| 1. |
- Degerstedt, Frida, 1974-
(författare)
-
Equity among children and youth with cerebral palsy : physical leisure activity, physical education, physiotherapy and quality of life
- 2023
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background & aim: Cerebral palsy (CP) is the most common reason for movement difficulties among children and youth in Sweden. Physiotherapy is usually introduced early in order to develop mobility and prevent further impairment, which in turn facilitates activity and participation. Physiotherapy is closely connected with physical activity, both as a goal and a mean, and physical activity contributes to aspects of health, in turn associated with quality of life (QoL). Physical education in school as well as physical leisure activity are important parts of the total physical activity participation among children and youth. Participation in physical leisure activity and physical education, as well as access to physiotherapeutic interventions, is insufficiently explored from an equity perspective regarding function, gender and ethnicity or birth country. The overall aim of the current thesis is to explore participation in physiotherapeutic interventions, physical leisure activity and physical education, as well as analyze the association between physical activity and quality of life, from an equity perspective for children and adolescents with CP in Sweden.Methods: The four papers that comprise this thesis are based upon three empirical studies: a National cross-sectional registry study (Papers I and II), based on the National Quality Registry Cerebral Palsy Follow-up Program (CPUP); an interview study with a qualitative approach (Paper III); and a national QoL survey complemented with registry data (IV). Quantitative data were analyzed with multivariable logistic-, linear- or quantile regressions. For the interview study, qualitative content analysis was used.Results: The number of participants in the registry studies were 2855 aged 0-18 years (Paper I) and 1935 aged 6-18 years (Paper II). The interview study (Paper III) included 11 participants aged 15-18 years, and the survey study (Paper IV) 149 participants, aged 15-18 years. Being born in Sweden entailed higher odds for participating in physiotherapy, physical leisure activity, physical education and physiotherapy, respectively, compared to those born outside Sweden (Paper I) or outside Europe (Paper II). More severe gross motor function difficulties were positively associated with higher odds of receiving physiotherapy, and negatively associated with physical activity participation (Paper II). Participants in the interviews report several examples of exclusion, struggles and (in-) sufficient support and inclusion through the categories ‘Exclusion and lack of support’, ‘Resistance, struggle and guilt’, and ‘Empowerment and support’. Gender as a vector in physical activity is mainly seen through the qualitative results, referring to physical education (Paper III). Frequent participation in physical leisure activity was associated with the domain Communication and physical health. Domains of QoL that referred to participation or function were negatively associated with having greater motor function difficulties, although not significantly associated with domains of social- and school wellbeing. Pain and bother is negatively associated with all five domains of QoL. Low educational level among the caregivers was associated with higher QoL-scores in the domain of social well-being (Paper IV).Discussion & Conclusions: The results that reveals differences regarding birth country indicates the relevance to raise awareness about possible inequity in participation in physical leisure activity, physical education, and physiotherapy for children and youth who have CP, as a prerequisite for improvement. Physiotherapists, school, and leisure sport leaders, as well as their organizations, need to be attentive to norms and bias in order to prevent inequity and discrimination due to for example birth country, gender or function, and provide support, which is included in the compensatory assignment of the schools and health care. This is emphasized by the experiences of exclusion expressed by participating youth with CP. Frequent physical activity participation is in part associated with higher QoL while Pain and bother is negatively associated with QoL, as is partly gross motor function difficulties. Prevention and treatment of pain and facilitation of physical activity is therefore important for children and youth with CP. Future studies should carefully consider targeting youth with a non-Nordic birth country and with large gross motor function difficulties or associated difficulties to widen knowledge about equity in physical activity- and physiotherapy participation, and QoL.
|
|
| 2. |
|
|
| 3. |
- Degerstedt, Frida, et al.
(författare)
-
Inequity in physiotherapeutic interventions for children with Cerebral Palsy in Sweden - a national registry study
- 2020
-
Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 109:4, s. 774-782
-
Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of this study was to investigate the distribution of physiotherapeutic interventions for children with Cerebral Palsy in Sweden from an equity perspective, considering sex, country of birth and geographical region.METHOD: This national cross-sectional registry study includes children with Cerebral Palsy aged 0-18 years who participated in 2015 in the Swedish national quality registry, the Cerebral Palsy follow-up program, CPUP. Comparisons and associations between physiotherapeutic interventions and sex, country of birth and geographical regions were conducted using Chi2 and logistic regression analysis, controlling for cognitive level, level of motor function, age group and dominating symptom.RESULTS: Of the 2855 participants, 2201 (79%) had received physiotherapy. Children born in Sweden had 1.60 times higher odds (95% CI 1.10-2.33) of receiving physiotherapy compared with children born in foreign countries. Distribution of physiotherapeutic interventions differed significantly between geographical regions. No associations between sex and physiotherapeutic interventions were observed.CONCLUSION: The results of this study indicate inequity in care in Sweden towards children with Cerebral Palsy born in other counties. Further, physiotherapeutic interventions were not equally distributed in different.
|
|
| 4. |
|
|
| 5. |
- Degerstedt, Frida, et al.
