| 1. |
- Bergström, Maria, 1983-
(författare)
-
Participation and support in everyday life over a decade : perspectives of persons with rheumatoid arthritis and their significant others
- 2023
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: The treatment of rheumatoid arthritis (RA) has evolved over recent decades. Today, many previous limitations related to, for example, joint damage have become rare, and persons with RA can often continue to work and engage in different aspects of everyday life. Nonetheless, persons with RA still report restrictions in everyday life, as they can be negatively impacted by symptoms like pain, stiffness and fatigue. As these symptoms might be invisible to others, the significant others of persons with RA can find it difficult to comprehend the effect of the disease. As a consequence, both the person with RA and the significant other may be affected, despite today’s effective treatment.As participation is a central concept within healthcare, it is also a prominent factor within rehabilitation and its goals. Despite access to contemporary treatment during the whole disease course, persons with RA still report participation restrictions. Since RA is a chronic disease, these remaining restrictions are of particular interest from a longitudinal perspective. However, support from the social environment, such as significant others, has the possibility to positively influence participation in everyday life. Therefore, it is essential to explore the influence of significant others and their support with the goal of enhanced participation in the everyday life of persons with RA, from a longitudinal perspective.Aim: The general aim of this thesis is to explore participation in the everyday life of persons with RA over a decade, and in relation to this investigate the influence of significant others and their support.Methods: This thesis consists of four studies that used different methodological approaches: qualitative, quantitative and mixed methods.Study I was a qualitative study where 59 persons with RA participated in semi-structured interviews approximately three years after diagnosis. Questions covered experiences in everyday life and participation. The material was analysed through content analysis.In Study II, longitudinal data from 274 persons with RA were analysed regarding disease activity (assessed by DAS28), grip force (assessed by Grippit), pain intensity (VAS mm) and activity limitations (assessed by HAQ). The data were collected at inclusion, year one and year two after diagnosis. Data related to sickness absence were also obtained, as well as self-assessed perceptions of experienced support. Through regression analyses, associations between disease-related variables and sickness absence were investigated, with support as a moderator.The data in Study III comprise semi-structured individual interviews with 16 persons with RA and their significant others, conducted approximately a decade after diagnosis. The interview guide was developed with Study I in mind and included similar topics, with the addition of support. This material was analysed using dyadic analysis, where a person with RA and the significant other comprised a dyad.Finally, in Study IV, a convergent mixed methods approach was used. Longitudinal data regarding disease-related variables (same as Study II) were collected during the first decade after diagnosis and analysed through linear mixed models. The qualitative material consisted of individual interviews conducted three and ten years after diagnosis and analysed by directed content analysis. The quantitative and qualitative results were integrated in accordance with the chosen method.Results: Significant others of persons with RA could encompass both facilitators and hinders to participation in the everyday life of persons with RA. Through the provision of support and helpful attitudes towards needed adaptations, they had a positive influence on participation in the everyday life of persons with RA. This was a continuous process since the persons with RA were still affected by the disease a decade after diagnosis, and adaptations by the significant others might also still be needed.Experiences of RA were found to differ between men and women over the first decade after diagnosis. Moreover, through a mixed methods design, discrepancies were found between the persons’ own descriptions in interviews and the quantitative results. For instance, women expressed issues related to grip force and disease activity in the interviews, but these issues were not detected in the same way in the quantitative results. These discrepancies were additionally not seen in men; however, both men and women still showed signs of disability a decade after RA diagnosis. Nevertheless, over time, the persons with RA and their significant others had learned to live with the disease and there was a sense of togetherness in everyday life with RA. Namely, they approached the disease together as a unit.Support was identified as a positive aspect that facilitated everyday life. It entailed both the support between the person with RA and the significant other, as well as the support from others outside of the dyad. Support could also come in different forms. For example, the person with RA could receive emotional support from a significant other, or healthcare professionals (HCPs) could provide informational support to either or both of the parties. In connection to the latter, a continuous need for knowledge was identified in both the persons with RA and the significant others. Support from significant others also proved to have an impact on work life specifically, as more perceived support was associated with an increased risk of sickness absence.Conclusively, significant others and their support can influence participation in the everyday life of persons with RA, and this influence can be facilitated through positive attitudes and different types of support during the first decade after diagnosis.Conclusions: Significant others are essential providers of support as facilitators for participation in the everyday life of persons with RA, including many years after diagnosis. However, they must also be attentive towards the further need for adaptations and possible emotional burden in the persons with RA. It is also important for significant others to find a balance between overprotecting and contributing to independence.The significant others in their turn might need support in understanding the impact of the disease. In this case, HCPs should be providers of support to both persons with RA and their significant others and consult with both of them as a unit in the rehabilitation process. This also exemplifies the need for support from outside the dyads of persons with RA and their significant others.Support is requested both at an early stage and throughout the disease course. Different types of support from significant others can therefore preferably be part of the rehabilitation process as a way to enhance participation in the everyday life of persons with RA.
