| 1. |
- Rostami, Arian, 1973-
(författare)
-
Police officers under pressure : sexual and gender-based harassment, stress, and job satisfaction in Sweden
- 2024
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Police officers encounter challenging and stressful situations at work, which negatively impact their health, job performance, and aspects of their lives. Regarding the gendered structure and competitive work environment of police organizations, women are under extra pressure from the pervasive gendered norms within the police organization. The aim of this dissertation is to study sexual and gender-based harassment and work-related stress as important work environment elements from a gender perspective, and to explore if and how these elements can affect police officers’ job satisfaction in the context of Swedish police work.This thesis is based on three studies: a scoping review, a quantitative study, and a qualitative study, resulting in four articles. In the scoping review study on sexual and gender-based harassment in police work in the European context 16 articles on sexual and gender-based harassment against police employees were studied. Thematic analysis was applied to obtain the main patterns across and within the included studies. In the qualitative study, data collection included one group interview and 12 individual interviews with male and female police officers. Thematic and content analysis were conducted to analyze the interviews. During the quantitative study, data were collected from 152 male and female police officers applying a set of questionnaires including sociodemographic questions, the Police Stress Identification Questionnaire (PSIQ), Sexual and gender-based harassment questions, and Job Descriptive Index (JDI). The scoping review showed that most of the European studies were focused on sexual harassment, while gender-based harassment was often overlooked or mixed with other types of harassment and discrimination. Six main themes were found in the studies; the existence of sexual and gender-based harassment, perpetrators, associated factors, consequences, individual response, and impact of organizational policies. In the mixed methods article, results from the quantitative and qualitative studies on sexual and gender-based harassment indicated that female police officers experienced a statistically significant higher percentage of gender-based harassment compared to male officers. However, there was not any significant gender difference in sexual harassment. “Sexual comments and jokes” and “mocking or telling jokes about the #MeToo campaign” by colleagues were reported as the most frequent sexual harassment and gender-based harassment items. Additionally, police officers identified the presence of toxic jargon and a culture of silence, along with ineffective or negative management styles, as organizational factors that can contribute to the perpetuation of such harassment. Also, the quantitative results on police work stress showed that police officers rated higher on the “impact on significant others” stress and “operational stress” subscales. In addition, female officers reported higher stress in these subscales compared to their male counterparts. The police officers who had experienced sexual harassment reported higher “self-image stress” and “operational stress”. Moreover, in studying job satisfaction among Swedish police officers, both male and female officers reported the highest satisfaction with “people on present job” and the lowest satisfaction with “opportunity for promotion” and then “pay”. No significant gender gap was found in job satisfaction subscales, nor was there a significant association between these subscales and experiences of harassment. However, organizational stress was negatively related to three domains of job satisfaction; “job in general”, “pay” and “supervision”. The research findings revealed that despite substantial changes in the Swedish police organization and work culture during recent decades, the issue of sexual and gender-based harassment remains persistent. This finding highlights the need for more attention to organizational factors (cultural and managerial issues) enabling sexual and gender-based harassment. The findings also underscore the higher levels of work pressure and challenges faced by female officers and the importance of challenging prevailing gender norms affecting both female and male police officers. Moreover, addressing organizational sources of stress can improve the working conditions and job satisfaction of police officers. Finally, the thesis highlights the importance of considering sexual and gender-based harassment along with work stress to create a safer and more productive police work environment.
