Publikationer

Abstract

Introduction: The present article aimed to investigate 1) if mental health problems (depression and burnout including the dimensions; emotional exhaustion, mental distance and cognitive and emotional impairment) differed between nurses and physicians in Sweden, 2) if any differences were explained by differences in sex compositions, and 3) if any sex differences were larger within either of the two professions.

Method: Data were derived from a representative sample of nurses (n = 2903) and physicians (n = 2712) in 2022. Two scales were used to assess burnout (KEDS and BAT) and one to assess depression (SCL-6). The BAT scale has four sub-dimensions. Descriptive statistics and logistic regression were used to analyse each scale and dimension separately.

Results: Results showed that 16-28 % of nurses and physicians reported moderate to severe symptoms of burnout. The prevalence differed between occupations across the scales and dimensions used. Nurses reported higher scores on KEDS while physicians reported higher scores on BAT including the four dimensions. Also, 7 % of nurses' and 6 % of physicians' scores were above the cut-off for major depression. The inclusion of sex in the models changed the odds ratios of differences between doctors and nurses in all mental health dimensions except mental distance and cognitive impairment.

Limitations: This study was based on cross-sectional survey data which has some limitations.

Conclusion: Our study suggests that the prevalence of mental health problems is prominent among nurses and physicians in Sweden. Sex plays an important role in the difference in the prevalence of mental health problems between the two professions.

Abstract

Background: The aim of this paper was to investigate if job demands, decision authority, and workplace violence mediate the association between employment in the health and social care industry and register-based sickness absence.

Methods: Participants from the Swedish Longitudinal Occupational Survey of Health who responded to questionnaires in 2006-2016 (n = 3951) were included. Multilevel autoregressive cross-lagged mediation models were fitted to the data. Employment in the health and social care industry at one time point was used as the predictor variable and register-based sickness absence >14 days as the outcome variable. Self-reported levels of job demands, decision authority, and exposure to workplace violence from the first time point were used as mediating variables.

Results: The direct path between employment in the health and social care industry and sickness absence >14 days was, while adjusting for the reverse path, 0.032, p = 0.002. The indirect effect mediated by low decision authority was 0.002, p = 0.006 and the one mediated by exposure to workplace violence was 0.008, p = 0.002. High job demands were not found to mediate the association.

Conclusion: Workplace violence and low decision authority may, to a small extent, mediate the association between employment in the health and social care industry and sickness absence.

Abstract

Objective To estimate the prospective associationbetween the exposure to three types of gender-basedviolence and harassment (GBVH) and psychotropicmedication.Methods Information on three measures of workplaceGBVH—sexual harassment (1) from superiors orcolleagues, (2) from others (eg, clients) and (3) genderharassment from superiors or colleagues—wereretrieved from the biannual Swedish Work EnvironmentSurvey 2007–2013 (N=23 449), a representativesample of working 16–64 years old registered inSweden. The survey answers were merged with data onantidepressants, hypnotics/sedatives and anxiolytics fromthe Swedish Prescribed Drug Register. Cox proportionalhazards analyses with days to purchase as time scale andfirst instance of medicine purchase as failure event werefitted, adjusted for demographic and workplace factors.Results Workers who reported exposure to genderharassment only (HR 1.2, 95% CI 1.07 to 1.36), to sexualbut not gender harassment (HR 1.21, 95% CI 1.04 to1.40), or to gender and sexual harassment (HR 1.31,95% CI 1.08 to 1.60) had an excess risk of psychotropicsuse in comparison to workers who reported neitherof the exposures in the past 12 months. We found nointeraction between the exposures and gender in theassociation with psychotropics use.Conclusions Exposure to sexual or gender harassmentat the workplace may contribute to the development ofmental disorders.

Abstract

Background: Receiving support from a return-to-work (RTW) coordinator (RTWC) may be beneficial for people on long-term sick leave. The aim of this study was to investigate whether the number of contacts with an RTWC and their involvement in designing rehabilitation plans for the patients were associated with perceiving support for RTW, emotional response to the RTWC, and healthcare utilization. Methods: In this cross-sectional study, 274 patients who had recently been in contact with an RTWC in Swedish primary or psychiatric care answered questions regarding their interaction with an RTWC, perceived support for RTW, and emotional response to the RTWC. Results: Having more contact with an RTWC was associated with perceiving more support in the RTW process (adjusted OR 4.14, 95% CI 1.49-11.47). RTWC involvement in designing a rehabilitation plan for the patient was associated with perceiving more support in the RTW process from an RTWC and having a more positive emotional response to the RTWC. Conclusions: From the patient's perspective, this study indicates that the involvement of an RTWC and receiving a rehabilitation plan that an RTWC has helped to design might be perceived as important in the RTW process.

Abstract

Background Nursing professionals exhibit high prevalence of stress-related health problems. Job demands and job resources are parallel drivers of health and well-being among employees. Better job resources associate with better job satisfaction, job motivation and engagement even when job demands are high. To date, there is limited research which explores the association between job demands, job resources and health outcomes among nursing professionals in the Swedish context. The aim of this study was therefore to investigate Swedish nursing professionals' job demands and job resources in relation to health outcomes, with comparisons between the private and public healthcare sectors. The specific research questions were as follows: (1) Are there differences between private and public healthcare regarding job demands, job resources, and health outcomes? and (2) Are there prospective associations between job demands and job resources in relation to health outcomes? Methods Data were drawn from the Swedish Longitudinal Occupational Survey of Health (SLOSH) 2016 and 2018, including 520 nurses and 544 assistant nurses working in the private and public healthcare sectors from 2016 (baseline). Data were analyzed using binary logistic regression. Results Nursing professionals reported higher threats, lower bullying, lower control, lower social support, and lower cohesion in the public healthcare units compared to the private healthcare units. The prospective analyses showed that job resources in terms of social support and rewards were associated with higher self-rated health and lower burnout. Cohesion was associated with higher self-rated health. Job demands in terms of psychological demands and job efforts were associated with lower self-rated health, higher burnout, and higher sickness absence, while emotional demands were associated with higher burnout. Conclusions Nursing professionals' job resources are deficient in public healthcare units. Job resources are associated with positive health outcomes, whereas job demands are associated with negative health outcomes, among nursing professionals. Strengthening job resources among nursing professionals in the private and public healthcare sectors can promote and sustain their work-related health.

Abstract

We aimed to provide an overview of how work environment and occupational health are affected, and describe interventions designed to improve the work environment during epidemics and pandemics. The guidelines on Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) were followed. The databases Cinahl, Medline, PsycInfo, and Web of Science were searched for population: working population; exposure: coronavirus epidemic or pandemic; and outcome: work environment, in articles published until October 2020. Quality assessment was based on a modified version of the Mixed Methods Appraisal Tool (MMAT). After deduplication 3711 articles remained, of which 530 were selected for full-text screening and 119 for quality assessment. After the exclusion of studies that were low quality, 95 remained, of which 85 focused on healthcare personnel and 10 on employees in other industries; 73 used quantitative methods and 22 used qualitative or mixed methods; the majority were based on cross-sectional data. Healthcare staff experienced increased job demands, poor leadership, and lack of resources (personal protective equipment, personnel, and competence). High demands and work with infected patients were associated with negative mental health outcomes. There was a lack of studies assessing interventions, studies from industries other than healthcare, and studies of high quality.

Abstract

Growing evidence indicates that retiring from paid work is associated, at least in the short-term, with dramatic reductions in sleep difficulties and more restorative sleep. However, much is still not known, in particular how universal these improvements are, how long they last, and whether they relate to the work environment. A methodological challenge concerns how to model time when studying abrupt changes such as retirement. Using data from Swedish Longitudinal Occupational Survey of Health (n = 2,148), we studied difficulties falling asleep, difficulties maintaining sleep, premature awakening, restless sleep, a composite scale of these items, and non-restorative sleep. We compared polynomial and B-spline functions to model time in group-based trajectory modelling. We estimated variations in the individual development of sleep difficulties around retirement, relating these to the pre-retirement work environment. Reductions in sleep difficulties at retirement were sudden for all outcomes and were sustained for up to 11 years for non-restorative sleep, premature awakening, and restless sleep. Average patterns masked distinct patterns of change: groups of retirees experiencing greatest pre-retirement sleep difficulties benefitted most from retiring. Higher job demands, lower work time control, lower job control, and working full-time were work factors that accounted membership in these groups. Compared to polynomials, B-spline models more appropriately estimated time around retirement, providing trajectories that were closer to the observed shapes. The study highlights the need to exercise care in modelling time over a sudden transition because using polynomials can generate artefactual uplifts or omit abrupt changes entirely, findings that would have fallacious implications.

Abstract

The high level of stress among teachers is a frequently reported problem globally but less is known about how demands and resources among teachers affect depressive symptoms, and to what extent gender differences in these conditions can explain potential differences in depressive symptoms. The present study investigated gender differences in teachers' self-reported depressive symptoms, and differences in their demands and resources in both work and home spheres. Associations between demands and resources, respectively, and depressive symptoms as well as gender differences in these associations were examined. Results from univariate and parallel growth modelling (N = 1,022), using data from six time points (2008 to 2018), found higher levels of depressive symptoms, higher emotional and quantitative work demands, and more time doing unpaid work among female teachers, whereas male teachers reported more time on leisure activities. Emotional and quantitative work demands were associated with depressive symptoms at baseline, and these associations also developed in parallel over time. Leisure time had a negative association with depressive symptoms at baseline. There were no gender differences in the strength of these associations. Findings suggest that gender differences in teachers' depressive symptoms could be attributable to women's greater demands in the work sphere and fewer resources in the home sphere than men as opposed to their being more vulnerable to workplace stressors.

Abstract

Purpose This aim of this study was to explore how hospital-based physicians in Sweden experienced the challenges in working conditions related to the provision of care during the initial response to the COVID-19 pandemic in 2020 when hospitals transitioned to pandemic care.

Design/methodology/approach The study has a qualitative design. Twenty-five hospital-based physicians were interviewed about their experiences from working in a hospital while healthcare organisations initially responded to COVID-19 pandemic in 2020. A thematic analysis was used to analyse the empirical material.

Findings The analysis resulted in four themes: involuntary self-management, a self-restrictive bureaucracy, passive occupational safety and health (OSH) management, and information overload. These themes reflect how the physicians perceived their work situation during the pandemic and how they tried to maintain quality care for their patients.

Practical implications The study gives valuable insights for formulating preparedness in regard to crisis management plans that can secure the provision of care for future emergencies in the healthcare services.

Originality/value This paper shows that a crisis management plans in the healthcare services should include decision structures and management, measures of risk assessment and OSH management, and the maintenance of personnel wellbeing. A prepared healthcare management can preserve quality care delivery while under crisis.

Abstract

The quality of meal-oriented support for people with intellectual disabilities is important for their health. The aim of the present study was to explore the experiences of meal-oriented support and diet counselling for adults with intellectual disabilities living in supported housing, from the perspective of housing staff and mothers. Five focus group interviews, including nine supporting staff members and nine mothers, were conducted. The interviews were analyzed using systematic text condensation. Five themes appeared; Extensive needs of the individual, Staff skills determine the food intake, Informal caregivers make up for shortage of support, Effective collaboration with a registered dietitian is needed and Responsibility of the organization state that professionalization of staff is needed. Lacking resources, such as time and nutritional knowledge, insufficient considerations of individual needs, and high staff turnover influence the meal-orientated services negatively. This study brings to the fore, staff working practices and the complexity of providing meal-oriented support for people with intellectual disabilities. Staff need skills to perform individually tailored support. This is best accomplished through effective collaboration between housing staff and relatives underpinned by knowledge from a registered dietitian. The working practices must be structured at the organizational level of the services.

