| 1. |
- Albin, Björn
(författare)
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Morbidity and mortality among foreign-born Swedes
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims: The general aim of this thesis was to describe and compare the group of foreign-born persons living in Sweden and native Swedes with regard to health development over time, thus studying the influence of migration on health. Methods: All four studies are based on data from Statistics Sweden (SCB) and the National Board of Health and Welfare, Centre for Epidemiology covering the period 1970?1999. The database used included all foreign-born persons aged 16 years and upwards who were registered as living in Sweden in 1970. For each foreign-born person a Swedish matched control was chosen. The control was matched and was similar in age, sex, occupation, type of employment and county of residence in 1970. In total 906,564 people were included, 50 percent foreign-born persons. Information from the National Board of Health and Welfare, Centre for Epidemiology on date of death and death diagnosis was added to the database. Exclusion criteria were if no information was available or if a person had emigrated or migrated back (?re-migrated?). Persons were then also excluded if the information from the control subject was missing due to migration. The database used for analysis finally consisted of 723,948 persons, 361,974 foreign-born and 361,974 Swedish controls. All statistical analyses were carried out using the SPSS (Statistical Package for Social Sciences) program, version 11.5, and both descriptive and analytic statistic methods were used. Results: The results of the four studies show that foreign-born persons living in Sweden 1970?1999 have higher mortality, lower mean age at time of death and a different pattern of causes of death. The studies also found a tendency to less utilization of health care and that county of residence influences mortality among foreign-born persons. The most important finding was that migration has an influence on health. Conclusion: To explain the differences found in health among foreign-born persons, several different factors have to be taken into account. Health is influenced by economic situation, housing, working conditions, unemployment, social network and background before migration. Social and physical environment or inequalities in resources and utilization of health care are important. Migration is shown to have a negative influence on health and is an important factor to consider when studying mortality and health in a population.
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| 2. |
- Westman, Anders, 1946-
(författare)
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Musculoskeletal pain in primary health care : a biopsychosocial perspective for assessment and treatment
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Long-term musculoskeletal pain is a large public health problem with serious consequences for both the individual and society. Psychosocial factors have been shown to be good predictors of long-term disability and play an important role in the transition from acute to chronic pain. Early identification and intervention of those that run the risk of developing long-term disability would offer a great opportunity for reducing costs and personal suffering. The overall aim of this thesis was to assess a biopsychosocial approach to the assessment and management of musculoskeletal pain patients in primary health care. To this end, biopsychosocial assessment and treatment methods were tested in two different populations of primary care patients suffering pain. Results indicated that improvements in quality of life and work capacity one year after early multimodal rehabilitation were basically maintained after five years. The most salient prognostic factors determining return to work were educational level and the individual’s perceived health (Study I). Psychosocial factors as measured by the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) were related to disability and perceived health three years after treatment for non-acute pain problems (Study II). The experimental group in the controlled multimodal pain rehabilitation programme had lower health care utilization and a reduced risk of using large amounts of medication after three years compared with the participants in the control group. However, there were no significant differences between the groups on variables such as work capacity, function, catastrophizing and pain (Study III). Distinct profiles of catastrophizing, fear-avoidance beliefs, and distress were extracted and meaningfully related to future sick leave and dysfunction (Study IV). Our findings provide support for the biopsychosocial model and highlight the importance of psychosocial factors in long-term outcome. The results underscore the need for early identification of patients at risk. Further, multimodal treatment that covers not only biological but also psychosocial factors seems to be a key to successful treatment, and ideally this intervention should be matched to the patients' needs.