|
|
| 2. |
- Bergström, Fredrik, 1983-
(författare)
-
The neural substrates of non-conscious working memory
- 2016
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Despite our distinct impression to the contrary, we are only conscious of a fraction of all the neural activity underlying our thoughts and behavior. Most neural processes occur non-consciously, and in parallel with our conscious experience. However, it is still unclear what the limits of non-conscious processes are in terms of higher cognitive functions. Many recent studies have shown that increasingly more advanced functions can operate non-consciously, but non-conscious information is still thought to be fleeting and undetectable within 500 milliseconds. Here we used various techniques to render information non-conscious, together with functional magnetic resonance imaging (fMRI), to investigate if non-consciously presented information can be retained for several seconds, what the neural substrates of such retention are, and if it is consistent with working memory maintenance.Results: In Study I we used an attentional blink paradigm to render stimuli (single letters) non-conscious, and a variable delay period (5 – 15 s) prior to memory test. It was found that non-conscious memory performance was above chance after all delay durations, and showed no signs of decline over time. Univariate fMRI analysis showed that the durable retention was associated with sustained BOLD signal change in the prefrontal cortex and cerebellum during the delay period. In Study II we used continuous flash suppression (CFS) to render stimuli (faces and tools) non-conscious, and a variable delay period (5 or 15 s) prior to memory test. The durable retention of up to 15 s was replicated, and it was found that stimuli identity and spatial position was retained until prospective use. In Study III we used CFS to render tools non-conscious, and a variable delay period (5 – 15 s) prior to memory test. It was found that memory performance was not better than chance. However, by using multi-voxel pattern analysis it was nonetheless possible to detect the presence vs. absence of non-conscious stimuli in the frontal cortex,and their spatial position (left vs. right) in the occipital cortex during the delay.Conclusions: Overall these findings suggest that non-consciously presented information (identity and/or position) can be retained for several seconds,and is associated with BOLD signal in frontal and posterior regions. These findings are consistent with working memory maintenance of non-consciously presented information, and thereby constrain models of working memory and theories of consciousness.
|
|
| 3. |
- Nishikawa, Saori, 1978-
(författare)
-
Japanese adolescents' self-concept and well-being in comparison with other countries
- 2009
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: In a rapidly changing and increasingly interconnected world, the issue of mental health and well-being among adolescents is one of the important research topics. However, there have been few studies amongst Japanese adolescents that have been published in international journals. Objectives: (I) to make a comparison in selfconcept between healthy adolescents in Japan and Sweden, (II) to address the influence of perceived parental rearing on self-concept and mental health problems among Japanese adolescents, (III) to investigate contributions of attachment and self-concept to mental health problems reported by Japanese adolescents, (IV) to address a comparison of mental health problems and self reported competence in adolescents from Greece, Japan, Russia, and Sweden. Methods: The following self-report instruments were used: Self- Description Questionnaire II (Marsh, 1992), Actual-Ideal Questionnaire (Nishikawa, 2003), Self-Description Questionnaire IIShort (Marsh, Ellis, Parada, Richards, & Heubeck, 2005), Youth Self- Report (Achenbach, 1991), Attachment Questionnaire- for Children (Sharpe et al., 1998), and Egna Minnen Beträffande Uppfostran (my memories of child upbringing) for Children (Muris, Meesters, & van Brakel, 2003). The participants for Paper I were adolescents aged 14 and 15 from Japan (n=144) and Sweden (n=96). One hundred ninety three Japanese students between the ages of 15-19 participated in Paper II and 228 students for Paper III. The participants for Paper IV were 812 healthy adolescents between 15 and 17 years of age from Greece (n=152), Japan (n=219), Russia (n=159), and Sweden (n=282). Results: Paper I showed that Japanese students reported less positive self-concept compared to the Swedish counterparts. The results were discussed in terms of different response style and modesty in Japanese culture. Paper II showed that dysfunctional parental rearing and insecure peer attachment were associated with negative self-concept and more mental health problems. A unique influence on mental health problems from parent-adolescent relationships depending on the gender of parents and adolescents was also found. Paper III showed a mediating role of self-concept in influencing the relationships between attachment style and Internalizing Problems. Paper IV indicated rather small differences across countries in the syndrome scales. Japanese and Swedish adolescents tended to score lower than Russian and Greek counterparts. Some cultural specific syndromes were found. Conclusion: These results reported in this thesis present a general view of Japanese adolescents’ self-concept and the influence of interpersonal relationships in mental health problems assessed by Western self-report instruments. When being compared with other countries, cultural background and response style must be taken into account.