|
|
| 2. |
- Söderström Malmborg, Julia, 1988-
(författare)
-
Pain and health in adolescents and young adults – pieces of a puzzle
- 2020
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Musculoskeletal pain is a burden for the individual and for society, and it has a negative impact on overall health. The biological, psychological, and social factors that govern pain and health form a complex puzzle to put together. Musculoskeletal pain conditions may be alleviated by physical activity, but a too high level of physical activity may also increase the risk of pain. Youth athletes may be especially vulnerable to developing pain due to factors related to training load and physical maturity. Being physically active and maintaining a healthy diet is associated with better health, but if carried out to excess these health behaviours may become unhealthy. Our understanding of musculoskeletal pain and health in adolescents and young adults needs to be developed, both in individuals involved in sports and exercise and in the general population.Aim: The overall aim was to study musculoskeletal pain and its relationship to various health-related factors in adolescents and young adults enrolled in sport or general education programmes.Methods: Study I was a cross-sectional study on university students (aged 19–29) from an exercise science programme (n = 118) and a business programme (n = 89), assessing health status, physical activity, and orthorexia nervosa (an exaggerated fixation on healthy food). Study II was a cross-sectional study (n = 178), and Study III a 2-year longitudinal (n = 131) study on sport school students (aged 14 at baseline), assessing musculoskeletal pain, health status, physical maturity, and sports performance. Study IV was a 3-year longitudinal study on students from a general upper secondary school (n = 256, aged 16 at baseline), assessing chronic musculoskeletal pain, health status, physical activity, sleep, stress, anxiety, and depression.Results: In Study I, compared to business students, exercise science students reported more pain, but better general health. A high level of physical activity in combination with orthorexia nervosa was most prevalent in men from the exercise science programme. In Studies II and III, pain was common in sport school students. At baseline, boys with constant pain were not as physically mature as boys with infrequent pain. Students with constant pain reported a worse health status than students with infrequent pain. At follow-up, frequent pain, frequent pain in two or more body regions, and a worse health status at baseline were identified as risk factors for having frequent pain at follow-up in girls. For boys, late physical maturation at baseline was a risk factor. Involvement in non-contact sports was also an identified risk factor over time in both sexes. Pain was associated with a worse sports performance in boys at both baseline and follow-up. In Study IV, chronic musculoskeletal pain was common in students from a general upper secondary school. A worse health status, severe sleeping problems, anxiety, and chronic musculoskeletal pain at baseline were associated with reporting chronic musculoskeletal pain at follow-up.Conclusions: Pain was prevalent, and also persistent, in adolescents and young adults, irrespective of attending sport or general education programmes. Pain is a biopsychosocial phenomenon and must be treated as such. Pain should be frequently monitored, and treatment should be introduced early on to prevent pain from becoming persistent.
