| 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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| 11. |
- Glasberg, Ann-Louise, 1967-
(författare)
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Stress of conscience and burnout in healthcare : the danger of deadening one's conscience
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall purpose of this thesis is to investigate whether there is an association between “stress of conscience” — that is, stress related to a troubled conscience — and burnout, and to obtain an enhanced understanding of factors related to stress of conscience and burnout in healthcare. Of the four “studies” included, one uses qualitative research methods and the others use quantitative research methods. The data are based on cross-sectional questionnaire studies (I, II, and IV) and open-ended interviews (III). We could find no existing suitable instrument for measuring troubled conscience in healthcare, and so we constructed and tested the “Stress of Conscience Questionnaire” (SCQ) (I), a nine-item instrument for assessing stressful situations and the degree to which they trouble the conscience. We included 164 participants in the pilot studies, an additional 444 in the main analysis, and 55 in the test-retest verification. Participants had various occupational backgrounds and were recruited from different parts of Sweden. Our findings suggest that the SCQ is a valid and reliable measurement for use in various healthcare contexts. Cronbach’s α for the overall scale was 0.83, ensuring internal consistency. Explorative factor analysis identified and labelled two factors: “internal demands” and “external demands and restrictions”. To investigate factors related to stress of conscience and burnout (II, IV) we used a sample of 423 healthcare personnel from various specialities and with various occupations, from a district in northern Sweden. Multiple regression analysis showed that the factors related to stress of conscience (II) were: perceiving that conscience warns us against hurting others while at the same time not being able to follow one’s conscience at work, and having to deaden one’s conscience in order to keep working in healthcare; and also moral sensitivity items belonging to the factor “sense of moral burden”. In addition, deficient social support from superiors, low levels of resilience, and working in internal medicine wards were all associated with stress of conscience. The model explained 40% of the total variance. Interviews were conducted with 30 healthcare managers, to illuminate their explanatory models of the sources contributing to burnout in healthcare settings (III). The data were analysed using qualitative content analysis. The findings indicate that continuous reorganisation and downsizing of health care has reduced resources, while at the same time demands and responsibilities have increased. These problems are compounded by high ideals and expectations, making staff question their own abilities and worth. All in all this throws healthcare employees into a spiralling sense of inadequacy and an emerging sense of pessimism and powerlessness. Multiple regression analysis showed that having to deaden one’s conscience, stress of conscience from lacking the time to provide the necessary care, the work being so demanding that it influences one’s home life, not being able to live up to others’ expectations, low social support from co-workers, and low levels of resilience were all related to emotional exhaustion. Other factors that had an impact were being female, being a physician or being other healthcare professional and working in geriatric care or a primary healthcare centre. The full model explained 59% of the variance. Factors contributing to depersonalisation were: having to deaden one’s conscience, stress of conscience from not being able to live up to others’ expectations and from having to lower one’s aspirations to provide good care, deficient social support from co-workers, and being a physician; however, the percentage of variation explained was smaller (30%) (IV). The findings indicate that burnout is related to being unable to live up to one’s moral convictions; thus, it is a consequence of healthcare employees’ feeling that they are not acting on their values and for the wellbeing of the patients.
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| 12. |
- Hasson, Dan, 1974-
(författare)
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Stress Management Interventions and Predictors of Long-term Health : Prospectively Controlled Studies on Long-term Pain Patients and a Healthy Sample from IT- and Media Companies
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis reports on the effects of stress management on long-term pain patients and on a healthy sample from IT and media companies; two groups that are commonly exposed to high stress levels. Even if there are important differences between these two groups, there are similarities such as the necessity for effective stress management. Stress-related and musculoskeletal disorders are major public health issues in most industrialized countries and are expected to become increasingly common during the coming decades. The pathogenic plastic changes in the CNS and immune system caused by long-term stress pose severe burdens to individuals, organizations as well as society in general. Thus, stress management may be essential to maintain and improve long-term health and wellbeing and to proactively counteract stress-related ill-health.This thesis is based on four papers: Paper I assessed the effects of massage as compared to relaxation tapes in long-term pain patients. Paper II validated some of the Visual Analogue Scale questions that were to be used in paper III and IV. Paper III assessed the effects on mental and physical wellbeing and biological stress markers from a web-based stress management and health promotion tool. Paper IV aimed at mapping out predictors for trends (improvement vs. worsening) in self-rated health (SRH) over a period of one year.The overall results indicate that individually focused stress management interventions in long-term pain patients as well as on a healthy, working population may have short-term beneficial effects on psychological and physiological stress, health and wellbeing. On a long-term basis the beneficial changes seem to revert. In paper four, it is indicated that the stress management intervention is not a significant predictor of long-term changes in SRH. Rather, other factors such as health perception, sleep quality and sense of coherence predicted improvement in SRH over time.