|
|
| 4. |
- Semb, Olof, 1968-
(författare)
-
Distress after criminal victimization : quantitative and qualitative aspects in a two-year perspective
- 2011
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis explores distress and reactions after crime by a previously unknown perpetrator in a two-year perspective. Distress was investigated at eight months and two years, using quantitative and qualitative methods. The specific aims of the thesis were (I) to explore the level of distress and the role of risk factors for post-traumatic and general symptoms eight months post crime, (II) to examine the natural course of adjustment at a two-year follow-up in female and male victims of interpersonal violence, III) to investigate the relationship between shame, guilt, and distress among 35 victims of a single severe violent crime, and (IV) to use qualitative analysis to describe individual post-crime trajectories. The following questionnaires were used: Symptom Check List 90 (Derogatis & Cleary, 1977), Harvard Trauma Questionnaire (Mollica et al., 1992), the Test for Self-Conscious Affect (Tagney et al., 1989). Data were also obtained via semi-structured interviews, including the use of visual analog scales for subjective mental health measures. The participants in paper I were male and female Swedish adult victims of reported interpersonal violence eight months earlier. Participants were between 18 and 66 years of age (n=41). At follow-up (Paper II) the sample size had decreased (n=35). In paper III, adult victims (aged 18-64) of reported interpersonal violence were assessed within two weeks of reported crime (n=35). In paper IV a subsample of 11 adult crime victims were drawn from among the participants from papers I and II. Paper I showed that women reported more distress than men. Prior trauma, adverse childhood, female sex, previous psychiatric history, and unemployment were all associated with more distress. Peritraumatic reactions (especially secondary emotions following cognitive appraisals after the event) predicted the three core PTSD symptoms and comorbid conditions, together with female sex and psychiatric history. Paper II confirmed most of the risk factors at eight months and that, in general, no further recovery took place between eight months and two years. Paper III showed that shame-proneness and event-related shame were highly intercorrelated and related to higher symptoms levels, while the guilt measures were unrelated to each other as well as to symptoms. Paper IV explored narratives of victimization; the results suggest that individual differences within the same trajectories of recovery should be expected.
|
|
| 5. |
- Dahlin, Erika, 1981-
(författare)
-
Train your brain : updating, transfer, and neural changes
- 2009
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- An initial aim of this thesis was to determine whether training of a specific executive function (updating) produces improvements in performance on trained and transfer tasks, and whether the effects are maintained over time. Neural systems underlying training and transfer effects were also investigated and one question considered is whether transfer depends on general or specific neural overlap between training and transfer tasks. An additional aim was to identify how individual differences in executive functioning are mapped to functional brain changes. In Study I, significant training-related changes in performance on the letter memory criterion task were found in both young and older adults after 5 weeks of updating training. Transfer to a 3-back test of updating was also demonstrated in the young adults. Functional Magnetic Resonance Imaging (fMRI) revealed overlapping activity in letter memory and 3-back tasks in fronto-parietal areas and striatum pre-training, and a joint training-related activity increase for the tasks in a striatal region. No transfer was observed to a task (Stroop) that engaged fronto-parietal areas, but not the striatal region and updating per se. Moreover, age-related striatal changes imposed constraints on transfer. In Study II, additional transfer tasks and a test of long-term maintenance were included. Results revealed that training-related gains in performance were maintained 18 months post-training in both young and older adults, whereas transfer effects were limited to tasks requiring updating and restricted to young participants. In Study III, analyses of brain activity and performance during n-back (1/2/3-back) were executed. This task enables manipulation of executive demand, which permits examination of how individual differences in executive functioning can be mapped to functional brain changes. Relative to a young high- performing group, capacity constraints in executive functioning were apparent between 1–2-back for the elderly participants and between 2–3-back for a young low-performing group. Capacity constraints in neural activity followed this pattern by showing a monotonically increasing response in the parietal cortex and the thalamus for young high performers, whereas activity levelled off at 1-back for elderly performers and at 2-back for young low performers. The response in the dorsal frontal cortex followed a similar pattern. Together, these findings indicate that fronto-parietal as well as sub-cortical areas are important for individual differences in executive functioning, training of updating and transfer effects.
