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- Stenlund, Therese, 1970-
(författare)
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Rehabilitation for patients with burnout
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Stress-related diseases and burnout have increased in Sweden during the last decades. In 2006, the most common diagnoses for new cases of sickness compensation were mental and behavioural disorders in both women and men. In spite of the large group of people seeking care for and on long-term sickness absence due to stress-related diseases and burnout, there is no agreement on which treatment they should be offered. The overall aim of this thesis was to describe patients on longterm sick leave because of burnout and to evaluate rehabilitation programs for this patient group. Two patient samples were recruited from the Stress Clinic at the University Hospital in Umeå, Sweden: REST (Rehabilitation for stressrelated disease and burnout; n=136) and QIST (Qigong for stress-related disease and burnout; n=82). A general population sample was from the 2004 Northern Sweden MONICA survey (n=573). Patients in REST were randomised into a 1-year rehabilitation program to either program A (Cognitively-oriented Behavioural Rehabilitation (CBR) and Qigong), or to program B (Qigong alone). In Paper I, baseline data were compared with data from the MONICA sample. In paper II, programs A and B were compared regarding effects on psychological variables and sick leave rates, and in Paper III, 18 patients from program A and B were interviewed to explore subjective experiences of the rehabilitation programs. Patients in QIST were allocated to an intervention with Qigong twice a week for 12 weeks or a control group. Psychological and physical measurements were assessed in QIST. Data were collected by questionnaires, physical measurements, the register on sick leave, and interviews. Patients with burnout reported a more restricted social network and higher work demands than the general population. In relation to women from a general population, women with burnout more often worked “with people”, reported high job strain, a more sedentary work situation and less emotional support. A per-protocol analysis showed no significant differences in treatment effect between program A and B in REST or between the intervention and control group in QIST. All groups improved significantly over time with reduced levels of burnout, anxiety, depression, and fatigue. In REST, lower scores on obsessive-compulsive symptoms, stress behaviour, and sick leave rates were found in both programs and in QIST both groups increased dynamic balance and physical capacity. In an intention-to-treat analysis, patients in program A in REST had significantly fewer obsessive-compulsive symptoms, and larger effect sizes in stress behaviour and obsessive-compulsive symptoms compared to patients in program B. Patients in both REST programs perceived that the 1-year rehabilitation program gave them specific tools to use in secondary prevention. They also emphasised that the good encounters, affirmation and group cohesiveness they perceived during the 8 rehabilitation was a necessary basis for initiation of a behavioural change leading to recovery. In conclusion, compared to a general population, patients with burnout perceived more demands at work and less social support. Lack of emotional support seemed to be more associated with burnout among women. There were no differences in effect between CBR and Qigong compared to Qigong alone, or between a 12 week Qigong intervention compared to a control condition. Improvements were found in all groups in the rehabilitation programs. CBR combined with Qigong have some advantages compared to Qigong alone. An environment with good encounters and affirmation of the patients was experiences as important by the patients and group rehabilitation had advantages as recognition and support from the group. Early rehabilitation measures are important to prevent long-term sickness absence. In future rehabilitation programs it might be necessary to have a more individualized approach and choose treatments preferred by the patient.
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| 3. |
- Alanentalo, Tomas, et al.
(författare)
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High-resolution three-dimensional imaging of islet-infiltrate interactions based on optical projection tomography assessments of the intact adult mouse pancreas
- 2008
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Ingår i: Journal of Biomedical Optics. - Bellingham, WA : SPIE--the International Society for Optical Engineering. - 1083-3668 .- 1560-2281. ; 13:5, s. 054070-
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Tidskriftsartikel (refereegranskat)abstract
- A predicament when assessing the mechanisms underlying the pathogenesis of type-1 diabetes (T1D) has been to maintain simultaneous global and regional information on the loss of insulin-cell mass and the progression of insulitis. We present a procedure for high-resolution 3-D analyses of regions of interest (ROIs), defined on the basis of global assessments of the 3-D distribution, size, and shape of molecularly labeled structures within the full volume of the intact mouse pancreas. We apply a refined protocol for optical projection tomography (OPT)-aided whole pancreas imaging in combination with confocal laser scanning microscopy of site-directed pancreatic microbiopsies. As such, the methodology provides a useful tool for detailed cellular and molecular assessments of the autoimmune insulitis in T1D. It is anticipated that the same approach could be applied to other areas of research where 3-D molecular distributions of both global and regional character is required.