Abstract

Background Work-related stress problems, i.e., burnout, depression, and anxiety, is a rising global health challenge. Poor mental health also appears to be a challenge for the construction industry, even though the occupational health focus has traditionally been on the physical work environment and musculoskeletal disorders. Yet, studies targeting the organisational level (i.e., work environment, policy) to enhance mental health within the construction industry are scant. Therefore, our first objective was to evaluate the effectiveness of a co-created occupational health intervention on stress and psychosocial working conditions within the construction industry in Sweden. The second objective was to evaluate whether the intervention was implemented as intended, i.e., implementation fidelity. The trial is registered in the ISRCTN clinical trial registry (ISRCTN16548039, ). Methods This is a controlled trial with one intervention and one matched control group. We co-created the program logic with stakeholders from the intervention group. The essence of the chosen intervention components, duties clarification, and structured roundmaking was enhanced planning and role clarification. We assessed adherence to the intervention and dose delivered (i.e., fidelity). We collected data on the outcomes (role clarity, team effectiveness, planning, staffing, quantitative demands, and the psychosocial safety climate) with online questionnaires at baseline, 12, and 24 months. Marginal means models adjusting for missing data patterns were applied to estimate potential differences in outcomes between groups over time. Results Fidelity was considered reasonably high. Yet, we found no intervention effects on the primary outcome stress. All outcomes, except role clarity deteriorated during the trial in the intervention and control group. However, the results indicate a positive effect of the intervention components on professionals' role clarity. The pandemic appears to have negatively affected stress and psychosocial working conditions. Conclusion The study's results suggest that co-creating occupational health interventions could be one solution for improved implementation fidelity. More studies are needed to evaluate these intervention components. Also, we recommend researchers of future intervention studies consider using missing not at random, sensitivity analysis.

Abstract

Background

Patients who need a live donor kidney transplant (LDKT) must often ask potential donors (PLDs) themselves. This is a difficult task and healthcare could unburden them by making this first contact, ensuring also that PLDs receive correct information. We investigated how PLDs experience receiving a letter from healthcare about LDKT, live kidney donation, and inviting them to meet with professionals to get more information.

Methods

The letter (LD-letter) was sent to a cohort of 46 individuals, from which a purposeful sample of 15 were interviewed using a semi-structured guide covering their experience of the letter, views on being approached by healthcare, and opinions on style and content. Interviews were analyzed using conventional inductive analysis.

Results

We identified three categories of experiences: Category (1) Reflections on receiving the letter, contains three subcategories relating to how the letter did not induce pressure to donate, did not affect the PLD's relationship with the patient with kidney disease, and made the letter-receiver feel important in the transplant process; Category (2) The letter creates clarification and trust, also contains three subcategories, relating to how it clarified the voluntariness of donation and neutrality of healthcare providers with respect to the PLD's decision, elucidated the patient with kidney disease's current stage of disease (where transplantation was approaching), and unburdened patients from the responsibility of contacting PLDs on their own; Category (3) Opinions and suggestions about the letter and further communication, with four subcategories, relating to preference of a letter as the first step for communication about LDKT, suggestions on style and content, views on following up the letter, and how open meetings about LDKT were an important information source. Furthermore, 80% of the interviewees found the letter's information comprehensive, 67% found it easy to read and respectful, and 86% rated it as good or very good.

Conclusion

Potential donors prefer and recommend a letter as the first step for communication regarding LD. The LD-letter unburdens patients from the task of asking PLDs and stresses the voluntariness of donation, does not leave PLDs feeling coerced or lead to negative effects in their relationship with the patient.

Abstract

Kunskapen om effekter av spridningen av coronaviruset sars-cov-2 i Sverige utifrån ett arbetsmiljöperspektiv är, av naturliga skäl, begränsad. Det finns dock internationell forskning från tidigare sjukdomsutbrott orsakade av andra coronavirus, vilken kan appliceras på svenska förhållanden och användas som underlag i en kunskapssammanställning.

I denna kunskapssammanställning sammanfattas kunskapsläget avseende hur arbetsmiljö, arbetsmiljöarbete och hälsa påverkas vid epidemier och pandemier orsakade av coronavirus. Kunskapssammanställningen ger också en bild av den publicerade forskningen avseende framför allt de första månaderna av covid-19-pandemin.

Abstract

Structural barriers such as inadequate housing, lack of employment opportunities, and discrimination are known to adversely affect the health of newly settled refugee migrants. However, these barriers remain largely unresolved and unaddressed. Thus, there is a need to better understand how other factors, such as individual-level health resources, may influence health and mitigate ill health in the early post-migration phase. In this study, we aimed to explore the relationship between health outcomes and individual health resources including health literacy, social support, and self-efficacy in newly settled refugee migrants. Survey data was collected from 787 refugee migrants in Sweden. Logistical regression analysis showed that limited health literacy, lack of emotional support, and low self-efficacy were consistently associated with poor health outcomes. Demographic variables such as gender, education, and type of residence permit were not as imperative. Individual-level health resources may play an important role in the general and psychological well-being of newly settled migrants. Promoting health literacy and facilitating the attainment of social support may buffer for structural challenges in the establishment phase and enhance the prospects of later health and social integration.

Abstract

This is a qualitative descriptive study of professionals' perceptions of facilitators and barriers for returning to work for women on long-term sick leave due to musculoskeletal pain and/or common mental disorder who participated in a vocational rehabilitation project. Data were collected through semi-structured interviews with 13 purposefully selected professionals from the Swedish Social Insurance Agency, the Swedish Public Employment Service, the health care services, and the municipal services. The interviews were analyzed with a manifest content analysis. The main facilitators were the close cooperation between the professionals and the individual support that was offered to the project participants. The main barriers were differences among the stakeholders' missions and goals, limitation in project duration and within the labor market, and the project participants' personal factors. These results emphasize the importance of cooperation between the professionals from the various stakeholders and focus on the individual's resources and needs. The study highlights the value of including health care professionals in vocational rehabilitation to benefit from their specific knowledge of the target group and their strengths and needs. Moreover, the study highlights the need to incorporate collaboration with employers and align with the local labor market in the development of vocational rehabilitation interventions.

Abstract

Workers exposed to gender harassment and illegitimate tasks may experience adverse mental health outcomes such as depression and burnout. However, the longitudinal effects and the complex interrelationships between these variables remain largely unexplored. We investigated the cross-lagged relationships between gender harassment, illegitimate tasks, and mental health outcomes among working adults in Sweden over a period of two years, as well as the gender differences in the cross-lagged effects. Additionally, the study examined whether illegitimate tasks mediated the relationship between gender harassment and negative mental health outcomes over time. Data were drawn from the Swedish Longitudinal Occupational Survey of Health (SLOSH), covering 2796 working men and 4110 working women in a two-wave analysis from 2018 to 2020. We employed a structural equation model to examine the cross-lagged effects and the mediating effect between gender harassment, illegitimate tasks, and mental health outcomes over time. Furthermore, we applied a multigroup analysis to determine gender differences in the cross-lagged effects. The results showed statistically significant cross-lagged relationships (forward, reverse, and reciprocal) between gender harassment, illegitimate tasks, and mental ill-health. There were statistically significant gender differences in these cross-lagged relationships (burnout: o'2(47) = 106.21, p < 0.01; depression: o'2(47) = 80.5, p < 0.01). Initial illegitimate tasks mediated the relationship between gender harassment and mental ill health outcomes over time. The gender differences in the interrelationships between gender harassment, illegitimate tasks, and mental ill-health outcomes among workers in Sweden indicate that policies, regulations, and interventions that address these exposures in organisations must be tailored to benefit both men and women.

Abstract

Background: Chronic pain and mental disorders are common reasons for long term sick leave. The study objective was to evaluate the efficacy of a multidisciplinary assessment and treatment program including acceptance and commitment therapy (TEAM) and stand-alone acceptance and commitment therapy (ACT), compared with treatment as usual (Control) on health outcomes in women on long-term sick leave.

Method: Participants (n = 308), women of working age on long term sick leave due to musculoskeletal pain and/or common mental disorders, were randomized to TEAM (n = 102), ACT (n = 102) or Control (n = 104). Participants in the multidisciplinary assessment treatment program received ACT, but also medical assessment, occupational therapy and social counselling. The second intervention included ACT only. Health outcomes were assessed over 12 months using adjusted linear mixed models. The results showed significant interaction effects for both ACT and TEAM compared with Control in anxiety (ACT [p < 0.05]; TEAM [p < 0.001]), depression (ACT [p < 0.001]; TEAM [p < 0.001]) and general well-being (ACT [p < 0.05]; TEAM [p < 0.001]). For self-rated pain, there was a significant interaction effect in favour of ACT (p < 0.05), and for satisfaction with life in favour of TEAM (p < 0.001).

Conclusion: Both ACT alone and multidisciplinary assessment and treatment including ACT were superior to treatment as usual in clinical outcomes.

Abstract

Work-related stress is a global problem causing suffering and economic costs. In Sweden, employees in human service occupations are overrepresented among persons on sick leave due to mental health problems such as stress-related disorders. The psychosocial work environment is one contributing factor for this problem, making it urgent to identify effective methods to decrease stress at the workplace. The aim of the study is to evaluate a participatory intervention to improve the psychosocial work environment and mental health using an embedded mixed methods design. The study is a controlled trial with a parallel process evaluation exploring fidelity and participants' reactions to the intervention activities, experiences of learning and changes in behaviours and work routines. We collected data through documentation, interviews and three waves of questionnaires. Our results show small changes in behaviours and work routines and no positive effects of the intervention on the psychosocial work environment nor health outcomes. One explanation is end-users' perceived lack of involvement over the process causing the intervention to be seen as a burden. Another explanation is that the intervention activities were perceived targeting the wrong organisational level. A representative participation over both content and process can be an effective strategy to change psychosocial working conditions and mental health.

Abstract

Enrichment is a phenomenon described as the synergistic and beneficial effects of participating in both work and private life. Far too few studies have acknowledged the role of gender in enrichment. By applying a gender theoretical approach, this article has two aims; first, we aim to study the role of gender in enrichment by examining the factorial structure of enrichment in men and women; secondly, we aim to study the relationship between enrichment and work and private life factors in an approximately representative sample of the Swedish working population. A multigroup confirmatory factor analysis with measurement in variance was performed and this resulted in a two-factor solution for enrichment for both men and women, representing the two directions of enrichment: work-to-life enrichment (WLE) and life-to-work enrichment (LWE). Factor loadings differ across genders, indicating that men and women construct and value items of enrichment differently. Next, linear mixed models were used to answer the second aim. Results show that gendered cultural norms in work and private life manifest in the relationship between factors in the work and home sphere and enrichment. Factors in work and private life with more or less masculine or feminine epithets relate differently to WLE and LWE for men and women. The main conclusion is that masculine and feminine norms are embodied in the values and experiences of enrichment and factors related to enrichment.

Abstract

One way to prevent work-related stress, is to implement primary occupational health interventions aimed at improving the psychosocial work environment. However, such interventions have shown a limited effect, often due to implementation failure and poor contextual fit. Co-creation, where researchers, together with end-users and other relevant stakeholders, develop the intervention is increasingly encouraged. However, few studies have evaluated the effects of co-created interventions, and participants' experience of the co-creation process. This is one of the first studies evaluating stakeholder perceptions of co-creating an occupational health intervention. We applied a thematic analysis, with data from 12 semi-structured interviews with stakeholders involved in the co-creation. Our results show that the respondents, in general, were satisfied with engaging in the co-creation, and they reported an increased awareness regarding risk factors of stress and how these should be handled. Additionally, the respondents described trust in the intervention activities and a good fit into the context. The study indicates that co-creating occupational health interventions can enhance the implementation and the contextual fit.