|
|
| 6. |
- Emsing, Mikael, 1980-
(författare)
-
Conflict management & mental health among Swedish police officers & recruits
- 2022
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: An essential part of police work is handling people in distress, often related to some form of conflict that police officers are expected to handle in a professional manner. Thus, interpersonal and conflict management skills are essential for police officers. Further, police work has been hailed as one of the most complex and stressful jobs that one can have. While important progress has been made in relation to how the complex and stressful nature of police work affects the individual officers - less is known about the timing and onset of these effects. Similarly, while there is a growing body of research into police conflict management, more research is needed to deepen our understanding of police conflict management, not least in the Swedish context. The overall aim of the present thesis was to contribute to existing knowledge about police work by investigating conflict management and mental health among Swedish police recruits and officers.Materials and methods: The present thesis used a mixed-methods approach and is built on four sub-studies. Sub-study 1 examined the evidence base for current practices, methods, and training in conflict management by means of a scoping review. Sub-study 2 used semi-structured interviews to examine how police officers perceived conflict and conflict-management and their training within the subject. Results from sub-study 2 where also used increating items for the instrument developed in sub-study 4. Sub-study 3 used a quantitative design to examine the mental health status of Swedish police recruits using the SCL-90 questionnaire. Sub-study 4 documented the initial steps towards developing an instrument to measure conflict behaviors and attitudes to conflict management among police officers and evaluated the psychometric properties of this instrument.Results: A large proportion of the studies included in the scoping review were conducted in the US and manyfocused-on use of force. The results also indicate that a lack of available data, unified definitions and experimental as well as longitudinal research designs makes it difficult to draw causal conclusions regarding the effectiveness of training in conflict management. In the interviews, respondents described conflict largely in terms of interpersonal conflicts, and focused less on intrapersonal conflict. The complexity and importance of the role played by instructors during probationary training was also salient in their descriptions. As for mental health status, recruits overall reported scores that where similar to the general population. A small number of recruits (n = 15) reported scores that where above the patient mean of the Swedish general population in the corresponding age group. The intended factor structure of the instrument developed could not be operationalized in the instruments current form, but the instrument could still provide insights and provides a basis for further development of the instrument.Conclusions: To enhance our understanding on police conflict management, scholars and police departments should work together to agree upon unified definitions on key concepts related to this topic. More research using longitudinal and experimental designs are needed to further develop training interventions related to conflict management. While a small number of recruits reported scores above the Swedish patient mean, extant research has indicated that stigmas surrounding mental health among police could lead to unconstructive coping behaviors. Further research on mental health among not only Swedish police officers but also recruits, could focus on helpseeking-behaviors and stigmas related to mental health to provide valuable insights on the topic. The instrument developed within the present thesis needs further development but nonetheless represents a first step towards examining individual differences in relation to police conflict management behaviors and attitudes towards conflict.