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| 3. |
- Yuwanich, Nuttapol, 1985-
(författare)
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Occupational stress among Thai emergency department nurses : Development and validation of an instrument for measuring stressors in emergency departments
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Working at an emergency department has some characteristics, which may generate stress. In this thesis, the stressors for emergency nurses were evaluated and an instrument was developed for measuring their impact. In order to gain a deeper understanding regarding the occupational stress among emergency nurses, a descriptive qualitative design with semi-structured interviews were used in two studies (I, II), one at a private and the other at a public hospital in Thailand. Three main categories of stressors were identified, related to the activity at the emergency departments, to human factors and to perceived consequences of these factors. Nurses in both private and public hospitals frequently experienced occupational stress, which influenced their psychophysiological health, and resulted in incomplete nursing care. Since no validated instrument had been published for measuring stressors in emergency nurses’ workplace, a scoping literature review was performed and a questionnaire for this purpose was developed, based on the review and the results from the interviews (I and II). The questionnaire was validated (III) and the influence of socio-economic factors were evaluated (IV). Four-hundred and five emergency nurses in Thailand completed a questionnaire containing 59 items. The responses were analyzed using 1) item generation, 2) content and face validity and test-retest reliability and 3) evaluation of the internal consistency and construct validity of the instrument. An exploratory factor analysis was performed on 200 of these responses and a confirmatory factor analysis on the remaining 205. The analysis provided a final four-factor solution with 25 items distributed among the factors Life and death situations, Patients’ and families’ actions and reactions, Technical and formal support, and Conflicts. The statistical evaluation (Cronbach’s alpha and intra-class correlation coefficient) indicated good homogeneity and stability. The type of organization, educational level and average income were associated with stressor related to Life and Death situations. Stressor related to Patients’ and families’ actions and reactions was predicted by educational level. While sociodemographic variables had no influence on stressor related to Technical and formal support and Conflicts. Future research regarding patient safety should focus on both emergency nurses’ and patients’ perspectives regarding consequences of occupational stress related to patient safety. Different perspectives may create a knowledge-base which can be used to develop guidelines or protocols aiming at reducing nurses’ stress and prevent its consequence, such as poor patient safety.
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| 4. |
- Grape Viding, Christina, 1966-
(författare)
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Cultural activities and health : Singer, patient, and healthcare staff perspectives. From feelings to biology
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objectives. The aim of this thesis was to explore and illuminate possible associations between various cultural activities and assessments of well-being, health, stress and emotions in a didactic setting and healthcare settings for singers, patients, and healthcare staff. Material and methods. Paper I describes an empirical intervention study with repeated measures from a small cohort of singers, before, during and after a singing lesson. Physiological and endocrinological measures, as well as self-ratings were used. A two-way analysis of variance (ANOVA), as well as non-parametric tests were used. Paper II describes a randomised controlled trail for women with exhaustion symptoms participating in an intervention called the “culture palette”, consisting of six different cultural activities. Exhaustion, alexithymia, sense of coherence and self-rated health with standardised scales were assessed. A Linear Mixed Models were used. Paper III describes a study using a phenomenological hermeneutical method in analysing focus group interviews with women with burnout symptoms and cultural producers and separate interviews with health care managers to elucidate the experiences of participating in the culture palette. Paper IV describes a study with a phenomenological hermeneutical method analysing focus group interviews with healthcare staff members about their experiences of participating in self-chosen cultural activities.Results. The analysis of paper I showed increased wellbeing and joy in amateur singers. The professional singers showed better cardio-physiological fitness during singing. Both groups experienced more energy and relaxation after the singing lesson. The analysis of paper II showed decreased symptoms of exhaustion, alexithymia and increased self-rated health in the women after participation in the cultural activities. However, there was no significant differences between intervention and control groups regarding sense of coherence (SOC). Paper III describes the analysis of the interviews and shows three themes, where the culture palette impacted on the level of the body, group and indirectly on the managers and healthcare organisation. Paper IV describes the analysis of the interviews and shows three themes where cultural activities had a positive impact on the physical/psychological level, and enhanced work relations. Challenges in implementing cultural activities in the healthcare organisation were illuminated. Conclusion. The cultural activities included in these studies show beneficial effects on health for individuals and groups, as well as for healthcare organisations. The multimodal components integrated in cultural activities exhibit possibilities of enhancing health, wellbeing and preventing and managing stress reactions. Cultural activities can enable the development of a more sustainable healthcare and eventually a more sustainable society.