|
|
| 3. |
- Arvidsson, Susann
(författare)
-
Health promoting factors in people with chronic musculoskeletal pain or with rheumatic diseases: a descriptive and interventional study
- 2011
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of this thesis with a salutogenic approach was to describe health promoting factors in people with chronic musculoskeletal pain and in people with rheumatic diseases, and to evaluate the effects of an intervention study with a self-care promoting PBL-program for people with rheumatic diseases having chronic musculoskeletal pain, sleep disturbances and/or fatigue. Methods: This thesis is comprised of four samples: a randomly selected sample from a Swedish general population (study I) and three different samples containing people with rheumatic diseases registered at a hospital for rheumatic diseases in the southwest of Sweden (studies II, III and IV). Study I had a longitudinal cohort design with an eight-year follow-up in a general population. There were 1109 participants without chronic pain and 700 participants with chronic musculoskeletal pain. Study II had a longitudinal cohort design with participants with rheumatic diseases (n=185) 12 months after rehabilitation at a hospital for rheumatic diseases. Study III had a descriptive qualitative design with a phenomenological approach based on a reflective life-world perspective. Twelve participants were interviewed about their experiences about health-promoting self-care. Study IV had a randomised controlled design with post-test six months after the one-year self-care promoting problem-based learning (PBL) program for people with rheumatic diseases. The participants were randomly assigned to the experimental group, 54 participants, or to the control group, 148 participants. Data in studies I, II and IV were analysed with statistics. In study III a Husserlian phenomenological approach based on a reflective life-world perspective was used in the data collection and analysis. Results: Study I: Although participants without chronic musculoskeletal pain reported better health-related quality of life (HRQL) than participants with chronic musculoskeletal pain, similar health factors were found to promote a better HRQL in the eight-year follow-up. The most important factors were feeling rested after sleep and having good sleep structure. Study II: The most important factors promoting better outcome in HRQL 12 months after rehabilitation in participants with rheumatic diseases were having a strong sense of coherence (SOC), feeling rested after sleep, having work capacity, and having good sleep structure. Study III: The meaning of health-promoting self-care as experienced by people with rheumatic diseases was that self-care takes place against a background of continual hope and belief to be able to influence health in positive ways. Self-care was a way of life and implied being ready to understand and respond to signals from the body. Three interrelated constituents elucidated the experiences: dialogue, power struggle and choice. Study IV: At the six month follow-up the participants in the experimental group had stronger empowerment after participation in the self-care promoting PBL-program compared with the control group which only got standard care for people with rheumatic diseases. There were no differences in HRQL, self-care ability, SOC, pain, quality of sleep or fatigue between the experimental group and the control group. The participants in the experimental group also stated that they had implemented lifestyle changes which they had not done without the PBL-program. Conclusion: The results of this thesis provide a valuable and useful insight in health promoting factors in people with chronic musculoskeletal pain and in people with rheumatic diseases, but also in that people with rheumatic diseases have benefit from taking part in patient education with a self-care promoting PBL-program. These results contribute to evidence supporting the introduction of a more salutogenic approach in rheumatology care and research.
|
|
| 4. |
- Bergman, Filip, 1992-
(författare)
-
Sustainability performance of multi-utility tunnels : Sustainability assessments for furthering knowledge and understanding
- 2022
-
Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The multi-utility tunnel has received increased attention as an alternative method for the installation of subsurface infrastructure for the distribution of electricity, water, sewage and district heating. In previous research, the multi-utility tunnel (MUT) has been described as a more sustainable technology compared to the conventionally used technique where the cables and pipes are placed with open-cut excavation (OCE), especially when the entire life cycle is taken into account. This thesis aims to contribute to an improved understanding of MUT's sustainability performance in relation to conventional installation using open-cut excavation. This is done by using literature study, interview study and quantitative sustainability assessments to gain an understanding of the current state of knowledge. Furthermore, this thesis also focuses on how knowledge can be deepened with the help of quantitative sustainability assessments and the challenges of conducting this type of assessment. This thesis shows that the state of knowledge regarding MUT's sustainability performance is low and scattered, with a lack of a holistic approach. Direct economic performance has gained the most attention, followed by indirect and social impact, and the environmental impact has so far barely been assessed. The sustainability performance depends to a large extent on the conditions of the specific case, and these should be considered when assessing the technology. Quantitative assessments have the potential to help deepen the knowledge of the sustainability implications of using MUT. The characteristics of MUT have some similarities with other types of physical infrastructure. Similarities are that the systems are long-lived, have project conditions that affect sustainability performance, and impact a broad spectrum of actors. One difference to typical infrastructure systems is that the owner and management structure of MUT is, by design, more complex as several types of utility systems are in use. The characteristics of MUT give some practical considerations that need to be addressed: data availability, including practitioners; detailed data; transparency; and flexibility. This thesis highlights the complexity of assessing MUT´s sustainability performance and advocates that future studies should have a learning-oriented approach so that the knowledge level can collectively and gradually improve over time rather than focusing on decision-oriented studies.