Abstract

The study investigated the association between onset of workplace violence and onset of sleep disturbances. We used self-reported data from the Swedish Longitudinal Occupational Survey of Health (SLOSH) collected in 2014, 2016, and 2018. A two-wave design was based on participants who had no exposure to workplace violence or sleep disturbances at baseline (n = 6,928). A three-wave design was based on participants who in addition were unexposed to sleep disturbances in the second wave (n = 6,150). Four items of the Karolinska Sleep Questionnaire were used to measure sleep disturbances and one question was used to measure the occurrence of workplace violence or threats of violence. Multivariate logistic regression analyses were performed. In the two-wave approach, onset of workplace violence was associated with onset of sleep disturbances after adjustment for sex, age, occupational position, education, and civil status (adjusted odds ratio 1.41, 95% confidence interval 1.02-1.96). The association was no longer statistically significant after further adjustment for night/evening work, demands, control, and social support at work. In the three-wave approach, results were only suggestive of an association between onset of workplace violence and subsequent onset of sleep disturbances after adjustment for sex, age, occupational position, education, and civil status. Onset of frequent exposure to workplace violence was associated with subsequent onset of sleep disturbances in the adjusted analyses, but these analyses were based on few individuals (13 exposed versus 5,907 unexposed). The results did not conclusively demonstrate that onset of workplace violence predicts development of sleep disturbances. Further research could elucidate the role of other working conditions.

Abstract

Objectives This prospective cohort study aimed to investigate gender harassment and sexual harassment as risk factors for prospective long-term sickness absence (LTSA, >= 21 days). Furthermore, support from colleagues was investigated as a moderating factor of this association. Methods Information on gender harassment, sexual harassment and support by colleagues were derived from the biannual Swedish Work Environment Survey 1999-2013, a representative sample of the Swedish working population (N=64 297). Information on LTSA as well as demographic and workplace variables were added from register data. Relative rates of LTSA the year following the exposure were determined using modified Poisson regression. Results Monthly to daily exposure to gender harassment was a risk factor for prospective LTSA among women [rate ratio (RR) 1.04, 95% confidence interval (CI) 1.02-1.05] and men (RR 1.07, 95% CI 1.04-1.10). Monthly to daily exposure to sexual harassment was also a risk factor for LTSA among women (RR 1.05, 95% CI 1.01-1.10) and men (RR 1.07, 95% CI 1.02-1.13). Exposure to sexual or gender harassment once in the last 12 months was not associated with LTSA. There was no support for an interaction between either of the exposures and support from colleagues in relation to LTSA. Conclusions Sexual harassment and gender harassment appear to contribute to a small excess risk for LTSA among women and men. For both kinds of offensive behaviors, the pervasiveness appears to be important for the outcome. The role of support by colleagues was inconclusive and needs further investigation.

Abstract

Mothers with cognitive limitations who have children in placement need to be listened to and to receive help in understanding and dealing with their situation. A support programme for this group was developed in Australia and then adapted for use in a Swedish context and named 'Mamma Trots Allt' (MTA). The aim was to examine the experiences of these mothers regarding their mothering role after participation in MTA. An explorative and qualitative design was used. Inclusion criteria were mothers with cognitive limitations, a child in placement and participation in MTA. Nine mothers, eight of them from a previous study, gave their informed consent to participate. A study-specific interview guide was adapted to people with cognitive limitations. The interviews took place after the final MTA session. The qualitative analyses resulted in a description of the mothers' experiences and how they changed after MTA, resulting in an overall theme, two subthemes, four categories and 11 subcategories. MTA facilitated the mothers' maturation and broadened their earlier, stereotypic life expectations. Offering a support programme benefits not only the mother but most likely the child as well.

Abstract

Background

The prevalence of sickness absence is particularly high among employees in health and social care, where psychosocial work stressors are pertinent. Managerial leadership is known to affect sickness absence rates, but the role leadership plays in relation to sickness absence is not fully understood; that is, whether poor leadership (i) is associated with sickness absence directly, (ii) is associated with sickness absence indirectly through the establishment of poor psychosocial working conditions, or (iii) whether good leadership rather has a buffering role in the association between work stressors and sickness absence.

Methods

Four biennial waves from the Swedish Longitudinal Occupational Survey of Health (SLOSH, 2010–2016, N=2333) were used. Autoregressive cross-lagged analyses within a multilevel structural equation modelling (MSEM) framework were conducted to test hypotheses i)–iii), targeting managerial leadership, register-based sickness absence and psychosocial work stressors (high psychological demands, poor decision authority and exposure to workplace violence).

Results

A direct association was found between poor leadership and sickness absence two years later, but no associations were found between leadership and the psychosocial work stressors. Finally, only in cases of poor leadership was there a statistically significant association between workplace violence and sickness absence.

Conclusions

Poor managerial leadership may increase the risk of sickness absence among health and social care workers in two ways: first, directly and, second, by increasing the link between workplace violence and sickness absence.

Abstract

Background: Work-life balance (WLB) is the extent to which individual's multiple life roles and demands carry over between each role. WLB can be divided into work interference with personal life (WIPL) and personal life interference with work (PLIW). This study aimed to investigate longitudinal associations between WIPL, PLIW and work ability outcomes.

Methods: In this cohort study, 224 employees in the energy and water sector in Sweden were followed-up over 2 years. Three questions derived from the Work Ability Index were used for measuring work ability outcome: current work ability compared with lifetime best; work ability regarding physical; and mental demands. Logistic regression models were used to analyse longitudinal associations between work ability and WIPL and WIPL respectively, controlling for workplace (company), position at work, experience of leadership quality, demographics, and work ability.

Results: Work ability compared to lifetime best were associated with WIPL in the adjusted logistic regression models (odds ratio (OR) 1.77, 95% confidence interval (CI) 1.15-2.73), and PLIW (OR 3.34, 95% CI 1.66-6.74). Work ability regarding physical demands was associated with WIPL (OR 1.60, 95% CI 1.07-2.40). Work ability regarding mental demands was associated with WIPL (OR 1.59, 95% CI 1.03-2.44) and PLIW (OR 2.88, 95% CI 1.31-6.32).

Conclusion: In this two-year longitudinal study, lower WIPL predicted good/excellent overall work ability compared with lifetime best, higher work ability regarding physical and mental demands, and lower PLIW predicted good/excellent overall work ability compared with lifetime best and higher work ability regarding and mental demands.

Abstract

Bakgrund

Med ekonomiskt stöd av Samordningsförbundet Uppsala län inleddes hösten 2018 arbetet med utveckling av förrehabiliterande insatser riktade till unga med aktivitetsersättning. Uppsala kommun var insatsägare och Arbetsförmedlingen, Försäkringskassan och Region Uppsala var samverkanspartners. En styrgrupp med representanter från de medverkande organisationerna formerades, och projektledare och projektmedarbetare anställdes.

Insatsens mål var tvåfaldigt; att utveckla en verksamhet riktad till unga vuxna i behov av stöd att komma i arbete samt att skapa en gemensam plattform för organisationernas arbete med målgruppen. Insatsen beviljades medel t o m juni 2020, och förlängdes efter förnyad ansökan t o m juni 2021.

Verksamheten fick namnet Ung Intro och som arbetssätt valdes Case Manager-metodiken i kombination med motiverande samtal. Case Manager-metodiken är en stödmodell där en Case Manager har koordinerande funktion för utredning, planering, insatser och uppföljning.  

Metod

Institutionen för Folkhälso- och vårdvetenskap vid Uppsala universitet fick uppdraget att genomföra en process- och effektutvärdering i syfte att studera insatsens arbetssätt i relation till dess mål, hinder och möjligheter för samverkan mellan partner och i relation till målgruppen samt att följa deltagarna från start till avslut i insatsen.

Data insamlades genom intervjuer vid tre tillfällen med Ung Intros medarbetare och styrgrupp. Vid två tillfällen intervjuades även berörda medarbetare vid Arbetsförmedling och Försäkringskassa. Dessutom tillkom projektdokumentation i form av styrgruppens minnesanteckningar, Ung Intros kvartalsrapporter till Samordningsförbundet Uppsala län och enkäter till insatsens deltagare vid inklusion och avslut. Data analyserades med kvalitativa och kvantitativa metoder, sammanställdes och återfördes till projektets styrgrupp.

Uppsala universitet hade även uppdrag att bidra till diskussion och planering av eventuell implementering av insatsen.

Resultat

Ung Intros medarbetare hade utbildningar av relevans för både arbetet med målgruppen och utvecklingen av en ny verksamhet. Fokus på individens behov, önskemål och resurser samt arbetssättet med Case Management i kombination med motiverande samtal ansågs skapa nytta för både Ung Intros deltagare och dess samverkanspartners.

Ett antal oklarheter och brister identifierades under intervjuerna, av vilka några var kvarstående även vid den tredje intervjuomgången. Oklarheterna rörde tidpunkt för när gemensam kartläggning ska genomföras, tidpunkt för när deltagare ska skrivas in i det förstärkta samarbetet mellan Arbetsförmedling och Försäkringskassa samt Arbetsförmedlingens roll för Ung Intros deltagare. Bland de identifierade bristerna var långa väntetider för utredning och behandling och bristande kontinuitet på grund av byten av personal inom organisationerna. 

Genom regelbundna möten har Ung Intros medarbetare och handläggare från Arbetsförmedling och Försäkringskassa fått förståelse och respekt för varandras uppdrag och arbetssätt, vilket underlättar deras samverkan i arbetet med deltagarna. Samverkan mellan organisationerna försvåras däremot av deras olika prioriteringar och regelverk.

För de av Ung Intros deltagare som besvarade både inklusions- och avslutsenkät framkom förbättringar avseende self-efficacy och självskattad hälsa vid avslutat deltagande i insatsen. Det är faktorer som är betydelsefulla för återgång i arbete och inträde på arbetsmarknaden.

Insatsen har en fungerande styrgrupp med relevanta och engagerade representanter från de medverkande organisationerna. Det framkom dock svårigheter att förankra och implementera beslut som fattats av styrgruppen i organisationernas ordinarie arbete, vilket medfört oklarheter kring vilka rutiner som gäller.

De diskussioner kring implementering av verksamhet eller rutiner som påbörjades hösten 2019 pågår fortfarande vid denna rapports skrivande. Inget resultat av implementeringsprocessen kan därför redovisas här men projektets förlängning ger möjlighet till fortsatt arbete kring implementeringen.   

Metoddiskussion

Användning av enkäter för uppföljning av Ung Intros deltagare var tidsmässigt krävande för medarbetarna och endast sex personer valde att besvara både inklusions- och avslutsenkät. Övriga metoder för datainsamling (intervjuer och dokumentation) genomfördes utan större problem. Det blev dock allt svårare att samla styrgruppens medlemmar, bl a orsakat av Corona-pandemin, vilket försenade den tredje intervju-omgången samt förhindrade återföring av resultatet av dessa intervjuer.  

Slutsatser

• Det finns stöd i forskningen inom området för Ung Intros arbetssätt med utgångspunkt i individens behov, Case Managers med koordinerande uppgifter och ansvar samt insatser i form av arbets- och/eller studierelaterade aktiviteter i kombination med psykosociala stödsamtal och social träning.
• Regelbundna möten mellan Ung Intros medarbetare och medarbetare vid de medverkande organisationerna bör stödjas och prioriteras för att stärka en långsiktigt hållbar samverkan dem emellan.
• Self-efficacy och hälsa är faktorer som har betydelse för återgång i arbete/inträde på arbetsmarknaden. För de personer som besvarade enkät vid avslut av Ung Intro, framkom högre nivåer av self-efficacy och förbättrad självskattad hälsa jämfört med i den enkät som besvarades vid inklusion.
• Om styrgruppen har mandat för att fatta beslut som rör arbetet i de egna organisationerna, bör strategier tas fram för hur rutiner som beslutats i styrgruppen ska förankras och implementeras som rutin i organisationernas ordinarie arbete. 
• Fortsatt arbete behövs för att besluta vad som ska implementeras i ordinarie verksamhet och hur detta ska ske för att bli långsiktigt hållbart. Eftersom insatsen har en fungerande styrgrupp, som har skapat kontakter mellan organisationerna, bör den kunna användas som pådrivande kraft för det arbetet.

Det behövs även fortsatt arbete för att uppnå insatsmålen, d v s att etablera rutiner och skapa överenskommelser på strukturell nivå mellan parterna för arbetet med målgruppen. Det kan göras under den förlängning som insatsen beviljats. 

