| 1. |
- Wiklund, Maria, 1962-
(författare)
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Close to the edge : discursive, gendered and embodied stress in modern youth
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Adolescent subjective health and mental problems have become a public health concern not only in Sweden but worldwide. The overall aim of this thesis is to deepen and widen the understanding of young peoples’ subjective health, psychosomatic and stress-related problems. A special focus is put on experienced stress among adolescent girls and young women. The study setting is one youth health centre, and three upper secondary schools in Umeå, a university town in northern Sweden. The research design combines qualitative and quantitative methods with the main focus on qualitative methods. An interdisciplinary theoretical synthesis is utilised, primarily based on bio-psycho-social, phenomenological, and social constructionist approaches. The three qualitative papers (I-III) are based on the same sample of 40 young women who had sought help at the youth health centre because of their stress-related problems. Paper I explores the stressors experienced by the young women, whereas Paper II explores the lived experiences of stress. Paper III examines the young women’s experiences of living in a violent partner relationship as young teenagers, and how this has affected their lives and health over time. Paper IV investigates perceived stress and subjective health complaints among older adolescents in upper secondary school. Methods Data was derived from: a) a qualitative interview study with 40 adolescent girls and young women, aged between 16–25 years, who had sought help at the youth health centre for stress problems. Qualitative content analysis was used in combination with discourse-orientated analysis (Paper I); a phenomenological approach (Paper II), and narrative method (Paper III); b) a school-based survey with a sample of 16–18-year-old boys and girls (n=1027), in upper secondary school, grades 1 and 2, from different educational programs at three schools. Perceived stress, self-rated health, subjective health complaints, anxiety, and depression, were measured with a questionnaire including a set of instruments. Statistical analyses were descriptive and analytical. Results Paper I identified multiple stressors of modernity, gender orders and youth. Contextual factors, including social constructions and practices of gender, played an important role for the stress experienced by these young women. The results revealed that multiple and intersecting stressors and demands connected to essential life spheres, contributed not only to experiences of distress but also to feelings of constraint. Moreover, the roles of excessive taking of responsibility and failing adult support were revealed. Paper II illuminated multidimensional lived and embodied experiences of distress. ‘Living close to the edge’ emerged as the common theme running through all of the interviews and captured the young women’s sometimes unbearable situations. The theme contains dimensions of physical, emotional, cognitive, social, and existential distress, as well as dimensions of distrust and disempowerment. Paper III examined two Swedish adolescent girls’ experiences of living in a violent relationship as teenagers, and how this has affected their lives and health over time. The analysis revealed violation, stress, trauma, coping, and agency during adolescence and the transition into adulthood. Paper IV showed a high level of perceived stress, and subjective health and stress complaints among boys and girls. High pressure and excessive demands from school were experienced by a majority of boys and girls. Perceived stress was correlated with subjective health and stress complaints and anxiety. There was a clear gender difference: two to three times as many girls than boys reported subjective health complaints, e.g. headaches, tiredness and sleeping difficulties, musculoskeletal pain, sadness and anxiety. Conclusion Several issues of relevance to public health were raised throughout the thesis. According to the interview results, the young women face multiple and intersecting stressors of modernity, gender orders and being young, which correspond to their multidimensional experiences of ‘living close to the edge’. Their experiences of stress are multidimensional, and include physical, emotional, cognitive, social and existential dimensions. Findings from the qualitative study were also mirrored in the findings from the larger group of adolescents in the school survey, where a high proportion of older adolescents, particularly girls, reported perceptions of stress. Moreover, perceived stress correlated to a variety of subjective health complaints and anxiety. The results can be understood and explained from a variety of perspectives. The experience of ‘managing alone’ indicated perceptions of inadequate social support. The overall results indicated a risk of more negative health development, particularly among adolescent girls and young women. Stressors of modernity, gender orders and youth were prominent. The continuation and normalisation of oppression and violence are also discussed as a severe gendered stressor in young women’s lives. This calls for a broad contextualised and gender-sensitive approach to young people’s stress and health problems. In conclusion, the age and gender gap in adolescent health needs to be further explored, and processes of distress, distrust and disempowerment have to be taken more seriously.