|
|
| 5. |
- Bergman, Niclas
(författare)
-
Aspects of probabalistic serviceability limit state design of dry deep mixing
- 2015
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- An expanding population and increased need for infrastructure increasingly necessitate construction on surfaces with poor soil conditions. To facilitate the construction of buildings, roads and railroads in areas with poor soil conditions, these areas are often improved by means of foundation engineering. Constructions that are fairly limited in scope are often founded on shallow or deep foundations. However, these methods are relatively expensive and thus not applicable for large-scale constructions like roads and railroads. A cost-effective way to deal with poor soil conditions is to use ground improvement. This thesis deals with a ground improvement method called deep mixing (DD)using lime-cement columns.Lime-cement columns are manufactured by pushing a mechanical mixing tool to the desired depth, with the tool then rotated and retracted while a lime-cement binder is distributed into soil, forming lime-cement columns. Because of the complex mixing process and inherent soil variability, soil improved by DD shows high variability with respect to strength and deformation properties. Due to this high variability, it is difficult to predict the properties in advance; it is therefore important to verify the properties after installation. In Sweden, this is normally done using the column penetration test (KKK) method.Current design praxis considers evaluated mean values in the design, and the effect of variability and uncertainties is dealt with by using a sufficiently high total factor of safety. A more rational approach for dealing with the effect of variability and uncertainties on the reliability of a mechanical system is to include them as parameters in the design model. This can be done by using reliability-based design (RRR). A major incentive for using ??? is that lower variability in design properties produces higher design values. This is important since it encourages contractors to improve their manufacturing methodologies because ??? allows more homogenous columns to be assigned higher design values. Reliability-based design is also in line with Eurocode 7, which states that the selection of the characteristic values for geotechnical parameters shall take the variability of the measured property values into account.The first part of this doctoral thesis deals with test methods and quantification of the strength variability of soil improved by lime-cement columns. Tip resistances from three different test sites using three different penetration test methods – the cone penetration test, the column penetration test and the total-sounding test – are analysed and quantified in terms of means, variances and scale of fluctuations. The second part introduces RRR in serviceability limit state (SSS) design, using First Order Reliability Methods (FFFF) and Monte-Carlo simulations.Summarizing the most important findings and conclusions from this study: The scale of fluctuation was estimated to be 0.2-0.7 m and 0-3 m in the vertical and horizontal direction, respectively. The relation between cone tip resistances measured using the cone penetration test and column penetration test does not correspond to the cone factors proposed in previous studies and in the Swedish Design Guidelines. The agreement between the column penetration test and total-sounding test was found to be “good enough”. It is therefore suggested that the total-sounding test be used as a complement to the column penetration test in evaluating the average strength properties of a group of medium- and high-strength lime-cement columns.Reliability-based design is a rational approach to incorporate strength and deformation parameter variability with an SSS design.