(författare)
-
Physiotherapeutic interventions and physical activity for children in Northern Sweden with cerebral palsy : a register study from equity and gender perspectives
- 2017
-
Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 10
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Young people with disabilities, especially physical disabilities, report worse health than others. This may be because of the disability, lower levels of physical activity, and discrimination. For children with cerebral palsy, access to physiotherapy and physical activity is a crucial prerequisite for good health and function. To date, there is limited knowledge regarding potential gender bias and inequity in habilitation services.Objectives: To map how physiotherapeutic interventions (PTI), physical leisure activity, and physical education are allocated for children with cerebral palsy regarding sex, age, level of gross motor function, and county council affiliation. This was done from a gender and equity perspective.Methods: A register study using data from the Cerebral Palsy follow-Up Program (CPUP). Data included 313 children ≤18 years with cerebral palsy from the five northern counties in Sweden during 2013. Motor impairment of the children was classified according to the expanded and revised Gross Motor Function Classification System (GMFCS).Results: In three county councils, boys received more physiotherapy interventions and received them more frequently than girls did. Differences between county councils were seen for frequency and reasons for physiotherapy interventions (p < 0.001). The physiotherapist was involved more often with children who had lower motor function and with children who had low physical leisure activity. Children with lower motor function level participated in physical leisure activity less often than children with less motor impairment (p < 0.001). Boys participated more frequently in physical education than did girls (p = 0.028).Conclusion: Gender and county council affiliation affect the distribution of physiotherapy interventions for children with cerebral palsy, and there are associations between gender and physical activity. Thus, the intervention is not always determined by the needs of the child or the degree of impairment. A gender-bias is indicated. Further studies are needed to ensure fair interventions.
|
|
| 6. |
- Degerstedt, Frida, et al.
(författare)
-
Unequal physical activity among children with cerebral palsy in Sweden : A national registry study
- 2021
-
Ingår i: Health Science Reports. - : John Wiley & Sons. - 2398-8835. ; 4:3
-
Tidskriftsartikel (refereegranskat)abstract
- Aim: To examine the extent to which sex, country of birth, and functional aspects influence participation in physical education and physical leisure activity among children with cerebral palsy (CP) in Sweden.Methods: This national cross-sectional registry study included children with CP aged 6 to 18 years who participated in the Swedish national quality registry, the Cerebral Palsy Follow-up Program, CPUP, in 2015. Comparisons and associations between sex, country of birth, and functional aspects and physical leisure/physical education were examined using chi-squared and multivariable logistic regression analysis.Results: The study included 1935 children. Of them, 1625 (87%) reported participating in physical education and 989 (53%) reported participating in physical leisure activity. Children born in Sweden had higher odds of participating in physical education (OR: 1.99; 95% CI: 1.20-3.28) and physical leisure activity (OR: 2.51; 95% CI: 1.70-3.72) compared with children born outside Europe. Greater impairment of gross motor function was associated with lower participation levels. Boys participated slightly more frequently in leisure activities than girls.Conclusion: Enhancing social inclusion with regard to disability, birth country, and sex are important and achievable goals for policymakers and practitioners for promoting participation in physical activity for children and adolescents with CP.