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| 13. |
- Hedborg, Kerstin, 1953-
(författare)
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Migraine and Stress : An Internet administered Multimodal Behavioral Treatment Intervention
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Migraine is a disabling neurological disorder with high prevalence, the clinical manifestations of which are highly dependent on stress. The overall theme of the present thesis was to address aspects of stress in migraine. A multimodal behavioral treatment (MBT) program was developed specifically designed for migraine and focusing on stress as a trigger and an intervention was performed using this Internet-administered program. Migraine symptoms were followed via an Internet administered diary and questionnaires were answered at regular intervals during the 11-month study period. The thesis is based on four papers: In Paper I, life events and current stress, personality traits, and gender were studied cross-sectionally in 106 women and 44 men with migraine, who suffered at least two attacks a month at inclusion. Paper II describes a randomized controlled trial of the MBT program performed on 58 women and 25 men recruited from participants of the study described in Paper I. In the MBT study participants were randomized into one control group and two MBT groups, one of which received hand massage as part of the treatment. In Paper III, complete migraine drug use and changes in use and in drug efficacy during the MBT program were studied. In Paper IV, the salivary cortisol levels of MBT participants were evaluated as a biological stress marker. The MBT program proved effective in decreasing migraine headache; it was feasible and there was low attrition. Moreover, MBT resulted in decreased migraine drug use and increased drug efficacy, but had no discernible effects on salivary cortisol profiles. No effect of hand massage on migraine headache frequency was seen. Personality trait profiling revealed high scores for the neuroticism factor. Stress susceptibility was the single most aberrant personality trait and correlated highly with the reported level of current stress and with experienced negative life events. Gender differences included higher scores for women on trait anxiety, negative life events, depressive mood, anxiety, tension type headache, use of triptans, and efficacy of analgesics, whereas men displayed higher use of analgesics. In conclusion, the efficacy and low attrition associated with the present MBT program appears promising and timely with regard to the development of better and more accessible migraine treatment. Stress susceptibility, gender, negative life events and psychosomatic comorbidity are important factors to consider in relation to the care of persons with migraine.
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| 14. |
- Henriksson, Chris, 1938-
(författare)
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Living with fibromyalgia : A study of the consequences for daily activities
- 1995
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Fibromyalgia (FM) is a chronic generalized muscle pain syndrome. This thesis is a study of 116 patients with FM, twenty living in the USA and the rest in Sweden, all meeting the classification criteria proposed by the American College of Rheumatology, and 39 patients with chronic regio!Jal muscle pain. The purpose was to explore the consequences of the fibromyalgia syndrome for the activities of daily life. The consequences of the syndrome have, been described from the patients' perspective. Data have been collected through different types of questionnaires, 250 semi-structured diaries, and qualitative analysis of 40 semi-structured interviews. A five-year follow-up study was performed to collect data on changes over time in symptoms and psychosocial consequences.The results show that the fibromyalgia syndrome influences daily life profoundly. Both pain and muscular fatigue are continuous, though there are changes in severity, both during the day and over longer periods. Most activities are difficult to perform, at least over a prolonged period. The time structure of the day is disrupted and most patients have to adjust habits and roles in order to manage their life situation. There is acontradiction between the level of disability experienced by the patients and their healthy and non-disabled appearance. This leads to misunderstandings and influences the selfimage. The results in this thesis indicate the importance of early intervention, where the patient is given information about the condition and support to adjust to the limitations, thus preventing unnecessary disabilities and handicaps from evolving.The comparison between patients with chronic regional muscle pain and fibromyalgia indicates that there is a quantitative, rather than a qualitative, difference between the two conditions.