|
|
| 7. |
- Gilenstam, Kajsa, 1974-
(författare)
-
Gender and physiology in ice hockey : a multidimensional study
- 2009
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background That men are prioritised over women has been called the “gender regime in sport”, and has in part been explained by the gender difference in performance. However, gender differences in physical performance between women and men can be debated to depend on how comparisons are made and on the fact that there are many different confounders that may influence the results. Even if attempts are made to overcome this and the groups of women and men are stated to be matched, there are still often differences in training experience in years, or differences in training load. Women tend to have less experience in ice hockey in relation to age and differences in training conditions have also been reported. The aim of this thesis was to investigate how female and male ice hockey players position themselves in their sport and to visualise the interactions between society and biology that may affect performance. Theoretical approach and methods Harding’s three perspectives (Symbolic, Structural and Individual) were applied on information from team administration as well as on results from questionnaires, semi-structured interviews, and tests of puck velocity, anthropometrics, body composition, isokinetic muscle strength, ergospirometry and on-ice tests from female and male ice hockey players. Results Vast differences in structural conditions were found, for example in hockey history and in the financial situation within the teams and both women and men were aware of the gender differences in structural conditions. However these differences were not even considered when comparisons of the ice hockey performance of women and men were made. Nine out of ten female players increased puck velocity when a more flexible stick and a lighter puck were used thus indicating that poorly adjusted equipment may affect performance. Male ice hockey players were taller, heavier and stronger, had more lean body mass and a higher aerobic capacity compared to the women in absolute values as well as in relation to body weight. However, the differences diminished or disappeared when the values were expressed in relation to lean body mass. Men had higher expectations on their situation as athletes and the interviewed women described men’s ice hockey as superior to theirs and consequently male ice hockey players deserved better conditions. Conclusions The views of women and men may affect structural conditions in sport which in turn may affect possibilities in sport for the individual. Gender differences in conditions thus risk confirming the traditional views of femininity and masculinity. However, by moving outside the normal gender boundaries individuals may change the traditional views of femininity and masculinity.
|
|
| 8. |
- Gotfredsen, Anne, 1981-
(författare)
-
Carving out collective spaces : Exploring the complexities of gender and everyday stressors within rural youth leisure
- 2021
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The reasons why young people are increasingly suffering frommental health problems, and the opportunities to turn this development aroundare globally debated. Stressors such as education, relationships, futuretrajectories of housing and employment all constitute important factors affectingyoung people’s mental health, leading to stress and achievement pressureespecially among girls and young women. The need to reduce individualization ofyoung people’s health problems, and instead encourage spaces for collectivesupport, action, and change has been called for in previous studies. Leisureparticipation has the potential to be such a collective space where young peopletogether can respond to stressors experienced in their daily life. Apart fromstudies on individual behavior change, leisure participation has been anoverlooked arena within public health and within research on young people’smental health and stress in particular. The complexity of youth leisure, especiallyin relation to gender and spatiality, calls for further investigation, exploring thesocial places of leisure that young people create themselves.Aim: The aim of this thesis is to understand how places of youth leisure areperceived and collectively constructed as social factors of youth mental health,and to analyze the strategies developed within these places to handle and respondto the everyday stressors experienced by young people.Conceptual framework: The analysis builds on four conceptual sections: (i)The stress process model explores stressors as situated in a wider social context,where social factors shape both the stressors that affect mental health, theresources to handle those stressors as well as the mental health outcomes. (ii) Thesocial practice theory highlights how social practices within places of leisure canbe identified as resources in relation to responses to stressors. (iii) The thirdsection of the framework takes on the relationship between stress, leisure, andpost-feminist perspectives on gender and successful femininity. The final section(iv) outlines leisure as a spatial (re)construction; emphasizing rural space andplace in relation to gender, stress, and precarity.Methods: This thesis builds on two sub-studies, generating three papers. SubstudyI is based on data from individual interviews with eight adult leaders fromdifferent leisure organizations (paper 1), and sub-study II (paper 2 and 3) is basedon an ethnographic multiple-case study with 16 girls (age 14-21) from two leisureorganizations. The setting for both sub-studies is rural northern Sweden. Thematerial from the ethnographic study was collected through participatoryobservations and focus group discussions using photo elicitation. For the first andsecond paper, thematic analysis was used as an analytical strategy, while a4discursive psychology approach (interpretative repertoires) was used for the thirdand final paper.Results: The first part of the results concerns how girls and adult leadersperceived and experienced daily stressors within the context of youth leisure.Such stressors were represented by the high demands girls face in relation toachievement pressure and time management, school, gender norms andexpectations, but also in relation to their leisure engagement. The second partexplores how the girls and adult leaders developed and negotiated strategies torespond to stressors, within the context of leisure. Responses were constructedthrough daily social practices within the context of leisure e.g. through sharingexperiences of stress with each other, based on a sense of belonging and trust. Inthe final part, rurality holds a central position in how place and space werediscursively constructed by the participants, in