health problems expressed by the schoolchildren. Bronfenbrenner’s ecological systems theory and other models for health determinants are used to illustrate the school nurse as a mediator working on the bridge over different health streams with schoolchildren’s health on an individual and a population level.
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| 10. |
- Larsson, Helena
(author)
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Existentiell ensamhet hos sköra äldre personer : ett närståendeperspektiv
- 2020
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Doctoral thesis (other academic/artistic)abstract
- The aim of this thesis was to explore existential loneliness from the perspective of significant others, to contrast their perceptions with frail older people’s experiences and to describe significant others’ and family care advisors’ views on existential support. This thesis is part of a larger research project about existential loneliness among frail older people, the LONE study. The thesis embraces three qualitative and one quantitative study. A total of 29 significant others, 15 frail older people and 120 family care advisors participated in the studies. The significant others were husbands, wives, daughters, sons, other relatives and friends to frail older people. The concept ‘frail older people’ was defined as older persons (≥ 75 years old) dependent on long-term health- or social care. The qualitative studies were based on multistage focus-group interviews (study I) and individual interviews (studies II and III). The quantitative study (IV) had a cross-sectional design and was based on a questionnaire specifically developed for the current study. Different methods to analyse data were used; hermeneutics (study I), content analysis (study II), a case study with thematic analysis (study III) and descriptive statistics (study IV). Findings from the four studies show that existential loneliness emerges when: 1) Longing for, but also striving for, a deeper feeling of connectedness, 2) Being in, but also enduring, an unwanted separation, and 3) Not finding, but still trying to recreate meaning. This thesis also shows that existential loneliness is often experienced in so-called limit situations in life and arises in difficult choices related to close relationships, in connection with experiences of meaninglessness and in the absence of connection to something or someone. The results show that existential loneliness emerges in the process of balancing between what was and what is to come in the unknown future. Significant others navigate themselves, and sometimes together with the older person, through an unfamiliar existence that makes them feel ambivalent about the de-cisions they have previously made and the decisions they need to make in the future, while also doubting the meaning in their current situation. Existential support should mainly focus on transition phases and on relational aspects. Person-centredness can be a way to make the existential needs of significant others and older people visible and to provide support based on their needs.
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