|
|
| 6. |
|
|
| 7. |
- Bergsten, Ulrika, 1966-
(författare)
-
Patients' and healthcare providers' experiences of the cause, management and interaction in the care of rheumatoid arthritis
- 2011
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of this thesis was to explore and describe patients’ and healthcare providers’ experiences of the causes, management and interaction in the care of rheumatoid arthritis (RA). Method: The thesis is based on four studies. Studies I and II contain data from an epidemiologic project involving patients who were recently diagnosed with RA. The patients answered an open-ended question about their conception of the cause of their RA (Study I). Qualitative data from 38 patients were analysed using the phenomenographic approach in order to identify variation in conceptions. The results of Study I formed the basis for categorizing the conceptions of 785 patients in the search for patterns of background factors (Study II). Study III aimed to explore how patients experienced their management of RA in everyday life. Data were collected by interviews with 16 patients and analysed according to Grounded Theory (GT). In study IV, the aim was to explore healthcare providers’ experiences of their interaction with patients’ management of RA. Data were collected by interviews with 18 providers representing different professions and analysed using GT. Findings: Patients’ conceptions of the cause of their RA revealed new aspects from the patient perspective that can complement pathogenetic models. Two descriptive categories emerged: consequences beyond personal control and overloaded circumstances, which included six categories of conceptions (Study I). The most common conceptions of the cause of RA were unexpected effects of events followed by work and family-related stress (Study II). Background factors that influenced the conceptions of the cause were age, sex and educational level. Patient management of RA involved using personal resources together with grasping for support from others in their striving for a good life. When linking these aspects together, four ways of management emerged: mastering, struggling, relying and being resigned (Study III). Healthcare providers’ experiences of their interaction with patients’ management shed light upon the important issue of delivering knowledge and advice. The providers’ attitudes constituted one cornerstone and patients’ responses the other. The providers reported that the interaction led to different outcomes: completed delivery, adjusted delivery and failed delivery. Conclusions: The findings contribute new knowledge from both patients’ and healthcare providers’ perspectives, which could be used to develop a more person-centred approach in rheumatology care. Person-centred care involves taking patients’ beliefs and values into account in addition to creating a trusting relationship between patient and provider. A successful person-centred approach requires an organisation that supports the person-centred framework.
|
|
| 8. |
- Emilson, Christina, 1969-
(författare)
-
Long-term perspectives on musculoskeletal pain : Health care utilization and integration of behavioral medicine treatment into physical therapy
- 2017
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- There are currently no effective methods for treating and preventing chronic pain. The aim of this thesis was to study prognostic factors for health care utilization, and the long-term outcomes of tailored behavioral medicine treatment for patients with musculoskeletal pain. Another aim was to increase knowledge about physical therapists’ assessment and analysis of patients’ pain conditions and to investigate the potential of subgrouping patients based on prognostic factors.Methods: In Study I, a prospective population-based cohort was followed over 21 years. Data from three measure points were analyzed: 1995 (n=2425), 2007 (n=1582) and 2016 (n=1184). Study II was a 10-year follow-up of randomized controlled trial (n=97), comparing tailored behavioral medicine treatment and exercise-based physical therapy. In Study III, a descriptive and explorative design was applied, using data from video-recordings of 12 physical therapists. In study IV, assignment to three subgroups based on the Örebro Musculoskeletal Pain Screening Questionnaire was validated against reference instruments, and the stability between two points of measurement was investigated in patients (n=40) who were seeking primary health care due to musculoskeletal pain.Results: Chronic pain, female gender and high age predict high health care utilization over 21 years, and a trajectory of stable high health care utilization over the entire period. The differences between groups in favor for tailored behavioral medicine treatment reported at post-treatment and after two years, were not maintained at the 10-year follow-up. A majority of the physical therapists assessed factors for poor prognosis. The analyses were mainly based on biomedical assessments and none of the physical therapists included behavioral factors. Subgroup assignment according to the Örebro Musculoskeletal Pain Screening Questionnaire appears to be valid and stable over time.Conclusion: Prognostic factors such as chronic pain and female gender need to be considered when allocating health care resources and planning treatment to improve long-term outcomes. The treatment should also be tailored based on individual functional behavioral analyses of key behaviors and on patient´s biomedical and psychosocial condition, including strategies for maintenance of behavioral changes. Evidence-based methods for integrating behavioral medicine treatment into physical therapy need to be further evaluated and improved.