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| 5. |
- Karlén, Jerker, 1971-
(författare)
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Early stress, cortisol in hair and health among children in different psychosocial environments
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Psychosocial circumstances during early life are increasingly recognized as crucial, not only for the growing individual but also for health throughout life. A possible mechanism could be physiologic dysregulation due to stress. Cortisol in hair is a new biomarker that allows assessment of long-term activity of the hypothalamic-pituitary-adrenal axis.The objective of this thesis was to investigate the relationship between early stress, levels of cortisol in hair and health among children in different psycho-social environments.The ABIS-study is a prospective population-based cohort study of every child born in southeast Sweden between Oct 1 1997 and Oct 1 1999 (N=21,700) in which approximately 17,000 families (79%) participated. The studies presented in Papers I, III and IV were based on ABIS data on children aged 1, 3, 5 and 8 years concerning stress related psychosocial variables as well as hair samples and diabetes related autoantibodies. Papers I and IV compared a subsample (n=2,448) from two different social environments. Paper III consisted of a subsample of 100 children as well as their mothers. Paper II covered 99 university students.Paper I showed that the risk for diabetes-related autoantibodies, both against GADA and IAG2A (>95% cut off), was significantly higher (p<0.0001) among children from the blue-collar than from the white-collar city. This difference persisted still after adjustment for other previously documented risk factors. In paper II the method of measuring cortisol concentrations in hair was developed and mean cortisol levels were significantly related to serious life events (p=0.045) among the students. Paper III demonstrated that, in children from one to eight years of age, cortisol levels in hair decreased over time and correlated to each succeeding age, between years 1 and 3 (r=0.30,p=0.002), 3 and 5 (r=0.39, p=0.001), and 5 and 8 (r=0.44, p=0.001). Repeated measures gave a significant linear association over time (p=0.001). Maternal hair cortisol levels during the second and third trimester and child hair cortisol at year 1 and 3 was also significantly associated. Paper IV showed that children with prenatal psychosocial exposures had higher infant cortisol levels in hair (B=0.40, p<0.0001, adjusted for gender and size for gestational age) in a dose-response manner and were more often (p≤0.05) affected by 12 of the 14 most common childhood diagnoses with a general pattern of rising ORs.In conclusion, the findings in this thesis showed that children born into an environment fraught with adverse psychosocial exposures seem to have an increased hypothalamic-pituitary-adrenal axis activity. It appears to be persistent throughout early childhood and affect health negatively, as evidenced through common childhood diseases and levels of autoantibodies. A widespread and dose response-like effect of adverse psychosocial circumstances was seen on the different outcomes studied throughout this thesis. This supports the model of physiologic dysregulation as a plausible pathway in how the duration and number of early detrimental exposures act as a trajectory to health disparities. Knowledge of these relationships could be valuable in selecting preventive measures, not least in primary care. Moreover, given the prolonged nature of exposure to a stressful social environment, the novel biomarker of cortisol in hair appears to be a useful aid in studies on how long-term stress affects health and may be particularly relevant when applied to research on children.
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| 6. |
- Stenfors, Cecilia U. D., 1982-
(författare)
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Subjective Cognitive Complaints in the Working Population : The Influence of Objective Cognitive Functioning and Working Conditions
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Cognitive functioning is important for managing work and life in general. However, subjective cognitive complaints (SCC), involving self-perceived difficulties with concentration, memory, decision making, and clear thinking are common in the general and in the working population and can be coupled with both lowered well-being and work ability. The present thesis investigated the extent to which SCC among people in the work force can be explained by objective cognitive functioning (study I & II) and working conditions (study III), utilizing samples from the working population. The potential roles of other common psychological problems which often co-occur with SCC were also investigated in studies I-III.In Study I, high levels of SCC were associated with significantly poorer episodic memory performance during high executive demands and a trend was found towards poorer episodic memory, while not being associated with semantic memory. In Study II, high levels of SCC were associated with significantly poorer executive cognitive performance on all three executive cognitive tests used. Symptoms of depression, chronic stress and sleeping problems were found to play an important role in the relations between SCC and episodic memory during divided attention in study I and executive cognitive functioning in study II. In Study III, in all cross-sectional data analyses, high quantitative demands, information and communication technology (ICT) demands, underqualification in the work situation and inter-personal conflicts were positively associated with SCC, whereas social support, good resources at work and overqualification in the work situation were negatively associated with SCC. In all prospective data analyses, quantitative job demands, ICT demands and underqualification were positively associated with future SCC, including when adjusted for baseline cognitive complaints.The findings may guide prevention of and interventions for SCC among people in the work force.
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| 7. |
- Duberg, Anna, 1976-
(författare)
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Dance Intervention for Adolescent Girls with Internalizing Problems : Effects and Experiences
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Globally, psychological health problems are currently among the most serious public health challenges. Adolescent girls suffer from internalizing problems, such as somatic symptoms and mental health problems, at higher rates than in decades. By age 15, over 50 % of all girls experience multiple health complaints more than once a week and one in five girls reports fair or poor health.The overall aim of this study was to investigate the effects of and experiences with an after-school dance intervention for adolescent girls with internalizing problems. The intervention comprised dance that focused on resources twice weekly for 8 months. Specifically, this thesis aimed to: I) investigate the effects on self-rated health (SRH), adherence and over-all experience; II) evaluate the effects on somatic symptoms, emotional distress and use of medication; III) explore the experiences of those participating in the intervention; and IV) assess the cost-effectiveness.A total of 112 girls aged 13 to 18 years were included in a randomized controlled trial. The dance intervention group comprised 59 girls, and the control group 53. In paper I, the dance group showed increased SRH scores compared to the control group (p = .02). Girls in the intervention group showed high adherence and a positive overall experience. In paper II, the dance group exhibited a decrease in somatic symptoms (p = .021), emotional distress (p = .023) and use of medication (p = .020) compared to the control group. In paper III, a strategic sample of 24 girls was interviewed. Qualitative content analysis was performed, and five generic categories emerged. Two were “An Oasis from Stress” and “Supportive Togetherness”, which was shown to represent the fundamental basis and setting of the intervention. The main category, participants’ central experience, was understood as “Finding embodied self-trust that opens new doors”. Paper IV revealed that, due to decreased number of visits to the school nurse and an increase in health related quality of life; the intervention was considered to be cost-effective (combined with the usual school health services). In summary, the results of this thesis show that this dance intervention for adolescent girls with internalizing problems generated positive health effects and proved to be cost-effective. For this target group, a non-judgmental environment and supportive togetherness proved to be of importance for participation. The results of this study may provide practical information for school health care staff and caregivers in designing future interventions.