Abstract

BACKGROUND: A novel approach to determine the effect of a treatment is to calculate the delay of event, which estimates the gain of event-free time. The aim of this study was to estimate gains in event-free time for stroke or systemic embolism, death, bleeding events, and the composite of these events, in patients with atrial fibrillation randomized to either warfarin or apixaban in the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation trial (ARISTOTLE).

DESIGN: The ARISTOTLE study was a randomized double-blind trial comparing apixaban with warfarin.

METHODS: Laplace regression was used to estimate the delay in time to the outcomes between the apixaban and the warfarin group in 6, 12, 18 and 22 months of follow-up.

RESULTS: The gain in event-free time for apixaban versus warfarin was 181 (95% confidence interval 76 to 287) days for stroke or systemic embolism and 55 (-4 to 114) days for death after 22 months of follow-up. The corresponding gains in event-free times for major and intracranial bleeding were 206 (130 to 281) and 392 (249 to 535) days, respectively. The overall gain for the composite of all these events was a gain of 116 (60 to 171) days.

CONCLUSIONS: In patients with atrial fibrillation, 22 months of treatment with apixaban, as compared with warfarin, provided gains of approximately 6 months in event-free time for stroke or systemic embolism, 7 months for major bleeding and 13 months for intracranial bleeding.

Abstract

Background Mental disorders are the most common reason for sick leave in Sweden. Knowledge about effective methods to help these individuals to return to work (RTW)/entry into work or studies is limited. Rehabilitation coordinators (RC's) have been introduced within healthcare with the purpose to promote cooperation, streamline the sick leave and rehabilitation process, and facilitate RTW for sick-listed patients. The function of RC's has shown positive results by reducing sick leave within primary healthcare. However, the function has not been evaluated in terms of specialist psychiatry. This paper describes the design of a study to evaluate effects of a RC intervention on sick leave and RTW/entry in work or studies in patients with moderate to severe affective and/or moderate to severe anxiety disorders within specialist psychiatric care. Methods A randomised controlled trial (RCT) comparing an intervention group receiving support from a RC with a control group receiving treatment as usual (TAU). The target group is patients on sick leave, treated for affective and/or anxiety disorder, aged 25-64, with or without employment. Discussion This study gives the possibility to evaluate a RC intervention for individuals with mental disorders. If the study has promising vocational outcomes, it may be of importance for the participants in many ways, e.g. increase participation in society, provide economic benefits and improve health and wellbeing. This would be valuable for the individual as well as for the society.

Abstract

Suboptimal adherence to medical treatments is prevalent across several clinical conditions and can lead to treatment failure. Adherence is a far from fully explored phenomenon and there is little knowledge about how patients interpret treatment effects. Commonly used treatment evaluation measures are often relative measures, which may be difficult for lay people and patients to understand.

The overall aim of this thesis was to investigate factors with relevance to adherence, to estimate treatment effects with the time-based Delay of Event (DoE) measure in anticoagulant preventive treatments, and to explore how lay people responded to the DoE measure, as compared with established measures, regarding treatment decisions and effect interpretation.

A quantitative population-based cross-sectional design was used for Study I. Study II used data from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) clinical trial and estimated effects as DoEs. Studies III and IV were carried out as randomised survey experiments.

The results showed that general adherence behaviour was associated with both environmental and social factors. Estimations of DoE showed that stroke or systemic embolism was delayed 181 (95% CI 76 to 287) days through twenty-two months of apixaban use, as compared with  warfarin use. The delay of major and intracranial bleeding was 206 (95% CI 130 to 281) and 392 (95% CI 249 to 535) days, respectively, due to apixaban use for twenty-two months, as compared with  warfarin use. Presenting preventive treatment effects as DoEs to lay people was associated with high willingness to initiate treatment and positive views on treatment benefits and willingness to pay for treatment.

Non-optimal adherence was partly associated with modifiable factors and it might be possible to increase adherence by managing these factors. Estimations of DoEs in preventive treatments gave information on effects regarding delay of different outcomes; the estimation also provides tools that might be useful for interpreting and communicating treatment effects in clinical decision-making. Lay people seemed to react rationally to variations in DoE magnitude; a higher proportion accepted treatment when the magnitude was greater.

Abstract

Purpose: The purpose of this paper is to investigate registered dietitians' (RDs) experiences in consulting to adults with intellectual disabilities (ID) in Sweden.

Design/methodology/approach: A descriptive study using a study-specific web-based questionnaire was administered, comprising both multiple-choice questions with a space for comments and open-ended questions. The open-ended answers and comments from 53 respondents were analysed with systematic text condensation.

Findings: Four categories were identified: RDs' experiences from the first meeting; explanations for late initial contact; the actions taken by RDs; and necessary measures for more sustainable nutrition care. Ten sub-categories described the challenges that RDs experience in more detail.

Practical implications: It is necessary to provide adults with ID and their supporting staff with individually tailored nutritional information. Individuals with ID must be actively involved in lifestyle changes that affect their everyday life. The RD must be included in the interdisciplinary team supporting adults with ID. If a new practice is to be implemented, it should be compatible with the existing values of adults with ID and their staff and must be feasible to implement in the everyday life of the individual.

Originality/value: This paper identified several barriers that should be overcome in relation to the preparation of RDs for consultation with adults with ID about nutritional health issues. A systematic structure, knowledge about nutrition and knowledge about adults with ID and their living situations are needed. An assessment instrument may meet health promotion needs and facilitate longitudinal follow-ups of nutritional problems.

Abstract

This study examines how health social workers (HSW) assess the rehabilitation needs of patients with long-term pain. Data were extracted from 66 patient assessments through a retrieval form based on the International Classification of Functioning, Disability, and Health. The assessments included information about relations, work, and recreation. Stress management, problem solving, self-care, participation in community life, and providing personal care were missing in parts of or all assessments. Differences in assessments suggest that information was registered based on traditional gender roles and age. Therefore, HSW need standardized assessment tools to ensure that assessments are relevant for all patients with long-term pain irrespective of gender or age.

Abstract

Despite the well-known associations between local environment and health, few studies have focused on environment and health care utiliza-tion, for instance health care seeking behaviour or adherence. This study was aimed at analysing housing type, behaviour based on perceived local outdoor safety, social support, informal caregiving, demographics, socioeconomics, and long-term illness, and associations with health-seeking and adherence behaviours at a population level. This study used data from the Swedish National Public Health Survey 2004–2014, an annually repeated, large sample, cross-sectional, population-based sur-vey study. In all, questionnaires from 100,433 individuals were returned by post, making the response rate 52.9% (100,433/190,000). Descrip-tive statistics and multiple logistic regressions were used to investigate associations between explanatory variables and the outcomes of refrain-ing from seeking care and non-adherence behaviour. Living in rented apartment, lodger, a dorm or other was associated with reporting refrain-ing from seeking care (adjusted OR 1.16, 95% CI 1.00–1.22), and non-adherence (adjusted OR 1.22; 95% CI 1.13–1.31). Refraining from go-ing out due to a perceived unsafe neighbourhood was associated with refraining from seeking care (adjusted OR 1.59, 95% CI 1.51–1.67) and non-adherence (adjusted OR 1.26, 95% CI 1.17–1.36). Social support and status as an informal caregiver was associated with higher odds of refraining from seeking medical care and non-adherence. This study suggests that living in rental housing, refraining from going out due to neighbourhood safety concerns, lack of social support or informal care-giver status are associated with lower health-seeking behaviour and non-adherence to prescribed medication.

Abstract

In Sweden, when needed, children of mothers with cognitive limitations are placed infoster homes. There is a lack of knowledge about the mothers with cognitive limitations,their experiences of their maternal role, whether they get the support neededto maintain the relationship with their children, and whether the support system isadapted to mothers with cognitive limitations. The aim was to describe the experiencesof the maternal role and support given in mothers with cognitive limitationswho have children in placement. An explorative and qualitative design was used.Eleven respondents were interviewed with support from a study‐specific guide. Amodel representing the respondents' experiences revealed one theme “Struggling,dependent and frustrated mothers,” and three categories: I am a mother, I am dependenton an incomprehensible system, and I reluctantly accept my situation. Motherswith children in placement experience a threat to their identity and experience a needto alter their maternal role. They need adapted support to understand the decisionsmade and facilitate the cooperation with child protection services and the fosterhome. Offering service adapted to their cognitive limitations could be helpful forthe struggling, dependent, and frustrated mothers.

Abstract

Purpose: The purpose of this study was to investigate associations between motivation for return to work and actual return to work, or increased employability among people on long-term sick leave.

Materials and methods: Data by responses to questionnaires was collected from 227 people on long-term sick leave (mean = 7.9 years) due to pain syndrome or mild to moderate mental health conditions who had participated in a vocational rehabilitation intervention. The participants’ motivation for return to work was measured at baseline. At 12-month follow-up, change in the type of reimbursement between baseline and at present was assessed and used to categorise outcomes as: “decreased work and employability”, “unchanged”, “increased employability”, and “increased work”. Associations between baseline motivation and return to work outcome were analysed using logistic and multinomial regression models.

Results: Motivation for return to work at baseline was associated with return to work or increased employability at 12-month follow-up in the logistic regression model adjusting for potential confounders (OR 2.44, 95% CI 1.25–4.78).

Conclusions: The results suggest that motivation for return to work at baseline was associated with actual chances of return to work or increased employability in people on long-term sick leave due to pain syndrome or mild to moderate mental health conditions.

• Implication for rehabilitation

• High motivation for return to work seems to increase the chances of actual return to work or increased employability in people on sick leave due to pain syndrome or mild to moderate mental health conditions.

• The potential impact of motivation for return to work is suggested to be highlighted in vocational rehabilitation.

• Rehabilitation professionals are recommended to recognise and take into consideration the patient’s stated motivation for return to work.

• Rehabilitation professionals should be aware of that the patient’s motivation for return to work might have an impact on the outcome of vocational rehabilitation.

Abstract

Ordinarie hälsokommunikation inom Stockholms läns landsting har utvärderats genom 10 intervjuer med aktörer inom landstinget och aktuella kommuner. I artikeln redovisas resultatet av intervjuerna samt av en workshop för berörda aktörer där resultat diskuterades. Studien visar att informanterna uppfattar den ordinarie hälsokommunikation som givande för deltagarna men för att fler personer ska få tillgång till aktiviteten behöver vissa problem diskutera och adresseras. Detta gäller organisationsform och finansieringsmodeller, att utveckla samarbete med övriga aktörer och myndigheter samt att utveckla information till personal vid aktuella myndigheter, till länets kommuner samt till de personer som inbjuds till aktiviteten. Fortsatt forskning bör även undersöka deltagarnas åsikter och erfarenheter av denna hälsokommunikationen.  

Abstract

Aim: To investigate perceived self-efficacy in unemployed young adults with disabilities and the association between self-efficacy and transition to work or studies.

Methods: This prospective cohort study collected data through self-report questionnaires and registry data from a vocational rehabilitation project with young adults, aged 19-29 years. The Swedish Social Insurance Agency, the Swedish Public Employment Service and the participating municipalities identified potential participants to the study. A total of 531 participants were included in the study, of which 249 (47%) were available for analysis. Multinomial logistic regression models were carried out to estimate the associations between self-efficacy, demographic, health and employment status. The latter was coded as: “no transition to work or studies”, “transition to studies”, and “transition to work”.

Results: A higher level of self-efficacy was associated with increased odds for “transition to work” (OR=2.37, p<0.05). This finding remained consistent when adjusting for possible confounders. The mean value of self-efficacy was low, and participants with lower self-efficacy reported worse self-rated health (p<0.001) compared with participants with higher self-efficacy.

Conclusions: The results from this study suggest that self-efficacy should be addressed in vocational rehabilitation of young adults with disabilities in order to support their transition and integration into the labour market.