relation to leisure, gender, andstressors. Here, one of the main results in the third part was the complexity ofhow the participants’ constructed leisure as a place of wellbeing. In order to buildand maintain a space that enabled responses to stressors, the girls constantlyneeded to invest time, engagement, achievements, and emotions. In addition,places of leisure needed to be constructed in certain ways to be perceived asbeneficial and ‘positive’, for example as a place marked by respectability and selfdevelopment.This illustrates the precarity of youth leisure where educational andlabor-market opportunities have changed how young people now understand freetime as something that should be ‘productive and meaningful’. The metaphor of‘carving out spaces’ speaks for the effort the girls had to make in order to createand sustain such places; not only in relation to a successful femininity, but alsoin relation to the rural community and the survival of rural places of leisure.Conclusions: This study contributes to a better understanding of youth leisure,and how to build sustainable and inclusive places of leisure from a gender andrural perspective. Places of leisure and civic engagement are perceived asimportant social factors of youth mental health, and needs to be taken intoconsiderations when young people’s stress and mental health are discussed.Places of youth leisure are spaces where responses to everyday stressors can becollectively developed. At the same time, youth leisure is also precarious,demanding, and contributes to the reproduction of gendered discourses onrespectability and responsibility, both in relation to a successful femininity, butalso in making it work for the rural collective.
|
|
| 9. |
- Novak, Masuma, 1969-
(författare)
-
Social inequity in health : Explanation from a life course and gender perspective
- 2010
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: A boy child born in a Gothenburg suburb has a life expectancy that is nine years shorter than that of another child just 23 km away, and among girls the difference is five years. There is no necessary biological reason to this observed difference. In fact, like life length, most diseases follow a social gradient, even in a country like Sweden where many believe there is no class inequity. This social inequity in health tells us that some of us are not achieving our potential in health or in life length compared to our more fortunate fellow citizens. Aim: This thesis attempts to explore the patterns of health inequities and the pathways by which health inequities develop from a life course and gender perspective. In particular focuses on the importance of material, behavioural, health related and psychosocial circumstances from adolescence to adulthood in explaining social inequity in musculoskeletal disorders (MSDs), obesity, smoking, and social mobility. Method: All four papers of this thesis were based on quantitative analyses of data from a 14-year follow-up study. The baseline survey was conducted in 1981 in Luleå, Sweden. The survey included all 16-year-old pupils born in 1965. A total of 1081 pupils (575 boys and 506 girls) were surveyed. They were followed up at ages 18, 21 and 30 years with comprehensive self-administered questionnaires. The response rate was 96.5% throughout the 14-year follow-up. In addition to the questionnaires data, school records, and interviews with nurse and teachers’ were used. Results: There were no class or gender differences in MSDs and in obesity during adolescence, but significantly more girls than boys were smokers. Class and gender differences had emerged when they reached adulthood with more women reporting to have MSDs but more men being overweight and obese. Women continued to be smokers at a higher rate than men through to adulthood. When an intersection between class and gender was considered, a more complex picture emerged. For example, not all women had higher prevalence of MSDs or smoked more than men, rather men with high socioeconomic position (SEP) had lower prevalences of MSDs and smoking than women with high SEP; and these high SEP women had lower prevalences than men with low SEP. The worst-off group was women with low SEP. The obesity pattern was quite the contrary, where women with high SEP had a lower prevalence of obesity than women with low SEP; and these low SEP women had a lower prevalence than men with high SEP. The worst-off group was men with low SEP. Regarding social mobility, health status (other than height in women) and ethnic background were not associated with mobility either for men or women. The results indicated that unequal distribution of material, psychosocial, health and health related behavioural factors during adolescence, young adulthood and adulthood accounted for the observed social gradients and social mobility. However, several factors from adolescence appeared to be more important for women while recent factors were more important for men. Important adolescent factors for social inequity and downward mobility were: unfavourable material circumstances defined as low SEP of parent, unemployed family member, and had no own room during upbringing; unfavourable psychosocial circumstances defined as parental divorce, poor contact with parents, being less liked in school, and low school control; and poor health related behaviour defined as smoking and physical inactivity. Among these factors, being less liked in school showed consistent association with all outcome measures of this thesis. Being less liked by the teachers and students was found to be more common among adolescents whose parents had low SEP. Men and women who were less liked in school during their adolescence were more likely as adults to be smokers, obese (only women), and downwardly mobile. The dominant adult life factor that contributed to class inequity in MSDs for men and women was physical heavy working conditions, which attributed to an estimated 46.9% (women) and 49.5% (men) of the increased risk in MSDs of the lower SEP group. High alcohol consumption among men with low SEP was an additional factor that contributed to class inequities in health and social mobility. Conclusion: Social patterning of health in this cohort was gendered and age specific depending on the outcome measures. Unfavourable school environment in early years had long lasting negative influence on later health, health behavior and SEP. The thesis supports the notion of accumulation of risk that social inequities in health occurs due to accumulation of multiple adverse circumstances among the lower SEP group throughout their life course. Schools should be used as a setting for interventions aimed at reducing socioeconomic inequities in health. The detailed policy implications for reduction of social inequities in health among men and women are discussed.