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| 5. |
- Gillander Gådin, Katja, 1960-, et al.
(författare)
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Young students as participants in school health promotion: an intervention study in a Swedish elementary school
- 2009
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Ingår i: International Journal of Circumpolar Health. - 1239-9736 .- 2242-3982. ; 68:5, s. 498-507
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. The aim was to analyse if young students could be substantive participants in a healthpromoting school project. The specific aims were to analyse the changes the students proposed in their school environment, how these changes were prioritized by a school health committee and to discuss the students' proposals and the changes from a health and gender perspective. Study design. An intervention project was carried out in an elementary school with students (about 150) in Grades 1 through 6. The intervention included small-group discussions about health promoting factors, following a health education model referred to as "It's your decision." At the last of 6 discussions, the students made suggestions for health-promoting changes in their school environment. A health committee was established with students and staff for the purpose of initiating changes based on the proposals. Methods. A content analysis was used to analyse the proposals and the protocols developed by the health committee. Results. The analysis showed 6 categories of the students' proposals: social climate, influence on schoolwork, structure and orderliness, security, physical environment and food for well-being. Their priorities corresponded to the students' categories, but had an additional category regarding health education. Conclusions. Principles that guide promoting good health in schools can be put into action among students as young as those in Grades 1 through 6. Future challenges include how to convey experiences and knowledge to other schools and how to evaluate if inequalities in health because of gender, class and ethnicity can be reduced through the focus on empowerment and participation.
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| 6. |
- Lorén, Christina E, et al.
(författare)
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FGF signals induce Caprin2 expression in the vertebrate lens.
- 2009
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Ingår i: Differentiation. - : Elsevier BV. - 0301-4681 .- 1432-0436. ; 77:4, s. 386-394
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Tidskriftsartikel (refereegranskat)abstract
- The lens of the eye is derived from the non-neural ectoderm situated next to the optic vesicle. Fibroblast growth factor (FGF) signals play a major role at various stages of vertebrate lens development ranging from induction and proliferation to differentiation. Less is however known about the identity of genes that are induced by FGF activity within the lens. We have isolated and characterized mouse cytoplasmic activation/proliferation-associated protein-2 (Caprin2), with domains belonging to both the Caprin family and the C1q and tumour necrosis factor (TNF) super-family. Here we show that Caprin2 is expressed in the developing vertebrate lens in mouse and chick, and that Caprin2 expression is up-regulated in primary lens fiber cells, after the induction of crystallins the earliest known markers for differentiated lens fiber cells. Caprin2 is subsequently down-regulated in the centre of the lens at the time and at the position of the first fiber cell denucleation and terminal differentiation. In vitro analyses of lens fiber cell differentiation provide evidence that FGF activity emanating from neighboring prospective retinal cells is required and that FGF8 activity is sufficient to induce Caprin2 in lens fiber cells. These results not only provide evidence that FGF signals induce the newly characterized protein Caprin2 in the lens, but also support the general idea that FGF signals are required for lens fiber cell differentiation.
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| 7. |
- Nakata, Minori, et al.
(författare)
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Solving tangled cases of work-related musculoskeletal disorders by international scientific cooperation.
- 2005
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Ingår i: NEW SOLUTIONS. - 1048-2911 .- 1541-3772. ; 15:4, s. 343-56
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Tidskriftsartikel (refereegranskat)abstract
- Work-related musculoskeletal disorders (WRMSDs) have become a serious worldwide problem. At the same time a number of workers experience a problem in getting their WRMSDs acknowledged. As an attempt to solve these problems, Japanese school lunch cooks' working conditions were discussed at international scientific meetings and a detailed inspection was done at a Japanese school kitchen by Swedish researchers. It revealed that both national and international researchers' opinions coincided. Statements of medical views were written for several tangled cases in Japan and Sweden referring to both the national and international literature. As a result, these tangled cases were acknowledged officially as WRMSDs. New arbitrators and mediators of WRMSDs are required who can understand and communicate between the world of medical and labor sciences and also between the world of science and daily work life.