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| 2. |
- Hedström, Erik, 1977-
(författare)
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Fractures in children : a population-based study from northern Sweden
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Fractures and other injuries are notoriously common in childhood and adolescence and a major cause of morbidity. They place a heavy burden on individuals, families, health systems and society. In a population-based study using data from the Injury Database at Umeå University Hospital we analysed injuries, and especially fractures, in Umeå and it´s five surrounding municipalities to increase knowledge on the epidemiology of injuries in children. We found an injury rate requiring visits to the hospital’s emergency department of 110/1000 person-years among those 0-19 years of age. For the same age group, the incidence of injuries resulting in admittance to hospital was 132/104 person-years. The incidence of fractures was 201/104 person-years. The accumulated risk of sustaining a fracture before 17 years of age was 34%, and the peak sex-specific incidence of fractures coincided with the pubertal growth spurt in both sexes. Fractures were more common from May-September when temperatures were warmer and days longer. The most common activity at injury in toddlers and preschool children was play, whereas teenagers were more often injured in sports and traffic-related activities. In an analysis of fracture incidence between municipalities we noted that children and adolescents growing up in rural communities appeared to sustain fewer fractures than their peers in an urban municipality, risk ratio 0.81 (95 % confidence interval 0.76-0.86). We speculated that this observation might be due to differences in behaviour and activities among teenagers in rural and urban communities. In a further analysis we combined data from the Injury Database with socioeconomic microdata. By linking data between individual children and their parents/families we could analyse the relevance of socioeconomic variables and the number of siblings on fracture rate. We observed that children in households with higher incomes sustained significantly more fractures. Comparing the highest and lowest quintiles for income, the rate ratio was 1.40 (1.28-1.54). We also found that having siblings correlated with an increased risk of fractures, rate ratio 1.28 (1.19-1.38). Parents’ education level and family type did not influence the prevalence of fractures significantly. It appeared that the association between variables at the individual level and fractures was stronger than the association between municipality and fractures. Conclusions: Our results show that the incidence of fractures varies with sex, age, developmental stages, skeletal growth, activities of daily life, and seasons. However, it is also influenced by place of residence, family’s socioeconomic status and having siblings. Refined methods and data allowing an analysis of subsets of fractures and other injuries on the individual/family- and area-level simultaneously should lead to further insights into the possible causal mechanisms underlying observed correlations.
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| 3. |
- Holmberg, Lars I, 1944-
(författare)
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Health, Risk-Taking Behavior and Sexuality in Swedish Adolescents
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aims of this research were to develop methods of identifying adolescents with unhealthy and/or risk-taking behavior with special reference to sexuality, and to evaluate support measures for young people in need of such interventions. A further aim was to assess strategies for preventing unhealthy and/or risk-taking behavior. Data were obtained by questionnaires (studies I, III, IV and V) and interviews (study II).The results showed that young men involved in unintended pregnancies would benefit from active participation in the decision making regarding continuation or termination of the pregnancy, and from support at Outpatient Clinics for Adolescents in Sweden, including information together with the partner (I).It was also concluded that consideration should be paid to questions and problems, e.g. feelings, apprehensions, moral issues and psychosocial factors, that require individual support from personnel with knowledge and resources to help young men in this difficult situation (II).Among the most important findings regarding young men who had been involved in an unplanned pregnancy were that in this group a high percentage had previously considered suicide and that anabolic steroids were frequently used, compared with young men without experience of pregnancy (III).The finding that unprotected intercourse occurred in a fairly high frequency among 13- to 18-year-olds, despite massive education and easy access to contraceptives, gives reason for further considerations regarding appropriate ways of providing information to young people (IV).Girls and boys in vocational programs in Swedish high schools exhibit more risk-taking behaviors than those in theoretical programs and these two groups differ in clustering and accumulation of these behaviors. This means that preventive interventional strategies need to be elaborated with regard to these differences, with the aim of improving health maintenance among adolescents (V).Child-and-youth centers with a developmental and research capacity need to be established with the broad purpose of drawing up health prevention programs for children and young people.