|
|
| 10. |
- Sandlund, Jonas
(författare)
-
Position-matching and goal-directed reaching acuity of the upper limb in chronic neck pain : associations to self-rated characteristics
- 2008
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Neck-shoulder pain is common in the general population and causes individual suffering as well as large costs for the society. Despite substantial efforts, there is still a shortage of methods for objective diagnosis and effective rehabilitation of such disorders. Thus, there is a great need to develop and evaluate new methods for these purposes. From clinical observations and recent research it has become evident that sensorimotor control can be impaired in people with neck-shoulder pain and may play a role in the pathogenesis of these disorders. In this thesis, precision of goal-directed arm movements, a previously unstudied class of movements in neck-shoulder pain, was studied. The main aim of the thesis was to investigate if people with chronic neck-shoulder pain have a reduced acuity of goal-directed movements of the upper extremity. A second aim was to study associations between reduced movement acuity and symptoms and self-rated characteristics. Upper limb repositioning acuity was assessed in blindfolded subjects performing tests of active, ipsilateral position-matching of two target positions (long and short) in movements constrained to horizontal-adduction of the shoulder. Reduced repositioning acuity, suggesting impaired shoulder proprioception, was found for both subjects with whiplash associated disorders (WAD) and non-specific neck-shoulder pain (NS). The degree of reduced acuity was shown to correlate with self-ratings of various health concepts, functioning and pain. A conspicuous finding was that there was lack of correlation between short and long target errors, along with the fact that associations between repositioning acuity and symptoms and self-rated characteristics was primarily found for the short target position. To further investigate the possible mechanisms underlying the disassociation between long and short target movement control, the association pattern between the outcome of several variants of ipsilateral position matching and velocity-discrimination tests, were studied. It was found that the perception of limb position in position-matching of short target locations appears to be predominantly based on movement velocity, whereas perception of limb position in movements to longer target locations may rely on a location-based perception mechanism. To extend the research on reduced upper extremity proprioception in neck-shoulder pain to a more natural movement situation, acuity of goal-directed pointing including full vision and 3D multi-joint movements was investigated in WAD, NS and healthy controls subjects. The results revealed a reduced acuity for both neck-pain groups. Moreover, distinct associations between end-point acuity and neck movement problems, limitations of some physical functions and, in WAD; some aspects of pain, were revealed. The findings demonstrate that the precision of upper limb movements can be reduced in chronic neck-shoulder pain. Substantial associations with symptoms and self-rated functioning suggest a clinical relevance of acuity measures of goal-directed arm movements. The findings indicate that tests of sensorimotor control can provide objective measures that may be useful in biopsychosocial profiling and characterization of subgroups of patients with chronic neck-shoulder pain, and that training target control of goal-directed movements should be considered in rehabilitation programs of people with these disorders.
|
|