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| 9. |
- Novak, Masuma, 1969, et al.
(författare)
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A life-course approach in explaining social inequity in obesity among young adult men and women.
- 2006
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Ingår i: International journal of obesity (2005). - : Springer Science and Business Media LLC. - 0307-0565 .- 1476-5497. ; 30:1, s. 191-200
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Tidskriftsartikel (refereegranskat)abstract
- To examine the cumulative influence of adverse behavioural, social, and psychosocial circumstances from adolescence to young adulthood in explaining social differences in overweight and obesity at age 30 years and if explanations differ by gender.A 14-year longitudinal study with 96.4% response rate.Data from 547 men and 497 women from a town in north Sweden who were baseline examined at age 16 years and prospectively followed up to age 30 years.Overweight and obesity were ascertained at ages 16 and 30 years. Occupation and education were used to measure socioeconomic status. The explanatory measurements were: age at menarche, smoking, physical activity, alcohol consumption, TV viewing, home and school environment, social support, social network, and work environment.No gender or social difference in overweight was observed at age 16 years. At age 30 years, significantly more men than women (odds ratio (OR) = 2.81, 95% confidence interval (CI) 2.14-3.68) were overweight or obese. Educational level was associated with overweight at age 30 years, but not occupational class. Both men (OR = 1.55, 95% CI 1.10-2.19) and women (OR = 1.78, 95% CI 1.16-2.73) with low education (< or =11 years) were at risk of overweight. The factors that explained the educational gradient in overweight among men were low parental support in education during adolescence, and physical inactivity, alcohol consumption, and nonparticipation in any association during young adulthood. The educational gradient in overweight in women was explained mostly by adolescence factors, which include early age at menarche, physical inactivity, parental divorce, not being popular in school, and low school control. Restricted financial resource during young adulthood was an additional explanatory factor for women. All these factors were significantly more common among men and women with low education than with high education.Social inequities in overweight reflect the cumulative influence of multiple adverse circumstances experienced from adolescence to young adulthood. Underlying pathways to social inequity in overweight differ between men and women. Policy implications to reduce social inequity in overweight include reduction of social differences in health behaviours and social circumstances that take place at different life stages, particularly psychosocial circumstances during adolescence.
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| 10. |
- Novak, Masuma, 1969, et al.
(författare)
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Inequalities in smoking: influence of social chain of risks from adolescence to young adulthood: a prospective population-based cohort study.
- 2007
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Ingår i: International journal of behavioral medicine. - : Springer Science & Business Media B.V.. - 1070-5503 .- 1532-7558. ; 14:3, s. 181-7
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Tidskriftsartikel (refereegranskat)abstract
- The pathway between socioeconomic disadvantages and smoking is a process that requires an understanding of life-course influence.This study investigated pathways of social risks at different life stages that are linked to adolescent smoking and maintenance of smoking through to young adulthood.A cohort consisting of all pupils (n = 1083) from one Swedish city were followed from age 16 to age 30 (1981-1995), with a 96.4% response rate.Odds ratios of being a smoker at age 30 among low educated were 2.54 for men and 2.53 for women. Using structural equation model analysis for men and women, a strong chain of risks was found from age 16 linking to smoking at age 30: adolescents with adverse socioeconomic status (SES) were more likely from a divorced family. Being from a divorced family and having poor contact with their parents influenced their smoking directly and through peers. Adolescents with adverse SES were also likely to be unpopular in school, which affected their smoking behavior directly and through peers. These socially disadvantaged participants, who were smokers at age 16, continued smoking until age 30 years. The risk pathways were similar for both men and women.Adult smoking reflects the cumulative influence of multiple socioeconomic and psychosocial chains of risks experienced during upbringing. The programs that are addressed to reduce smoking among socially disadvantaged adolescents would have an impact in reducing smoking inequalities in adults.
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