|
|
| 7. |
|
|
| 8. |
- Enberg, Birgit, 1956-
(författare)
-
Work experiences among healthcare professionals in the beginning of their professional careers : a gender perspective
- 2009
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Swedish healthcare organizations have undergone substantial organizational and economic restructuring during the 1990s due to financial cutbacks. Little is known about recently graduated healthcare professionals´ work experience in healthcare and their future career preferences. The overall aims of this thesis was, to increase knowledge about how recently graduated healthcare professionals in Sweden perceive their work in healthcare organizations. A gender perspective is adopted. In this national cross-sectional study, four stratified random samples were separately drawn from the 1999 Swedish university graduates who were nurses (NS), occupational therapists (OT), physical therapists (PT) and (registered) physicians (PN) and who at the time of the sampling procedure were living in Sweden. Stratification was performed by sex. A total of 3989 were eligible and of those, 1434 were selected: 535 NS, 250 OT, 250 PT and 399 PN. A questionnaire was constructed containing questions about socio-demographic factors, working conditions, career preferences, work satisfaction and questions about the responsibility for and actual work with home and family, the so called unpaid household work. The questionnaires also contained questions measuring psychosocial working conditions: the effort-reward imbalance questionnaire (ERI-Q) and the demand-control questionnaire (DCQ). Collection of the data for NS, OT and PT was completed in March 2002 and for PN in May 2003. The response rate was 81% and 76% respectively. The total sample thus consists of 1145 participants; 423 nurses, 212 occupational therapists, 205 physiotherapists and 305 physicians. Most of the respondents were employed in the public sector, but many desired privately employment within the coming five year period, men more often than women. Career preferences for future work differed between women and men. A majority indicated that they did not have the opportunity to pursue knowledge development in the professional field during working hours and nearly one half could not work as independently as they wished. Satisfaction with work in general was high, but many were dissatisfied with management at work and a majority was dissatisfied with the work organization. This dissatisfaction was associated with the opportunity to work as independently as they wished and the opportunity to pursue knowledge development in the professional field. Significantly more women than men had the main responsibility for home and family and did most of the unpaid household work. Among the OT and PT working for county councils and municipalities, the results revealed that those working for municipalities, experienced low control at work compared with those working for county councils. No differences were found between OT and PT or between men and women in the two professions regarding the DCQ and the ERI-Q except for the WOC scale. Women had significantly higher scores on the WOC scale compared with men. Logistic regression analyses revealed a significant association between WOC and ERI, effort, reward and sex. One fourth of the OT and PT working for county councils and municipalities was dissatisfied with their job and this dissatisfaction was significantly associated with type of employer, reward and effort-reward imbalance (in the ERI-Q) and control (in the DCQ). Differences regarding scoring on the ERI-Q were found between nurses and physicians working in county councils but not between women and men in the same group, with the exception of the scores on overcommitment. Significantly more nurses were defined as having high effort, low reward and effort-reward imbalance compared with the physicians. More women in the NS and PN group were defined as experiencing WOC compared to men. Logistic regression analyses revealed significant associations between experiences of WOC and ERI, effort and reward. Nearly one fifth in the NS and PN group were dissatisfied with work and this dissatisfaction was particularly high among those with high effort, low reward, those with the greatest imbalance between effort and reward and those who experienced high overcommitment. In conclusion, in order to limit future work related problems and to be able to retain well educated professionals in healthcare work, dissatisfaction among the recently graduated must be taken seriously. Healthcare employers should better utilize the knowledge that recently graduated possess, regarding for example how to be a part of the development of the profession and the job. It is also important that healthcare employers address gender (in) equality at work and that work environments allow both women and men to combine careers with family duties.
|
|
| 9. |
|
|
| 10. |
- Enberg, Birgit, et al.
(författare)
-
Work experiences among nurses and physicians in the beginning of their professional careers - analyses using the effort-reward imbalance model
- 2013
-
Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 27:1, s. 36-43
-
Tidskriftsartikel (refereegranskat)abstract
- Work experiences among nurses and physicians in the beginning of their professional careers analyses using the effortreward imbalance model The aim of the study was to scrutinise how nurses and physicians, employed by the county councils in Sweden, assess their work environment in terms of effort and reward at the start of their career. The aim was also to estimate associations between work satisfaction and the potential outcomes from the effortreward imbalance (ERI) questionnaire. The study group, 198 nurses and 242 physicians who graduated in 1999, is a subsample drawn from a national cross-sectional survey. Data were collected in the third year after graduation among the nurses and in the fourth year after graduation among registered physicians. The effortreward imbalance questionnaire, together with a question on work satisfaction, was used to evaluate psychosocial factors at work. The results reveal that nurses scored higher on effort, lower on reward and experienced higher effortreward imbalance, compared with physicians. Women scored higher on work-related overcommitment (WOC) compared with men. Among the physicians, logistic regression analysis revealed a statistically significant association between WOC and ERI, sex, effort and reward. Logistic regression analysis also revealed a statistically significant association between WOC and ERI and between WOC and effort among the nurses. Dissatisfaction with work was significantly higher among those who scored worst on all three ERI subscales (effort, reward and WOC) and also among those with the highest ERI ratios compared with the other respondents. In conclusion, to prevent future work-related health problems and work dissatisfaction among nurses and physicians in the beginning of their professional careers, signs of poor psychosocial working conditions have to been taken seriously. In future work-related stress research among healthcare personnel, gender-specific aspects of working conditions must be further highlighted to develop more gender-sensitive analyses.
|
|