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| 8. |
- Jouper, John, 1960-
(författare)
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Qigong in daily life : motivation and intention to mindful exercise
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In many countries physical inactivity and a sedentary lifestyle are identified as major public health problems. A general health goal is therefore to promote an active lifestyle throughout the entire life span. The reasons given for not adopting a physically active lifestyle and/or taking part in vigorous exercise include old age, negative social and physical environments, physical disability and other health related issues. Qigong exercise, a low-intensity Chinese self-care method, has therefore been suggested as an alternative activity to vigorous exercise. There is, however, little knowledge about leisure-time qigong exercisers and their reasons for adherence. The general aim of this thesis was therefore to explore leisure-time medical qigong and those practicing it, and to examine how individuals’ motivation and intention to exercise are related to their actual exercise in daily life. Behavioural changes towards an active lifestyle will be discussed from both medical qigong and exercise psychology perspectives. Suggestions are then summarized into a qigong-based Wellness Coaching Model. Participants were recruited from a qigong association and introductory qigong courses. Data were collected by questionnaires and were analysed using both descriptive and inferential statistical methods. The reasons given for leisure-time medical qigong exercise were to aid recovery from illness and to preserve health. Participants in the low-intensity qigong exercise group studied were somewhat older, and their main reason for participating was to achieve a general feeling of wellness. As a group they had mainly low-stress levels and were highly energized. Concentration on qi-flow during exercise correlates positively with improved health feelings, and exercise is performed with deep mindful concentration three to six times per week for an average of thirty minutes. Perceived stress correlates negatively with health, energy and exercise behaviour suggesting that stress has to be managed in order for wellness to emerge. Intrinsically motivated exercisers are more concentrated, and perceive their stress as lower than that of their more externally motivated counterparts. Strong behaviour intentions are significantly correlated with actual exercise frequency. When exercise is performed in a qigong state, with a heightened level of concentration, adherence is higher than otherwise is the case. Results suggest that health-professionals aiming to secure qigong exercise adherence should stimulate feelings of wellness as an intrinsic motive for exercise, strengthen the individuals’ intention to exercise, and promote a calm energy state (low-stress and high energy) before commencement of exercise.
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| 9. |
- Nilsson, Berit, 1940-
(författare)
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Vad betyder känsla av sammanhang i våra liv? : aspekter på stabilitet, kön, hälsa och psykosociala faktorer
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Känsla av sammanhang (KASAM) är ett sätt att studera hälsa och välbefinnande ur ett salutogent perspektiv. Med denna infallsvinkel kan såväl avgränsade sjukdomsgrupper i små populationer, som en större normalbefolkning undersökas. Det är väsentligt att studier också kan ske över tid för att ha möjlighet att fånga en utveckling. Syftet med denna studie var, att med magbesvär som infallsvinkel, studera KASAM och den salutogena modellens relation till hälsa, kön, psyko- sociala faktorer och stabilitet.Vid en klassifikation av patientens sjukdomstillstånd, gjord separat av patient, läkare och kurator, visade jämförelsen full överensstämmelse i hälften av fallen. En motsvarande jämförelse gällande patientens allmänna hälsotillstånd visade full överensstämmelse i en tredjedel av fallen. Synliggörandet av dessa skillnader antyder behovet av reflektion, över såväl den egna bedömningen som andras, i den kliniska vardagen.En grupp personer med magbesvär intervjuades 16-18 år efter en gastroskopiundersökning. Fynden i en kvalitativ studie visade att patientens inflytande på sitt liv, direkt eller indirekt, tycktes vara relaterat till om han/hon var frisk vid uppföljningen. Att ha inflytande över sitt liv kan också innebära att vara i stånd till att ha inflytande i mötet med vårdgivare och över adekvat behandling.I en tvärsnittsstudie av en normalbefolkning (WHO MONICA Project) visade sig medelvärdena för KASAM, efter uppdelning i tre olika diagnosgrupper, vara signifikant lägre i en grupp med magbesvär (n=309) i jämförelse med såväl en grupp med identifierad sjukdom (n=198) som