Abstract

Purpose To investigate the effects of two vocational rehabilitation interventions on self-efficacy, for women on long-term sick leave ≥ 1 year due to chronic pain and/or mental illness. Methods This study uses data from a randomised controlled trial consisting of two phases and comprising 401 women on long-term sick leave. They were allocated to either (1) a multidisciplinary team assessment and multimodal intervention (TEAM), (2) acceptance and commitment therapy (ACT), or (3) control group. Data were collected through repeated measurements from self-reported questionnaires before intervention, 6 and 12 months later and registry data. Data from measurements of general self-efficacy, sociodemographics, anxiety and depression were analysed with linear regression analyses. Results During the intervention period, the women in the TEAM group’s self-efficacy mean increased from 2.29 to 2.74. The adjusted linear regression model, which included group allocation, sociodemographics, self-efficacy pre-treatment, anxiety and depression showed increased self-efficacy for those in the TEAM intervention at 12 months (B = 0.25, 95% CI 0.10–0.41). ACT intervention had no effect on self-efficacy at 12 months (B = 0.02, 95% CI − 0.16 to 0.19). The results in the adjusted model also showed that higher self-efficacy at pre-treatment was associated with a higher level of self-efficacy at 12 months (B = 0.68, 95% CI 0.54–0.81). Conclusion A multidisciplinary team assessment and multimodal intervention increased self-efficacy in women on sick leave for an extremely long time (mean 7.8 years) who had a low mean level of self-efficacy prior to inclusion. Thus, self-efficacy needs to be addressed in vocational rehabilitation.

Abstract

Background: People on long-term sick leave often have a long-lasting process back to work, where the individuals may be in multiple and recurrent states; i.e., receiving different social security benefits or working, and over time they may shift between these states. The purpose of this study was to evaluate the effects of two vocational rehabilitation programs, compared to a control, on return-to-work (RTW) or increased employability in patients on long-term sick leave due to mental illness and/or chronic pain. Methods: In this randomized controlled study, 427 women and men were allocated to either (1) multidisciplinary team management, i.e., multidisciplinary assessments and individual rehabilitation management, (2) acceptance and commitment therapy (ACT), or (3) control. A positive outcome was defined as RTW or increased employability. The outcome was considered negative if the (part-time) wage was reduced or ceased, or if there was an indication of decreased employability. The outcome was measured one year after entry in the project and analyzed using binary and multinomial logistic regressions. Results: Participants in the multidisciplinary team group reported having RTW odds ratio (OR) 3.31 (95% CI 1.39-7.87) compared to the control group in adjusted models. Participants in the ACT group reported having increased employability OR 3.22 (95% CI 1.13-9.15) compared to the control group in adjusted models. Conclusions: This study of vocational rehabilitation in mainly female patients on long-term sick leave due to mental illness and/or chronic pain suggests that multidisciplinary team assessments and individually adapted rehabilitation interventions increased RTW and employability. Solely receiving the ACT intervention also increased employability.

Abstract

Quality of life (QoL) has become an important outcome in evaluations of services and support for people with intellectual disabilities (ID). Many people with ID request more say and want to be involved in the development of services and support provision. The original Uppsala QoL (UQoL) model consists of a general essence and hierarchically ordered themes and describes QoL from the perspective of people with ID through individual interviews. The aim of the present study is to examine the UQoL regarding its inherent component parts and to explore the interrelationship between them. The study contributes to the understanding of the concept of QoL from the perspective of people with ID. Focus group interviews were conducted with people with mild and moderate ID. The results indicate that QoL is to experience well-being. The key component of QoL is to experience adult social status. which is determined by whether the individual experiences having control of their life, experiences a sense of personal safety and feels social belonging. In concordance with the original model, the UQoL2 is mainly made up of components equivalent to those frequently reported in the QoL literature. Nevertheless, some differences require attention. The primary component, adult social status, has not previously been highlighted in the QoL literature. The point of departure in the UQoL model is the users ' perspective rather than the user perspective as perceived by professionals or researchers. The UQoL is not primarily linked to the quality of service provision, but to peoples' daily life. A revised version of the original UQoL is suggested. Unlike the original model, other than the fact which that adult social status is superior, the components are not hierarchically organized, rather the interrelation between them is emphasized.

Abstract

En viktig metod för att främja hälsa hos nyanlända migranter är hälsokommunikation på det egna modersmålet. Flera initiativ har tagits för att utveckla hälsokommunikationen med migranter i Sverige. Särskild Hälsokommunikation har införts i flera delar av landet, däribland i Stockholms län. Sedan 2015 är hälsokommunikation integrerad i Samhällsorienteringen i Stockholms län, för de flyktingar som omfattas av etableringslagen.

I denna rapport presenteras en utvärdering av utvecklingen av den tidigare etablerade ordinarie hälsokommunikationen som ges av Stockholms läns landstings hälsokommunikatörer i tolv kommuner i länet. Syftet är att utvärdera vilka utvecklingsbehov som finns för den ordinarie hälsokommunikationen.

Genom intervjuer med aktörer inom landsting och kommuner har vi undersökt hur de aktuella kommunerna ser på organisation och finansieringsmodeller för ordinarie hälsokommunikation. Vidare har en enkätundersökning bland deltagare i hälsokommunikationen genomförts med syfte att kartlägga vad som kännetecknar deltagarna i den ordinarie hälsokommunikationen utifrån sociodemografiska och hälsorelaterade faktorer.

Utvärderingen pekar på flera utvecklingsområden för den ordinarie hälsokommunikationen.

Denna hälsokommunikation skulle exempelvis i större utsträckning kunna fördjupas och inriktas mot specifika målgruppers behov. Det finns också utrymme för att utveckla samverkan med andra aktörer som når målgrupperna, såsom Arbetsförmedling, hälso- och sjukvård och socialtjänst, samt att nå manliga migranter och yngre vuxna i större utsträckning.

Innehåll och metodik kan anpassat till målgruppens bristande hälsolitteracitet, d.v.s. förmåga att få tag på, förstå, värdera och använda sig av hälsoinformation. Det finns även ett intresse av att utveckla den lokala förankringen av verksamheten, samtidigt som den centrala samordningen och stödet har en viktig funktion. Rollfördelningen mellan de centrala funktionerna och de lokala aktörerna kan förtydligas och långsiktiga avtal anpassas till detta.

Abstract

Background Common measures used to describe preventive treatment effects today are proportional, i.e. they compare the proportions of events in relative or absolute terms, however they are not easily interpreted from the patient's perspective and different magnitudes do not seem to clearly discriminate between levels of effect presented to people. Methods In this randomised cross-sectional survey experiment, performed in a Swedish population-based sample (n=1041, response rate 58.6%), the respondents, aged between 40 and 75years were given information on a hypothetical preventive cardiovascular treatment. Respondents were randomised into groups in which the treatment was described as having the effect of delaying a heart attack for different periods of time (Delay of Event,DoE): 1month, 6months or 18months. Respondents were thereafter asked about their willingness to initiate such therapy, as well as questions about how they valued the proposed therapy. ResultsLonger DoE:s were associated with comparatively greater willingness to initiate treatment. The proportions accepting treatment were 81, 71 and 46% when postponement was 18months, 6months and 1month respectively. In adjusted binary logistic regression models the odds ratio for being willing to take therapy was 4.45 (95% CI 2.72-7.30) for a DoE of 6months, and 6.08 (95% CI 3.61-10.23) for a DoE of 18months compared with a DoE of 1month. Greater belief in the necessity of medical treatment increased the odds of being willing to initiate therapy. ConclusionsLay people's willingness to initiate preventive therapy was sensitive to the magnitude of the effect presented as DoE. The results indicate that DoE is a comprehensible effect measure, of potential value in shared clinical decision-making.

Abstract

This study explores factors influencing condom use among Swedish women and men who visited a sexual health clinic after unprotected sex during international travel. Semi-structured interviews were conducted with 25 women and 25 men. The data were analyzed using conventional content analysis. The informants' narratives were categorized as strategies and barriers. Strategies found were: risk assessment, testing, and treatment for sexually transmitted infections. The barriers were characterized as technical and personal or emotional. The findings indicate that sexual behavior may be different while traveling internationally, and that a release of social constraints and increased alcohol consumption were risk factors for practicing unprotected sex. Some of the strategies may be appropriate for the prevention of sexually transmitted infections, but several strategies and most barriers were used to explain why unprotected sex was practiced. Thus, people need the opportunity to reconsider strategies and strengthen confidence in their ability to use condoms. An individual-based approach employed within routine health care may support the practice of safer sex and prevent further transmission of sexually transmitted infections.

Abstract

Background: Social inequities are considered to affect healthcare utilization, whereas less is known about the factors associated with refraining from seeking dental care. This study aimed to investigate whether people with no social support, long-term illness, caregiver burden and low socioeconomic status (SES) refrained from seeking dental care in higher proportion than the general Swedish population.

Methods: This study used cross-sectional questionnaire data from repeated nationwide health surveys during 2004-2013 of a total of 90 845 people. The questionnaire included questions on demographic characteristics, social support, long-term illness, caregiving burden, SES and dental care-seeking behaviour. Descriptive statistics, chi-square tests, correlation analyses and logistic regressions were used to investigate associations between independent variables and dental care-seeking behaviour.

Results: In the total sample, 15.1% of respondents reported refraining from seeking dental care. Having no emotional social support or having no instrumental social support was separately associated with reporting refraining from seeking dental care in adjusted multivariate models (odds ratio [OR] 1.26, 95% confidence interval [CI] 1.18-1.34 and OR: 1.89, 95% CI: 1.67-2.13, respectively). Having a long-term illness was associated with refraining from seeking dental care in adjusted models (adjusted OR: 1.43, 95% CI: 1.35-1.51). Furthermore, being an informal caregiver was associated with refraining from seeking dental care (adjusted OR: 1.15, 95% CI: 1.07-1.23). Low SES was associated with higher refraining from seeking dental care; the strongest association was with having financial problems (adjusted OR: 3.57, 95% CI: 3.19-4.00). Interaction effects were found between education level and SES, and between social support and long-term illness, and the outcome.

Conclusions: The findings in this study imply that having no social support, having long-term illness, being informal caregiver or having financial problems are factors associated with reporting refraining from seeking dental care, on a population basis.

Abstract

This study aimed at analysing associations among housing type, neighbourhood safety behaviour, self-rated health (SRH), psychological well-being and unhealthy days in the general population. From 2004 to 2013, 90,845 Swedes completed a questionnaire about their health, number of days with poor health, psychological well-being, housing type, and whether they refrained from going out based on perception of neighbourhood safety. People not living in private housing and those who did not go out for safety reasons reported lower SRH and psychological well-being and higher frequency of recent unhealthy days and days without work capacity due to poor health.

Abstract

Objective: Mental illness and chronic pain are common reasons for long-term sick leave, typically more so for women. This study investigated the effects on return to work of 2 vocational rehabilitation programmes. Methods: In this randomized controlled study, 308 women were allocated to treatment with acceptance and commitment therapy, to multidisciplinary assessment and individualized rehabilitation interventions, or to a control group. Return-to-work at 12 months was assessed as: (i) returning to health insurance; (ii) number of reimbursed health insurance days during follow-up; (iii) self-reported change in working hours; (iv) a composite measure of self-reported change in work-related engagement. Results: The mean age of the Swedish study population was 48.5 years (standard deviation (SD) 6.3 years) and the mean time on sick leave 7.5 years (SD 3.2 years). There were no significant differences in reimbursed days or returning to the health insurance at 12 months. The multidisciplinary assessment and individualized rehabilitation interventions group, compared with control, reported a significant increase in working hours per week, as well as a significant increase in work-related engagement. Conclusion: Multidisciplinary assessments and individual rehabilitation interventions may improve the chance of return-to-work in women with long-term sick leave due to pain condition or mental illness.

Abstract

Aims and objectives

To examine disease‐related stress, coping strategies and the need for information and support in patients with inflammatory bowel disease (ulcerative colitis or Crohn's disease).