|
|
| 9. |
- Filipsson, Karl, 1991-
(författare)
-
From behaviour to genes: anti-predator responses of brown trout (Salmo trutta) under winter conditions
- 2020
-
Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Temperature has major effects on the performance of poikilotherms. In encounters with predators, low winter temperatures constrain predator detection and escape capabilities in prey fishes. Most studies of the anti-predator responses of fish under winter conditions focus on endothermic terrestrial predators, whereas effects of piscivorous fish are generally overlooked. The studies presented in this thesis explore behavioural and physiological responses of juvenile brown trout (Salmo trutta) at winter temperatures of 3 and 8 °C in the presence and absence of a winter-active piscivorous fish (burbot, Lota lota). In Paper I, I report behavioural responses of trout in relation to the time of day. At the lower temperature and in the presence of burbot, trout reduced their activity. Trout used overhead shelter the most during the day and in the presence of burbot. Trout also spatially avoided burbot at night and at dawn but not during the day. In Paper II, I examined plasma cortisol and mRNA expression of stress-related genes. A redundancy analysis showed that both temperature and the presence of burbot explained a significant amount of the observed variation. Trout had higher cortisol levels when exposed to the burbot. Analyses of individual gene expressions revealed that trout had higher mRNA expression at 3 than at 8 °C for 11 of the 16 examined genes. Only one gene, RBP1, was expressed to a higher degree in the presence of burbot, but there were also interaction effects between temperature and burbot presence for two genes coding for serotonin and glucocorticoid receptors. My studies show that piscivorous fish shape anti-predator responses of juvenile brown trout, both behaviourally and at the gene level, under winter conditions. The observed thermal effects on mRNA levels underscore the importance of temperature in fish stress responses, with implications for stream salmonids in a warmer climate.
|
|
| 10. |
- Holmström, Stefan, 1970-
(författare)
-
Workplace stress measured by Job Stress Survey and relationships to musculoskeletal complaints
- 2008
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The main purpose of this thesis was to evaluate and test the Job Stress Survey (JSS, Spielberger, 1991; Spielberger & Vagg, 1999), a self-report instrument which assesses workplace stress. In the thesis a thorough evaluation is made of JSS scales and items, and the relations to health, particularly musculoskeletal complaints. The aim of Study I was to evaluate the factor structure and the psychometric properties of a Swedish version of the JSS. The instrument was distributed to medical service personal and metal industry workers (n=1186). Factor analyses demonstrated a good resemblance between the present version and the American original version. The results also showed that the internal consistencies, as well as the test-retest reliabilities of the scales are high, and the concurrent validity are good. Study II examined work-related stress measured by JSS for the subgroups of gender, industry workers and medical service personnel, and special attention was given to the problem of differential item functioning (DIF) on these subgroups. The main findings were that both gender and occupation has a substantial impact on specific sources of work-related stress assessed by JSS scales and individual items. The result of the DIF analyses showed no item bias in the gender subgroup, but for the occupational subgroups there where items showing DIF in two of the scales. These items do not jeopardize the conclusions made on scale level since the number of items showing DIF are too few to make an impact on the overall result on the different scales. In Study III the relation between self-reported stress and health, particularly musculoskeletal problems were examined longitudinally in two metal industry factories. Results showed high levels of stress and musculoskeletal complaints in these factories and significant and strong relationships between the JSS scales and musculoskeletal, as well as psychosocial ratings. Lack of Organizational Support was found to be more related to musculoskeletal pain than Job Pressure. Longitudinal differences were found between the factories and between different types of musculoskeletal complaints. The general conclusions from the studies are that the present version of JSS shows a good resemblance with the American original, and that JSS is a useful instrument for studying relationships between stress and health.
|
|