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| 4. |
- Jerdén, Lars
(författare)
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Health-promoting health services : personal health documents and empowerment
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In 2003, the Swedish Parliament adopted a national public health policy that included the domain - “A more health-promoting health service”. Strategies and tools are needed in the work to reorient health services. Personal health documents are documents concerning a person’s health, and are owned by the individual. Several studies that have evaluated such documents indicate that they could be of interest in health-promotion work. However, there is insufficient knowledge concerning personal health documents that target adolescents, and little is known about the feasibility of such documents in a Swedish cultural context. The concept of empowerment is gaining increased interest for health services, but the associations between empowerment, self-rated health and health behaviour are sparsely studied. The overall aim of the thesis is to explore a strategy - empowerment - and a tool - personal health documents - that might facilitate the work of the public health goal of a health-promoting health service. Specific aims are to examine the feasibility of using personal health documents in health promotion; to examine professionals’ experiences of working with health promotion and personal health documents; to examine the association between personal health documents and self-reported health behaviour change; and to examine the perception of empowerment in relation to self-rated health and health behaviour among adolescents. Two personal health documents that targeted adults and adolescents were developed and evaluated. Distribution to adults in different settings was compared in a cross-sectional study (n = 1 306). Adolescents received the document in school, and surveys were performed at baseline and after one year (n = 339). Practical use and attitudes by document owners were studied by questionnaires. Teachers (n = 69) answered a questionnaire, and community health nurses were interviewed (n = 12). The interviews also explored nurses’ experiences of working with health promotion in general, and were analysed by qualitative methodology. Adolescents’ empowerment was examined by a questionnaire (n = 1 046). Most participants reported reading in the documents; writing in the documents varied between 16% (distribution in occupational health) and 87% (adolescents). The health document was perceived as useful by 35% of the adolescents. Factors significantly related to personal usefulness were being born outside Sweden, experiencing fair treatment by teachers, being a non-smoker and having a positive school experience. Community health nurses were striving for a balance of being a doer of practical, disease-oriented tasks and a health-promotion communicator. The structural organisation in health care centres was important for their work with health promotion and the health document. Teachers were generally in favour of continued work with the document. In different settings, between 10% and 26% of adults reported changes in their health situations as a result of reading the booklet. Self-reported changes in health situations were less likely using postal distribution, and there were no significant differences between the other types of distribution. Adolescents with low empowerment scores reported poorer self-rated health and more risk-taking behaviours such as smoking and binge drinking. To conclude, personal health documents are feasible to use in different settings. Health promotion in health services needs active support from leaders as well as adequate support systems. Findings suggest that personal health documents can be tools for promoting self-reported lifestyle changes among adults in different settings. There is a close relation among adolescents between low empowerment in the domain of health, low self-rated health and health behaviours such as binge drinking and smoking.
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| 5. |
- Petersen, Solveig, 1955-
(författare)
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Recurrent pain and health related quality of life in young schoolchildren
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The objectives of this thesis were 1) to describe the occurrence and co-occurrence of recurrent pain (headache, stomach-ache, and backache) in young school children; 2) to describe Health Related Quality of Life (HRQoL) in these children, from the perspective of the child, 3) to examine the psychometric properties of the PedsQL, a pediatric HRQoL instrument. Three data collections were performed, two in Umeå, Sweden, and one in a nearby smaller municipality, Lycksele. In Umeå, the first survey included schoolchildren from grades 0-6 and three years later all schoolchildren attending grade three and six were approached. In Lycksele all school children attending grades three through six and grade nine were invited to participate. Pain and quality of life were measured by questionnaires. The main findings of the thesis were that 2/3 of the children experienced pain from the head, stomach or back recurrently (at least monthly) and 1/3 experienced weekly pain. Weekly headache was reported by 23% of the children, 19 % reported weekly stomach-ache and 7% weekly backache. Half of the children with recurrent pain conditions reported pain from several body sites, and, in children with weekly pain, 2/3 reported multi-site pain. HRQoL in children with recurrent pain problems was markedly impaired, especially in children with multi-site pain and in children with weekly pain. Finally, The Swedish PedsQL self-report forms showed acceptable psychometric properties. In conclusion, in young schoolchildren, headache, stomach-ache and backache are common conditions associated with a clearly reduced HRQoL. The results show an urgent need for early preventive and curative programs targeting HRQoL domains such as physical, emotional, social and school areas. The results also indicate that recurrent pain should be regarded a potential general pain disorder rather than merely a local disorder. The PedsQL was found to be a reliable and valid measure of HRQoL in young Swedish school-aged children.
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| 6. |
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| 7. |
- Ragnarsson, Susanne, et al.
(författare)
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Recurrent pain in school-aged children : a longitudinal study focusing on the relation to academic achievement
- 2022
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Ingår i: Pain. - : Lippincott Williams & Wilkins. - 0304-3959 .- 1872-6623. ; 163:11, s. 2245-2253
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Tidskriftsartikel (refereegranskat)abstract
- Recurrent pain is an increasing public health problem among school-aged children, with potential negative impact on children's daily lives, such as schoolwork. The overall aim of this study was to investigate whether recurrent pain in school year 6 was associated with poorer academic achievement at the end of elementary school in school year 9. The study was a follow-up study based on data from "The Study of Health in School-Aged Children from Umeå". Participants were 1567 children aged 12 to 13 years who attended school year 6. A follow-up was performed in school year 9, when the children were 16 years old. The children answered a questionnaire about recurrent pain (headache, stomachache, and backache). Information about academic achievement was collected from school registers. The results showed that having weekly recurrent pain in school year 6 predicted lower final overall grade points in school year 9 than in children with no recurrent pain. This applied for recurrent headache, stomachache, backache, and multiple pains and for both girls and boys. Recurrent pain did not predict secondary school eligibility, however. Perceived problems with academic achievement and problems with concentration partly mediated the association between recurrent pain and lower final overall grade points. Sleep problems were not associated with academic achievement and were therefore not a mediator. Thus, the results suggest that recurrent pain may predict later impairment of academic achievement and that problems with concentration and children's perceived achievement in school, but not sleep problems, may partly explain this relationship.
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