Background

Psychological stress is an important factor in ulcerative colitis and Crohn's disease, and therefore, coping strategies and support needs should be considered in routine clinical practice.

Design

This is a qualitative study using a descriptive interview‐based approach.

Method

Fifteen patients with ulcerative colitis (n = 7) or Crohn's disease (n = 8) were interviewed. The interviews were analysed with content analysis.

Results

The informants largely focused on disease‐related stress (e.g. access to a toilet, symptoms and worries) and relations to other people (various reactions from others and social situations). Behavioural strategies (i.e. taking actions and the need for making plans, prepare and adapt), social strategies (seeking help and information and sharing feelings about the disease with others) and emotional strategies (distraction, positive attitude and acceptance) were adopted to cope with the stress associated with the disease. The need for information and support concerned instrumental support (disease‐related information) and emotional support (to talk about disease management).

Conclusion

Faecal urgency and the fear of losing bowel control are important stressors for patients with inflammatory bowel disease. The patients handle this problem using various coping strategies depending on the type of stressful events. Both instrumental and emotional support were requested which primarily occurred at the time of diagnosis and disease flare‐ups.

Relevance to clinical practice

Patients with ulcerative colitis or Crohn's disease ask for information and psychosocial support that are tailored to their individual needs and at different stages in the disease trajectory to improve everyday life and strengthen self‐management strategies.

Abstract

Background: The process of returning to work after long-term sick leave can sometimes be complex. Many factors, (e.g. cooperation between different authorities and the individual as well as individual factors such as health, emotional well-being and self-efficacy) may have an impact on an individual’s ability to work. The aim of this study was to investigate clients’ experiences with an individually tailored vocational rehabilitation, the Dirigo project, and encounters with professionals working on it. The Dirigo project was based on collaboration between rehabilitation authorities, individually tailored interventions and a motivational interviewing approach. 

Methods: A descriptive qualitative design was used with data collected through interviews. Fourteen individuals on long-term sick leave took part in individual semi-structured interviews. The interviews were analysed using content analysis.

Results: The analysis showed overall positive experience of methods and encounters with professionals in a vocational rehabilitation project. The positive experiences were based on four key factors: 1. Opportunities for receiving various dimensions of support.  2. Good overall treatment by the professionals. 3. Satisfaction with the working methods of the project, and 4. Opportunities for personal development.

Conclusions: The main result showed that the clients had an overall positive experience of a vocational rehabilitation project and encounters with professionals who used motivational interviewing as a communication method. The overall positive experience indicated that their interactions with the different professionals may have affected their self-efficacy in general and in relation to transition to work. The knowledge is essential for the professionals working in the area of vocational rehabilitation. However, vocational rehabilitation interventions also need a societal approach to be able to offer clients opportunities for job training and real jobs.

Abstract

Background: This study analyzes the process of establishing and developing a cooperative vocational rehabilitation project with special focus on organizational and professional aspects. In the project, officials from the Swedish Social Insurance Agency and the Swedish Public Employment Service worked cooperatively with participants on long-term sick leave, youths with disability benefits, and people receiving social allowances. The officials used Motivational Interviewing (MI) as a method when meeting participants, and were able to offer flexible and tailored case management. The goal was to improve work ability and promote self-sufficiency.

Methods: The process evaluation was carried out through continuous data collection throughout the project (2012-2014), resulting in a total of 28 individual interviews and 17 focus groups with officials and managers. The material was categorized through an inductive content analysis, and analyzed using social capital as a theoretical frame.

Results: The evaluation points to how issues related to design, organization and management contributed to the project not reaching its goals, e.g. problems with recruitment of participants, the funding structure, and staffing problems on the managerial level. Still, officials reported positive effects of close cooperation, which was perceived as facilitating the case management by fostering a mutual understanding and access to resources and rehabilitation measures from more than one authority.

Conclusions: Cooperative work combined with the use of MI and flexible case management seem to promote an increased trust between officials from different authorities and participants, which in the study is conceptualized as bonding and bridging social capital (between officials) and linking social capital (between officials and participants). The organizational problems combined with the relatively large differences in approaches between the project and regular practice obstructed implementation, where the authorities involved did not appear to be ready for implementing methodologies that require organizational restructuring.

Abstract

Aim: The aim of this study was to examine the screening accuracy of four brief alcohol screening instruments in a general hospital setting.

Methods: Ten outpatient clinics were recruited to ensure a representative mix of demographics (e.g. sex, age and diagnosis). The staff at the reception desk handed out pre-sorted envelopes with questionnaires and information letters to the visitors. The questionnaires consisted of the 10-item Alcohol Use Disorders Identification Test (AUDIT), the Weekly Consumption Question (WCQ), the Heavy Episodic Drinking (HED) question and two questions on sex and age. Sensitivity and specificity were calculated for the AUDIT-C, AUDIT-3, WCQ and HED using the full 10-item AUDIT for comparison, with cut-off points of 6 for women and 8 for men.

Results: In all, 898 questionnaires were included (52% women). According to the full AUDIT, 12.0% of the women and 14.8% of the men were drinking above the hazardous level. Corresponding percentages for the brief screening instruments for women and men, respectively, were as follows: AUDIT-C: 17.2% and 27.4%; the AUDIT-3: 6% and 16.2%; the WCQ: 2% and 1.6%; and the HED screener: 12.9% and 21.2%.

Conclusions: The AUDIT-C may be used as a brief screener in a general hospital setting. The WCQ, as a stand-alone screening tool, may underestimate hazardous drinking habits. Screening results from the AUDIT-3 and the HED should be interpreted with caution when applied to women because of the risk of underestimation.

Abstract

Active traveling to a daily occupation means that an individual uses an active way of traveling between two destinations. Active travel to work or other daily occupations offers a convenient way to increase physical activity levels which is known to have positive effects on several health outcomes. Frequently used concepts in city planning and regional planning today are to create environments for active commuting and active living. Even then, little research has focused on traveling modes and subjective health outcomes such as self-rated health (SRH). This study aimed to explore and investigate associations between travel mode and health-related outcomes, such as self-rated health (SRH), body mass index (BMI) and overall physical activity, in an adult population in Sweden. A cross-sectional study was conducted in a randomly selected population-based sample (n = 1786, age 45-75 years); the respondents completed a questionnaire about their regular travel mode, demographics, lifestyle, BMI and SRH. Chi-square tests and logistic regressions found that inactive traveling was associated with poor SRH, a greater risk of obesity or being overweight and overall physical inactivity. In addition, lifestyle factors, such as choice of food and smoking habits, were associated with SRH, BMI and overall physical activity.

Abstract

The aim was to increase understanding of parents' experiences of having a child with cochlear implant (CI) and to explore how these related to children's use of CI. Twelve parents of children, full-time users or limited users of CI, participated in the study. Qualitative content analysis showed that the parents of children who used their CI differed from the parents with limited users in how they handled stressors. Support from health care professionals was seen as insufficient. Parents need to get involved in dynamic processes, where health care resources promote parental coping.

Abstract

Objectives: This study aimed to investigate patients' willingness to initiate a preventive treatment and compared two established effect measures to the newly developed Delay of Events (DoE) measure that expresses treatment effect as a gain in event-free time. Methods: In this cross-sectional, randomized survey experiment in the general Swedish population, 1079 respondents (response rate 60.9%) were asked to consider a preventive cardiovascular treatment. Respondents were randomly allocated to one of three effect descriptions: DoE, relative risk reduction (RRR), or absolute risk reduction (ARR). Univariate and multivariate analyses were performed investigating willingness to initiate treatment, views on treatment benefit, motivation and importance to adhere and willingness to pay for treatment. Results: Eighty-one percent were willing to take the medication when the effect was described as DoE, 83.0% when it was described as RRR and 62.8% when it was described as ARR. DoE and RRR was further associated with positive views on treatment benefit, motivation, importance to adhere and WTP. Conclusions: Presenting treatment effect as DoE or RRR was associated with a high willingness to initiate treatment. Practice implications: An approach based on the novel time-based measure DoE may be of value in clinical communication and shared decision making.

Abstract

BACKGROUND: Adults with cognitive disabilities often have difficulties in dealing with the complexity of everyday life. With cognitive assistive technology (e.g. electronic planning devices [EPDs] and individual support), they can bring order to their often chaotic life. Assumptions are that environmental factors influence with non-use of EPDs.

OBJECTIVE: To explore how adults with cognitive disabilities perceive the influence of environmental factors in the use of EPDs.

METHODS: A reference group with experience of use of EPDs assisted the researchers. Twelve adults with cognitive disabilities and experience of using EPDs participated. An interview guide was implemented covering environmental factors according to the International Classification of Functioning, Disability and Health. Qualitative content analysis was applied in the analyses.

RESULTS: Five categories and two themes emerged, which were integrated into a model of facilitating factors influencing the use of EPDs. Measures to prevent or eliminate negative influences of the device use are important to be taken. CONCLUSIONS: Professionals need more knowledge about EPDs, while users need individual adaption of the EPDs. EPDs need to be user-friendly, manageable and work in any seasons. Implications for Rehabilitation The users should have access to specially trained prescribers. There is a need for development of user-friendly and manageable products to function in any climate. Knowledge is lacking on how to implement the users in all stages of the prescribing process. Prescribers should increase knowledge in the use of EPDs to influence the attitudes of the social environment.

Abstract

Background: Informal caregiving by relatives is a great resource for individuals as well as for society, but the caregiving role is associated with health problems for the caregiver. This study aimed to compare caregivers' self-rated health, number of recent days with poor health and psychological wellbeing with that of non-caregivers in a general Swedish population. Methods: From 2004 to 2013, 90,845 Swedish people completed a postal questionnaire about their health, number of recent days with poor health during last month, psychological wellbeing and if they were performing caregiving or not. Descriptive statistics, chi-square analysis, ANOVA, logistic regressions and negative binomial regression models were used to investigate associations between being a caregiver or not and health and wellbeing. Negative binomial regression was used to assess the relation between caregiver status and recent days with poor health or functioning. Results: Eleven percent reported having a caregiving role. Caregivers reported poorer self-rated health compered to non-caregivers, also in adjusted models; odds ratio (OR): 1.07 with a 95 % confidence interval (CI): 1.01-1.13. Caregivers also reported lower psychological wellbeing compared to non-caregivers; OR: 1.22, CI: 1.15-1.30. Caregiving status was associated with more recent days with poor physical health and more recent days with poor mental health. Conclusions: This study suggests that caregivers have worse perceptions in self-rated health and psychological wellbeing compared with non-caregivers, indicating that the role of caregiver is adversely associated with health. This association also appears in terms of reporting days of poor health in the last month. The underlying mechanism of these associations, including the potential detrimental health effects of being a caregiver, needs to be investigated in longitudinal studies.

Abstract

Objective: The aim of this study was to explore the personal and social resources of children with a cochlear implant from a child's perspective. Method: This descriptive cross-sectional study included 19 children with cochlear implants, aged 9-12 years. Data was collected, using the children's sense of coherence (CSOC) scale, the Network map, and the strengths and difficulties questionnaire (SDQ). The data was analyzed using descriptive and correlation statistics. Results: Most children had a strong sense of coherence. School life was an important arena for their social network. The mental health was comparable to normal hearing children. Still, some of the children with implants had low SOC and poor mental health. High SOC and closeness of the social network, especially in school, were associated with good mental health. Conclusion: This study shows that Swedish school-aged children with cochlear implants as a group have access to personal and social resources as strong sense of coherence and social networks. Still, there are individual children with psychosocial problems who need support and treatment.