en grupp utan de efterfrågade symtomen/sjukdomarna (n=1212).I en panelstudie med en uppföljning efter fem år visades att det förelåg en statistiskt signifikant minskning av KASAM i totalpopulationen (n=1254) och att män och kvinnor hade en likartad minskning. Studien visade också KASAM endast var stabil hos personer med höga ingångsvärden. Personer i åldersgruppen 45-74 år och personer med en identifierad sjukdom hade den största sänkningen. Nedgången är i linje med samhällsutvecklingen under den studerade perioden under 1990-talet, med en nedmontering av delar i det tidigare välfärdssamhället.En studie, som jämförde två tvärsnitt i en normalbefolkning med fem års mellanrum, visade en statistiskt signifikant nedgång av KASAM. Sänkningen var mest uttalad bland kvinnor, i den yngre åldersgruppen (25-44 år) och bland dem med en identifierad sjukdom. Personer med mångåriga magbesvär hade det lägsta medelvärdet i båda tvärsnitten.Att kartlägga hur olika faktorer relaterar till KASAM kan utgöra en väg både vad gäller att förstå hur politiska beslut påverkar skilda sektorer i samhället, och var enskilda människor befinner sig i olika processer vid hälsa och sjukdom. Patienter med mångåriga magbesvär rapporterade en låg känsla av sammanhang och är till synes en grupp som borde uppmärksammas i vården. Det är väsentligt att inte bara mäta KASAM som en personlig variabel utan också se hur strukturförändringar påverkar den enskilda människan. Olika vårdgivare kan tillsammans med patienten vara öppna för att inte enbart det medicinska perspektivet utan att även patientens inflytande och sociala situation lyfts fram.
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| 10. |
- Ekberg, Kerstin, 1948-
(författare)
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An epidemiologic approach to disorders in the neck and shoulders
- 1994
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Complaints about pain in the locomotor system represent a commonly occuning health problem among working people all over the world. In this context, a series of studies were employed to determine if work organization and psychosocial conditions at work, in addition to physical work load, contribute to the development of disorders in the neck and shoulders. The potentially health-promoting effect of early and active rehabilitation of those already suffering from disorders in the neck and shoulders was also evaluated.A first psychophysiological study showed that various stress conditions during monotonous work had limited effects on muscle tension. The interindividual variability in muscle reactions to stress was large, but the results indicate that some individuals may react with a sustained, low-level muscle activity that is associated with pain.A cross-sectional study of a sample of a normal working population and a case-control study of patients with disorders in the neck and shoulders revealed a set of work-related core determinants, which appear to be essential component causes for the development of symptoms and signs. Prevalence ratios (PR) were calculated for determinants of early symptoms in the cross-sectional study, and odds ratios (OR) were estimated in the case-control study for determinants of disorders of the neck and shoulders. Repetitive movements demanding precision (PR 1.2 and OR 7.5, respectively), high work pace (PR 1.2 and OR 3.5, respectively), low quality work content (low decision latitude and lqw skill discretion; PR 1.3 and OR 2.6, respectively), and uncertainty about how to perform and-manage the tasks (work-role ambiguity; PR 1.2 and OR 16.5, respectively) were associated with both development of early symptoms, and disorders in the neck and shoulders. The results also show that being a woman (PR 1.3 and OR 11.4, respectively) and I or an immigrant (PR 1.3 and OR 4.9, respectively) imposes a higher risk for developing signs and symptoms in the neck and shoulders, possibly due to selective job-assignment.A controlled, two-year follow-up of cohorts of subjects with early and active rehabilitation versus traditional, less active treatment of neck~shoulder disorders respectively, did not support the hypothesis that active rehabilitation, as compared to traditional treatment methods, promotedbetter health, unless work conditions were changed. People who remained on the same job after rehabilitation, independent of type of treatment, had a less positive prognosis (relative risk 3.6) than those who had a changed work situation.Further analysis of which factors retained people in long-term sick-leave suggested that work conditions are more important than personality and other individual characteristics in determining the amount of time that will elapse before individuals will resume work after a sickleave. There was no gender-difference in this respect.
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