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| 15. |
- Karlsson, Magnus
(författare)
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Själv men inte ensam : om självhjälpsgrupper i Sverige
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In this thesis, self-help groups are defined as small, autonomous groups of people that meet regularly to cope with a shared problem through mutual aid. There is reason to believe that self-help group activity is increasing in Sweden. Since no general attempts to map self-help group activity have been made in Sweden, one aim of this study was to map such activities in ten strategically selected geographical areas. A second aim was to analyze the internal and external circumstances of these groups in order to improve our knowledge about Swedish self-help groups in general.The thesis builds on four empirical studies. The first study aimed to map self-help group activity in the ten selected regions, using a questionnaire sent to vicars in the Church of Sweden, heads of welfare offices, head counselors in the health service and representatives of voluntary organizations (n=599). The second study sought a broader understanding of the internal and external circumstances of self-help groups. Eight groups, strategically selected from the outcome of the first study, were group interviewed. The aim of the third study was to examine whether the results of the group interviews were valid for all the groups found in the initial mapping. A questionnaire (27 items) was sent to key persons (n=73) in the groups. The fourth and final study had a partially deductive approach. One aim was to improve our understanding of the roles played by different kinds of knowledge in the groups. A second aim was to test whether the participants in the groups were “peers” or whether there were leaders in the groups in terms of creating, upholding and representing different kinds of knowledge. Four groups, comprising 18 migraine sufferers, were examined by means of a personal questionnaire, a network test and group interviews.The results of the studies showed that 0.5 percent of the population in the selected regions belonged to a self-help type of group at the time for the study. The most common problems among the 228 groups found were related to alcohol (44), illness and physical disorder (41), grief (22) and parenthood (21). Group members emphasized the importance of mutual understanding in their groups, and in the thesis the groups are understood on the theoretical basis of sociology of knowledge. The thesis argues that a specific kind of knowledge - experiential knowledge - is developed in self-help groups. This kind of knowledge is based on mutual understanding and contributes to a deeper understanding. Some differences between experiential knowledge and professional knowledge are highlighted. Besides mutual understanding, the participants valued the spirit of community and the information given in the groups. Finally, the results indicate that groups that had a formal leader (representing professional knowledge) tended to value information more, while groups where the participants were peers (relying on experiential knowledge) primarily valued mutual understanding.In this thesis, self-help groups are seen as belonging to the third sector, and therefore as related to voluntary organizations. However, it is argued that self-help groups may be a contemporary phenomenon with the participants often being consumers rather than members. Despite the group constellation, self-help groups may sometimes have the value of an individual project.
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| 16. |
- Ringsberg, Karin
(författare)
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Patients with asthma-like symptoms but negative asthma tests and patients with bronchial asthma
- 1997
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Patients with asthma-like symptoms but with negative results in asthma tests have recently been identified. The symptoms are mainly triggered by strong odours, physical exercise and mental stress. These patients are often misdiagnosed and mistreated. They mostly have to find coping strategies by themselves. Patients with diagnosed bronchial asthma sometimes are 'educated in their own disease' by health care professionals in order to increase their compliance and to help them to find coping strategies.The overall aim of this thesis was to identify and describe patients with asthma-like symptoms but negative asthma tests and to find diagnostic instruments to differentiate these patients from patients with bronchial asthma and healthy subjects and to investigate some possible mechanisms behind the disorder. A further aim was to describe the effects of a cognitive and affective treatment of patients with diagnosed bronchial asthma and to discuss if this model might also be applicable to patients with asthma-like symptoms but negative asthma tests.Altogether 24 patients with asthma-like symptoms but negative asthma: tests, 28 patients with bronchial asthma and 10 healthy controls participated in four studies. Only women aged 18-60 years were included. They were investigated with psychological tests, questionnaires and provocation with physical exercise, voluntary hyperventilation and mental stress. In-depth interviews were also performed. In a fifth study, the effects of a cognitive and affective model for treating patients with bronchial asthma, an "asthma school'', were studied by means of different questionnaires and lung function testo;, Althogether 38 patients with bronchial asthma, women and men aged· 18-70 yrs, participated.The results showed that the patients with asthma-like symptoms suffered more frequently from a greater variety of symptoms compared to the patients with asthma and healthy contJ:ols. They were more depressed, less hedonic, more hypochondriac and had lower trust in others than the patients of the astluna group. They had a higher health care consumption compared to the patients with asthma The physical exercise test did not provoke any bronchoconstriction in the patients with asthma-like symptoms. Neither could the symptoms be explained by physical unfitness. The provocations with voluntary hyperventilation and mental stress revealed that hyperventilation might be present in these patients and that mental stress might be one trigger factor. In a qualitative study, the patients stated that they felt dejected, confused and non confirmed by health care professionals, family and friends. Their subjective hyperreactivity limited them socially. They lacked adequate coping strategies. The findings were characterised by numerous self-reinforcing vicious circles where the circles comprised subjective hyperreactivity, social limitations and non confinnation. Patients with bronchial asthma benefit from being treated in an "asthma-school''. After having attended an "asthma-school", the patients increased their knowledge of the disease slightly more than a control group. They also increased their quality of life and decreased their health care conswnption.In summary, no evidence was found for the diagnosis of asthma in the patients with asthmalike symptoms but negative asthma tests. It is possible to separate them from patients with bronchial asthma by using different lung function tests, and different provocation tests. Patients with bronchial asthma benefit from taking part in an "asthma school". A similar treatment, with both a cognitive and an affective approach, might also be applicable in patients with asthma-like symptoms but negative asthma tests. A multidisciplinary approach and confirmation of these patients is important.
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