Abstract

Mental illness and pain are common causes of long-term sick absence and major difficulties in vocational rehabilitation. The aim of this study was to investigate health in a group of women with pain or mental illness who had exhausted their days of sickness benefit. This cross-sectional study uses baseline data from 355 women on long-term sick leave participating in controlled intervention studies aiming at returning to work. The study population filled in a written questionnaire with questions of self-rated health and sleep quality and validated indexes of mental health, satisfaction with life and general self-efficacy. Clinical psychiatric screening was performed on 230 individuals. The study population had a mean age of 48.8 years (SD 8.4), with an average time on sick leave of 7.8 years (SD 3.2). Self-rated health and sleep quality was poor compared with other populations. In all, 80.1% had at least one psychiatric diagnosis according to the psychiatric screening, and the average numbers of psychiatric diagnoses were 2.2 (SD 1.9). Foreign-born women showed significantly higher levels of mental illness, poorer self-rated health and sleep quality and lower self-efficacy and life satisfaction than native Swedish women. Women with long sick leave because of mental illness and/or pain have poor self-rated health and sleep quality, high prevalence of mental illness and low self-efficacy and life satisfaction. Psychiatric screening suggests more extensive mental illness than what was stated on the sick leave certificates. The health of foreign-born women seems to be worse than that of native Swedish women.

Abstract

Self-efficacy has been shown to be related to sick leave and to be a predictor of return to work after sickness absence. The aim of this study was to investigate whether factors related to sick leave predict self-efficacy in women on long-term sick leave because of pain and/or mental illness. This cross-sectional study uses baseline data from 337 Swedish women with pain and/or mental illness. All included women took part in vocational rehabilitation. Data were collected through a sick leave register and a baseline questionnaire. General self-efficacy, sociodemographics, self-rated health, anxiety, depression, view of the future, and social support were measured and analyzed by univariate and multivariate linear regression analyses. The full multivariate linear regression model, which included mental health factors together with all measured factors, showed that anxiety and depression were the only predictive factors of lower self-efficacy (adjusted R-2 = 0.46, P < 0.001) and explained 46% of the variance in self-efficacy. The mean scores of general self-efficacy were low, especially in women born abroad, those with low motivation, those with uncertainties about returning to work, and women reporting distrust. Anxiety and depression are important factors to consider when targeting self-efficacy in vocational rehabilitation.

Abstract

BACKGROUND: People with cognitive disabilities have difficulties in accomplishing everyday tasks. Electronic planning devices (EPDs) may compensate for the gap between a person’s capacity and everyday challenges. However, the devices are not always used as intended. Despite that, cognitive assistive technology has been investigated in several studies, knowledge regarding when and what makes adults decide to use EPDs is incomplete. People with cognitive disabilities have difficulties in accomplishing everyday tasks. Electronic planning devices (EPDs) may compensate for the gap between a person’s capacity and everyday challenges. However, the devices are not always used as intended. Despite that, cognitive assistive technology has been investigated in several studies, knowledge regarding when and what makes adults decide to use EPDs is incomplete. OBJECTIVE: The aim was to explore the subjective experiences of people with cognitive disabilities in relation to the use of EPDs. The aim was to explore the subjective experiences of people with cognitive disabilities in relation to the use of EPDs. METHODS: A qualitative approach was applied with a qualitative content analysis. Twelve respondents were interviewed with support from a study specific guide. A qualitative approach was applied with a qualitative content analysis. Twelve respondents were interviewed with support from a study specific guide. RESULTS: A model representing the respondents’ experiences in the use of EPDs, comprising one theme, Possibility to master my daily life , four categories, Degree of fit to my needs, I am aware of my cognitive disability, I get help to structure my everyday life and The EPD improves my volition and ten subcategories, was developed. A model representing the respondents’ experiences in the use of EPDs, comprising one theme, Possibility to master my daily life , four categories, Degree of fit to my needs, I am aware of my cognitive disability, I get help to structure my everyday life and The EPD improves my volition and ten subcategories, was developed. CONCLUSIONS: EPDs allow people with cognitive disabilities the possibility to deal with daily challenges; those who find EPDs beneficial tend to use them. EPDs can help people with cognitive disabilities in organisation, managing time and improve volition. EPDs allow people with cognitive disabilities the possibility to deal with daily challenges; those who find EPDs beneficial tend to use them. EPDs can help people with cognitive disabilities in organisation, managing time and improve volition.

Abstract

Purpose:  To describe daily time management in adults with and without mental disability and to examine differences in the level of their daily time management; to describe the possessions and use of electronic planning devices (EPDs) in activities and how environmental factors influence the use of EPDs in adults with mental disability. Methods: In a descriptive and cross-sectional design 32 participants using EPDs and a matched comparison group of 32 healthy adults was recruited. Time-Self rating scale measuring daily time management was adapted for adults. A study specific questionnaire was applied to collect data on five ICF environmental factors. Rasch modelling, descriptive and non-parametric statistics were applied. Results: Time-S has acceptable psychometric properties for use on adults with mental disability. People with mental disability and low level of daily time management who use advanced EPDs are more influenced by environmental factors. The study group perceived that encouragement and support from professionals as well as services influence their use of EPDs. Conclusions: Time-S can safely be used for people with mental disability. EPDs do not fully compensate the needs of the target-group. Prescribers need to give considerations to this and therefore they should be provided with more knowledge about this matter.

Abstract

Background: Self-rated health is a robust predictor of several health outcomes, such as functional ability, health care utilization, morbidity and mortality. The purpose of this study is to investigate and explore how health locus of control and disease burden relate to self-rated health among patients at risk for cardiovascular disease. Methods: In 2009, 414 Swedish patients who were using statins completed a questionnaire about their health, diseases and their views on the three-dimensional health locus of control scale. The scale determines which category of health locus of control - internal, chance or powerful others - a patient most identifies with. The data was analyzed using logistic regression and a structural equation modeling approach. Results: The analyses showed positive associations between internal health locus of control and self-rated health, and a negative association between health locus of control in chance and powerful others and self-rated health. High internal health locus of control was negatively associated with the cumulative burden of diseases, while health locus of control in chance and powerful others were positively associated with burden of diseases. In addition, age and education level had indirect associations with self-rated health through health locus of control. Conclusions: This study suggests that self-rated health is positively correlated with internal locus of control and negatively associated with high locus of control in chance and powerful others in patients at high risk for cardiovascular disease. Furthermore, disease burden seems to be negatively associated with self-rated health.

Abstract

We have explored Swedish medical social workers' attitudes, beliefs, knowledge, and behavior concerning evidence-based practice (EBP) and investigated the properties of a questionnaire to measure EBP. One hundred seventy-four Swedish medical social workers within university hospital care and primary care participated in a cross-sectional survey. Our results showed positive attitudes toward EBP and the use of evidence to support clinical decision making. EBP was seen as necessary and something that needed to be implemented more often. The main barriers to implementing EBP were lack of time (78%), the perception that EBP does not take into account the limitations of the clinical practice setting (78%), and lack of knowledge about relevant research (46%).

Abstract

Objective

This study attempts to identify a structure among patient-related factors that could predict treatment adherence in statin patients, especially with regards to the necessity-concern framework.

Methods

414 Swedish patients using statins completed a questionnaire about their health, treatment, locus of control, perception of necessity-concern and adherence. The data were handled using a structural equation modeling approach.

Results

Patients that reported high perceptions of necessity to treatment seemed to adhere well, and side effects appear to affect adherence negatively. Disease burden, cardiovascular disease experience and high locus of control seem to have mediating effects on adherence.

Conclusion

This study provides support for the hypothesis that health- and treatment-related factors, as well as locus of control factors, are indirectly associated with treatment adherence via their association with mediating factor necessity.

Practice implications:

This study highlights the importance of considering patients' beliefsabout medications, disease burden, experience of cardiovascular events and locus of control as these factors are associated with adherence behavior to statin treatment. This study also emphasizes more generally the importance of an approach targeting necessity and concern when communicating with and treating patients with lipid-lowering medication. (

Abstract

Objective: The aim was to explore and compare how children with cochlear implants, their parents, and their teachers perceive the children's mental health in terms of emotional and behavioral strengths and difficulties.

Methods: The self-report, parents', and teachers' versions of the Strengths and Difficulties Questionnaire (SDQ) were used to assess the mental health of 22 children with cochlear implants. The children's assessments were then compared to the parents' and 17 teachers' assessments. The data were analyzed using the SPSS software package.

Results: Total difficulties (p = .000), emotional symptoms (p = .000), and conduct problems (p = .007) were greater according to the children than according to parents and teachers. Younger children (9 years, n = 12) reported more emotional symptoms than older children (12 and 15 years, n = 10). Almost a quarter of the children rated themselves in a way indicating mental ill-health. Parents and teachers each indicated mental ill-health for one child.

Conclusions: Children with cochlear implants express greater concerns about their mental health than their parents and teachers do. This is important knowledge for adults in families, schools, and health care in order to support these children and offer treatment when needed.

Abstract

Syftet med projektet var att dokumentera erfarenheter av underlättande och hindrande omgivningsfaktorer när det gäller som personer med psykisk funktionsnedsättning som använder elektroniska planeringshjälpmedel.

Abstract

Objective

The aim of this study was to enhance knowledge about the life circumstances of children with cochlear implants or hearing aids, regarding daily functioning and attitude to the impairment.

Methods

Data were obtained from 36 children with cochlear implants and 38 children with hearing aids via study-specific questionnaires with fixed answer alternatives. The questions covered (1) usage of aids and related factors, (2) hearing in different everyday situations, (3) thoughts about the children's own hearing and others’ attitudes to it, and (4) choice of language. The data were analyzed using SPSS, and presented via the theoretical frame of the International Classification of Functioning, Disability and Health, Child and Youth version (ICF-CY).

Results

Children with CI and HA functioned equally well in daily life, but there were also certain differences. Symptoms from neck and shoulders were more common among children with hearing aids than among children with cochlear implants (p < .001). Children with hearing aids used their aids significantly less often than those with cochlear implants (p < .001). The participation variables showed that children with hearing aids had significantly more hearing problems in team sports (p = .033) and outdoor activities (p = .019), in comparison to children with cochlear implants. The two groups had similar thoughts regarding their own hearing, mostly considering it not to be a problem. They also did not generally think that other people found their hearing to be a problem.

Conclusions

Children with cochlear implants and children with hearing aids have, in some aspects, equally good functioning in everyday life situations. However, certain differences were found in dimensions of functioning, regarding neck and shoulder pain, usage of aids and sign language, and hearing problems in some activities.

Abstract

Vuxna personer med psykisk funktionsnedsättning har ofta problem med sin kognitiva förmåga, vilket leder till problem med att hantera vardagslivets komplexitet. Med behovsanpassade kognitiva hjälpmedel och individuellt stöd från kunnig personal finns möjlighet för personen att få ordning på sitt ofta kaotiska vardagsliv. Dock finns studier och klinisk erfarenhet som påvisar att hjälpmedel inte används i den utsträckning som förväntats. Antaganden finns om att komplexa faktorer i omgivningen interagerar med hjälpmedelsanvändning.

Syftet med studien var att dokumentera erfarenheter av underlättande och hindrande omgivningsfaktorer som personer med psykisk funktionsnedsättning har av användningen av elektroniska planeringshjälpmedel.

Metod: tolv personer med psykisk funktionsnedsättning och med erfarenhet av elektroniska planeringshjälpmedel rekryterades efter informerat samtycke via förskrivare och besök vid dagliga verksamheter. En studiespecifik frågeguide med öppna frågor med ett innehåll som täcker omgivningsfaktorer enligt Klassifikation av funktionstillstånd, funktionshinder och hälsa (ICF) användes i de inspelade intervjuerna. Materialet bearbetades med kvalitativ, induktiv innehållsanalys.

Resultatet utmynnade i sex kategorier och två teman formade till en modell med underlättande eller hindrande faktorer som inverkar på användning av elektroniska planeringshjälpmedel enligt deltagarna. Kategorierna benämndes: Insikt om funktionsnedsättning/behov; Medveten social omgivning; Egen kontroll och hanterbarhet av hjälpmedel; Nytta av och brister i hjälpmedlets funktion; stöd av kunnig personal; och Tydligt och lättbegripligt myndighetsutövande. Teman benämndes: Tydlig önskan om delaktighet och Nödvändig individuell anpassning. Åtgärder för att förebygga eller förhindra omgivningens negativa inverkan på hjälpmedelsanvändning är angelägen.

