| 1. |
- 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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| 2. |
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| 3. |
- 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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| 4. |
- 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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| 6. |
- 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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| 7. |
- 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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| 8. |
- Stenlund, Therese, 1970-, et al.
(författare)
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Cognitively Oriented Behavioral Rehabilitation in Combination with Qigong for Patients on Long-Term Sick Leave Because of Burnout : REST-A Randomized Clinical Trial
- 2009
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Ingår i: International Journal of Behavioral Medicine. - : Springer Science and Business Media LLC. - 1070-5503 .- 1532-7558. ; 16:3, s. 294-303
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Tidskriftsartikel (refereegranskat)abstract
- Despite an increase in the occurrence of burnout, there is no agreement on what kind of rehabilitation these patients should be offered. Primary aim of this study was to evaluate effects on psychological variables and sick leave rates by two different group rehabilitation programs for patients on long-term sick leave because of burnout. Rehabilitation program A (Cognitively oriented Behavioral Rehabilitation (CBR) and Qigong) was compared with rehabilitation program B (Qigong only). In a randomized clinical trial, 96 women and 40 men with a mean age of 41.6 +/- 7.4 years were allocated to one of the two rehabilitation programs. A per-protocol analysis showed no significant difference in treatment efficacy between the groups. Both groups improved significantly over time with reduced levels of burnout, self-rated stress behavior, fatigue, depression, anxiety, obsessive-compulsive symptoms, and sick leave rates. In an intention-to-treat analysis, patients in program A had fewer obsessive-compulsive symptoms and larger effect sizes in self-rated stress behavior and obsessive-compulsive symptoms compared to patients in program B. This study showed no differences in effect between CBR and Qigong compared with Qigong only in a per-protocol analysis. Both rehabilitation programs showed positive effect for patients with burnout.
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| 9. |
- Stenlund, Therese, et al.
(författare)
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Effects of qigong in patients with burnout : a randomized controlled trial
- 2009
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 41:9, s. 761-767
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate the efficacy of Qigong in rehabilitation for patients with burnout. DESIGN: Prospective, randomized controlled trial. SUBJECTS: Eighty-two patients (68 women and 14 men, mean age 44.3 (standard deviation 9.1) years) diagnosed with burnout.METHODS: Basic care was offered to both the intervention and the control group. Patients in the intervention group received basic care and, in addition, performed Qigong twice a week for 12 weeks. Psychological variables, health-related quality of life, perceived relaxation and physical measurements were assessed at baseline and after the intervention period.RESULTS: No significant difference in treatment efficacy between the groups was found by either intention-to-treat or per-protocol analyses. Both groups improved significantly over time, with reduced levels of burnout, fatigue, anxiety and depression, and increased dynamic balance and physical capacity. CONCLUSION: In this study, a Qigong intervention twice a week for 12 weeks had no additional effect beyond basic care for patients with burnout.
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| 10. |
- Stenlund, Therese, et al.
(författare)
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Patients with burnout in relation to gender and a general population
- 2007
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 35:5, s. 516-523
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: The aims of this study were to describe gender differences in patients with burnout and compare these patients with a general population with respect to physical, psychosocial and work variables. METHODS: Data were collected from a total of 136 patients (96 women and 40 men, 41.6 +/- 7.4 years), diagnosed with stress-related disease and burnout at the Stress Clinic, University Hospital of Umeå. Data on burnout, physical, psychosocial and work characteristics were compared with similar data from a geographical and age-matched population based survey, the 2004 Northern Sweden MONICA study. The survey sample included a total of 573 participants (283 women and 290 men, 40.7 +/- 8.5 years). RESULTS: Women with burnout reported a higher rate of impaired awakening, lower job control, greater proportion of unpaid work and worked to a greater extent "with people" compared to men. Men with burnout had a more restricted social network and reported working more overtime than women. Patients with burnout reported a higher rate of unemployment, a more restricted social network and higher work demands compared to a general population. Women with burnout reported less emotional support, a more sedentary work situation, high job strain and worked to a greater extent "with people" than women from the general population. CONCLUSIONS: There are some differences in working conditions and social network between women and men with burnout. Patients with burnout differ from a general population regarding individual and social factors as well as work-related factors.
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