Abstract

Background: People with long-term sickness absence due to diffuse health problems are difficult to rehabilitate back to work. In this quasi-experimental study 48 individuals with time-limited sickness benefit were recruited to a return to work (RTW) project. The intervention group (30) participated in a 12-month programme based on a cognitive approach with the aim of strengthening the individuals’ self-esteem and empowerment. The reference group (18) received rehabilitation as usual. Methods: Evaluation methods used for the study group were self-reported questionnaires at baseline, before intervention and at follow-up after 1 year. Results: One year after the intervention 27% had returned to full or part-time work and yet another 10% were in work training and 13% in rehabilitation/treatment with an optimistic back to work prognosis. In the reference group only 1 person had partially (25%) returned to work. Subjectively rated health (SRH) and sleep quality improved following the intervention. MADRS scores decreased during the year for the intervention group. The results support the idea that return to work is an important contributor to better self-perceived mental health for people who have been outside the labour market for a long time. Conclusion: The project shows that long-term sickness absence due to diffuse and subjective health problems is not a permanent condition even in participants with substantial work absences periods. In addition, the importance of structured co-operation between the authorities and the project leaders is supported by previous research.

Abstract

There is a need to develop interventions to support returning to work for patients with long-term time sick absence due to diffuse health problems. In a pilot project 30 persons with long sickness absence (mean 6 yrs) met with a motivational coach at three different occasions to go through their life history, present health situation and psychosocial/social situation. An action plan was formed by the participants and was after the intervention communicated to representatives from the social insurance office and the employment office to create a mutual understanding and facilitate the search for an employer. At evaluation after one year 27% of participants had returned to part- or full-time work and another 23% were in work training or rehabilitation activities but with a fairly good prognosis to return to work in the future. Mean MADRS-score and self-rated health had improved at the one-year follow up.

Abstract

Background. Self-rated health (SRH) is a robust predictor of subsequent health outcome, independent of objective health measures and life-style-related health risk factors. However, the determinants of SRH are as yet largely unknown. In accordance with the prevailing stress theory, we hypothesized that SRH is associated with personal coping resources, psychological strain, life-style variables, and endocrine variables.

Methods. A total of 106 healthy women, 22-59 years of age, were followed for up to 3 years with annual blood sampling (cortisol, prolactin, testosterone) and written questionnaires in which information on SRH, psychological strain, coping resources, socio-economic and life-style variables was sought.

Results. In bivariate, screening logistic regression analyses, intended to find candidate variables for a final analysis model, all coping resource variables (sense of coherence, mastery, and self-esteem) were significantly related to SRH, and so were two psychological strain variables (vital exhaustion, and sleep disturbances), one life-style variable (fitness), but none of the endocrine variables. In the final multivariate analysis model, including all candidate variables, only vital exhaustion (P < 0.0001), fitness (P = 0.0002), and sense of coherence (P = 0.0006) were independently associated with SRH, together explaining 74% of the SRH variance.

Conclusion. Some elements of the hypothesis, i.e. the effects of coping resources, psychological strain, and life-style variables on SRH, were supported by the results, while others, i.e. effects of endocrine measures on SRH, were not, indicating a possible gender difference.

Abstract

Lack of goal clarity is known to have negative effects on organizational as well as individual wellbeing. This study assesses effects of goal clarity on organizational wellbeing in the Church of Sweden. Data was based on questionnaires from a random sample of 501 parishes and 1002 individuals from the upper parish management. The response rate was 62%. The results showed significantly more positive experiences of effects of goal clarity on organizational wellbeing for those having former experience with of this type of work and among those representing larger parishes. Older employees reported a higher degree of engagement in the work while younger employees expressed a higher degree of influence. The results suggest that work with goal clarity has a positive impact on organizational wellbeing, which in turn is expected to have positive effects on employee wellbeing. Further research is required to examine the relationships between goal clarity work and organizational as well as individual wellbeing.

Abstract

Just before and a few years after the turn of the millennium the burden the health insurance significantly increased in Sweden. This led to several initiatives to understand the causes and to reverse the trends. Government organizations, such as The Scientific Assessment of Health Technology, The National Board of Health and Welfare and The Social Insurance Board all contributed in different ways by producing knowledge, new guidelines as well as by changing their exercise of authority. Together with political reforms these initiatives have been effective in reducing the number of people on medical expenses insurance. If the changes reflect a better public health is, however, uncertain.

Abstract

Lack of goal clarity is known to have negative effects on organizational as well as individual wellbeing. This study assesses effects of goal clarity on organizational wellbeing in the Church of Sweden. Data was based on questionnaires from a random sample of 501 parishes and 1002 individuals from the upper parish management. The response rate was 62%. The results showed significantly more positive experiences of effects of goal clarity on organizational wellbeing for those having former experience with of this type of work and among those representing larger parishes. Older employees reported a higher degree of engagement in the work while younger employees expressed a higher degree of influence. The results suggest that work with goal clarity has a positive impact on organizational wellbeing, which in turn is expected to have positive effects on employee wellbeing. Further research is required to examine the relationships between goal clarity work and organizational as well as individual wellbeing.

Abstract

Vi utvärderar samverkansformen Resursteam, som bedrivits som ett försök för att minska långa sjukskrivningar. Resursteam innebär att ett team med hand-läggare från Försäkringskassan, husläkare, sjukgymnast och beteendevetare, vid regelbundna möten bedömer sjukskrivna personers rehabiliteringsbehov och ger förslag på åtgärder. Det övergripande syftet är att skatta effekten av Resursteam på den försäkrades sjukskrivningslängd och självskattade hälsa. Vi har genomfört (i) en kartläggning av verksamheten, (ii) en enkätstudie till sjuk-skrivna som deltagit i Resursteam och till jämförelsepersoner samt (ii) skattat effekten av Resursteam på självskattad hälsa och sjukskrivning. Resultaten är entydiga och visar på inga eller negativa effekter för de personer som ingått i Resursteam. Som exempel kan nämnas att tiden i sjukskrivning förlängs med cirka 20 procent i genomsnitt.

Abstract

This controlled longitudinal study was conducted to investigate the effects of organizational change on employees' self-reported health, work satisfaction, work-related exhaustion, stress, and sick leave. The population consisted of 226 employees at T1 and 198 at T2, divided into a study group affected by organizational changes, and a reference group not affected by them. Group differences for the outcome measures self-rated health (SRH), work satisfaction, work-related exhaustion, and hormones associated with stress were analysed using a two-factor ANOVA design for repeated measurements. Our findings showed no significant differences, either across time or between groups for SRH, work satisfaction, and work-related exhaustion. However, we did find significant change across time and between groups for the recovery hormone DHEA-S. Days of sick leave increased by 7% for employees in the study group and by 2% in the reference group. Serum cortisol showed significantly decreased levels across time but not between groups. The decreased recovery potential in the study group might have long-term health implications. The study points to the importance of looking at the impact of organizational change on employee well-being from a number of perspectives, such as self-reported health parameters, registered sick-leave data, and biological stress markers.

Abstract

Objective: Health-related quality of life (HRQoL) for patients with ulcerative colitis (UC) or Crohn's disease (CD) is influenced by symptoms and treatments. Periods with increased disease activity are specifically trying, but the knowledge of how patients manage this is sparse. The aim of this cross-sectional study was to examine (1) HRQoL for patients with UC or CD, (2) how patients cope with increased disease activity, and (3) if coping is associated with HRQoL. Methods: A postal questionnaire was sent to patients with UC and CD who attended the gastroenterology and surgery department at a Swedish university hospital. Coping, HRQoL, and emotional well-being were assessed by Jalowiec Coping Scale, Short Form-36 Health survey, Short Health Scale, and the Hospital Anxiety and Depression Scale. Results: Patients with increased disease activity reported impaired HRQoL and emotional distress. This was more prevalent among patients with CD, as compared to patients with UC. Optimistic, self-reliant and confrontive coping strategies were most frequently used to manage stressors, with no differences found between patients in exacerbation or remission or between patients with UC or CD. Conclusion: Impaired HRQoL and emotional distress is prevalent among patients with exacerbation in UC and CD. Thus, a complete evaluation of psychosocial status and management of psychosocial distress should be included in the clinical treatment of the patient. Patients use a variety of coping strategies in an effort to manage increased disease activity. However, these results did not support any associations between coping and HRQoL.

Abstract

The aim of this thesis was to investigate health-related quality of life (HRQoL) and coping strategies for individuals with ulcerative colitis (UC) or Crohn’s disease (CD), and to study the effect of a group-based patient information on anxiety/depression and HRQoL. HRQoL and anxiety/depression were investigated (n=492) (Study I). In Study II, anxiety/depression, HRQoL, satisfaction with information and evaluation of the patient information were studied (n=49). Coping with disease activity was investigated in 166 patients reporting current exacerbation (Study III). Fifteen patients were interviewed about disease-related stress, how this is managed and the need of support from the health care (Study IV). Patients with UC reported better HRQoL and less anxiety/depression than did patients with CD during both remission and exacerbation. Satisfaction with information had increased at follow-up 6 months after patient information. The information and the possibility to discuss with lecturers and group members were valued as most important. No change was found in anxiety/depression or HRQoL at follow-up. Both problem-focused and emotion-focused strategies were employed to cope with disease activity, with no difference between patients with UC or CD. The urgent need of toilet availability and stress associated to social situations were the major disease-related stressors. This stress was managed by finding out the location of toilets, bringing toilet paper and extra underwear and emptying bowel before an activity. The patients wanted information and possibilities to talk to experienced staff and to other patients about how to live with the disease. This thesis shows that HRQoL for some patients with UC, and primarily for patients with CD, is impaired. Thus medical staff should be observant of the psychosocial well-being of patients with CD and also of patients with relapse. Methods to identify and support patients with anxiety/depression and poor HRQoL need to be developed. Interventions should target the patient’s specific problems and at appropriate times.

Abstract

Background: Stress is one of the major reasons for sickness absence and especially the health care sector appears to be at risk. This cross sectional study aimed to identify risk factors of absence due to self-reported stress among health care employees. Methods: 225 health care employees were categorized into two groups based on self-rated sickness absence for stress or not. Questionnaire data and stress sensitive hormones measurements were used. Results: Employees with stress related sick leave experienced their health, work satisfaction as well as their social- and home situation worse than employees without stress- related sick leave. No statistically significant differences were identified regarding stress-sensitive hormones. The risk for employees not satisfied at work to become absent due to stress compared to those with a sufficient work situation appears to be about three times higher (OR 2.8, 95% CI 1.3 - 5.9). For those not satisfied with their social situation, the risk for being sickness absent appear to be somewhat higher (OR 3.2; CI 1.2 - 8.6).

Individual factors as recovery potential and meaning of life and work related factors as skill development and work tempo predicted employee’ s work satisfaction. Conclusion: Based on cross sectional data, work-site and individual factors as well as social situation appear to increase the risk for absence due to stress among health care employees. Lower recovery potential, higher work tempo and a worse leadership appeared to be related to the high degree of work related exhaustion among the employees.

Abstract

Objective: Simple global self-ratings of health have been found to hold considerable predictive validity in relation to morbidity and mortality. Inverse associations between chronic stress and self-rated health (SRH) have been found and suggested to explain part of the predictive validity of SRH. Studies including biological data are, however, few. The purpose of this paper is to study the relationship between endocrine measures of stress and SRH.

Methods: A longitudinal study of 102 healthy middle-aged men. Written questionnaires and blood samples were collected at baseline and at follow-up 1 year later.

Results: A decrease in SRH below the level of good was associated with significantly increased s-prolactin and decreased s-testosterone. Poorer SRH and increased levels of s-prolactin were significantly associated with increased vital exhaustion at follow-up.

Conclusion: Our study identifies a possible biological pathway, which might be of relevance in understanding the well-established association between SRH and health.