Ann Öhman

FROM SHAME TO RESPECT: MUSCULOSKELETAL PAIN PATIENTS' EXPERIENCE OF A REHABILITATION PROGRAMME, A QUALITATIVE STUDY

OBJECTIVE This study aimed to describe and analyse how participants with fibromyalgia or chronic, widespread, musculoskeletal pain, 1 year after completion, experienced a rehabilitation programme; and what knowledge and strategies they had gained. DESIGN, METHODS AND SUBJECTS: Semi-structured interviews with 16 female patients were analysed using the grounded theory method of constant comparison. RESULTS One core category, from shame to respect, and 4 categories, developing body awareness/knowledge, setting limits, changing self-image and negative counterbalancing factors, and hopelessness and frustration over ones employment situation emerged from the data. The core category represents a process where the informants changed emotionally. Three categories were identified as important for starting and maintaining the process, one category affected the process negatively. CONCLUSION The rehabilitation programme started the process of change, from shame to respect. The informants learned new strategies for handling their pain and other symptoms; they improved their self-image and communication in their social environment.

Subjective health complaints in older adolescents are related to perceived stress, anxiety and gender - a cross-sectional school study in Northern Sweden.

BackgroundNegative trends in adolescent mental and subjective health are a challenge to public health work in Sweden and worldwide. Self-reported mental and subjective health complaints such as pain, sleeping problems, anxiety, and various stress-related problems seem to have increased over time among older adolescents, especially girls. The aim of this study has therefore been to investigate perceived stress, mental and subjective health complaints among older adolescents in Northern Sweden.MethodsData were derived from a cross-sectional school-based survey with a sample consisting of 16–18 year olds (n = 1027), boys and girls, in the first two years of upper secondary school, from different vocational and academic programmes in three public upper secondary schools in a university town in northern Sweden. Prevalence of perceived stress, subjective health complaints, general self-rated health, anxiety, and depression were measured using a questionnaire, including the Hospital Anxiety and Depression Scale (HADS).ResultsA large proportion of both girls and boys reported health complaints and perceived stress. There was a clear gender difference: two to three times as many girls as boys reported subjective health complaints, such as headache, tiredness and sleeping difficulties and musculoskeletal pain, as well as sadness and anxiety. High pressure and demands from school were experienced by 63.6% of girls and 38.5% of boys. Perceived stress in the form of pressure and demands correlated strongly with reported health complaints (r = 0.71) and anxiety (r = 0.71).ConclusionsThe results indicate that mental and subjective health complaints are prevalent during adolescence, especially in girls, and furthermore, that perceived stress and demands may be important explanatory factors. Future studies should pay attention to the balance between gender-related demands, perceived control and social support, particularly in the school environment, in order to prevent negative strain and stress-related ill-health. The gender gap in subjective adolescent health needs to be further explored.

'A constant struggle' : successful strategies of women in work despite fibromyalgia.

Purpose. This study aimed to explore, and obtain increased knowledge of, the strategies used by working women with fibromyalgia regarding control of pain, fatigue and other symptoms. Method. Qualitative methods with an emergent design were used. The informants were women with fibromyalgia who had participated in rehabilitation 6–8 years earlier, and were still in work. Diaries, focus groups and individual interviews were used for data collection. Content analysis and grounded theory were used for the analyses. Results. A model with three categories emerged. The core category ‘constant struggle’ contains eight sub-categories: enjoying life, taking care of oneself, positive thinking, setting limits, using pain as a guide, creative solutions, learning/being knowledgeable and ‘walking a tightrope’. The category ‘grieving process’ was a prerequisite for managing the struggle and the category ‘social support’ contained what facilitated the struggle. Conclusion. The informants fought a constant struggle against the symptoms and the consequences of their fibromyalgia. Their strategies were action-oriented and evinced a positive spirit. To have grieved and accepted their situation was a prerequisite for managing, and support from the family was a help in the struggle.

Parental share in public and domestic spheres: a population study on gender equality, death, and sickness

Study objective: Examine the relation between aspects of gender equality and population health based on the premise that sex differences in health are mainly caused by the gender system. Setting/participants: All Swedish couples (98 240 people) who had their first child together in 1978. Design: The exposure of gender equality is shown by the parents’ division of income and occupational position (public sphere), and parental leave and temporary child care (domestic sphere). People were classified by these indicators during 1978–1980 into different categories; those on an equal footing with their partner and those who were traditionally or untraditionally unequal. Health is measured by the outcomes of death during 1981–2001 and sickness absence during 1986–2000. Data are obtained by linking individual information from various national sources. The statistical method used is multiple logistic regressions with odds ratios as estimates of relative risks. Main results: From the public sphere is shown that traditionally unequal women have decreased health risks compared with equal women, while traditionally unequal men tend to have increased health risks compared with equal men. From the domestic sphere is indicated that both women and men run higher risks of death and sickness when being traditionally unequal compared with equal. Conclusions: Understanding the relation between gender equality and health, which was found to depend on sex, life sphere, and inequality type, seems to require a combination of the hypotheses of convergence, stress and expansion.

Career Choice and Professional Preferences in a Group of Canadian Physiotherapy Students

This article focuses on reasons for the career choice and the longitudinal development of attitudes to healthcare work and the physiotherapy profession. The study is part of a larger project on professional development in physiotherapy. A cohort of 60 Canadian physiotherapy students was surveyed on two occasions during their educational programme. The questionnaire was constructed using a theoretical framework about professional socialization. Forty students completed both versions of the questionnaire yielding a response rate of 67%. Seventy-two per cent were women and 28% were men. Job accessibility or economic (25.5%) were the most frequently indicated reasons for the career choice. The most frequently chosen role models were the preceptors in clinical placements (52%). None of the students indicated having a faculty member as a role model. The desire to work in private practice and with adults was ranked highly in both administrations of the questionnaire. Few students regarded home care and community health as preferable healthcare facilities after graduation. Research, managerial work or occupational health were not given as preferable areas of practice. There advantages were statistically significant differences between women and men in their preferences for private practice work and the public sector of healthcare. The results are discussed in relation to gendered division of labour in healthcare and to the development of the profession.

Career Choice, Professional Preferences and Gender ? the Case of Swedish Physiotherapy Students

The aim was to identify reasons for the career choice and professional preferences among students enrolled in the Swedish physiotherapy education. The study design was longitudinal and used a questionnaire administered to a cohort of 273 students in the beginning of the university programme in 1997 as well as at the completion of the programme in 1999, yielding a response rate of 93%. Data were analysed with factor analysis and univariate and multivariate logistic regression analysis. To test the relationship between the factors and outcomes that showed significant effect in the logistic regression analysis, a path analysis was performed. The two most preferred healthcare facilities after graduation were sports medicine clinics and fitness centres. Future work in private practice was highly endorsed by a majority of students. Health promotion was highly valued. Care of elderly and hospital work were not preferred. Significant differences between men and women appeared. Men were more likely to have chosen the programme because of their interest in sports and physical activity. Men were also more choice decided about future professional activities, whereas women were more open for several areas of practice. Men preferred to become the owner of a private clinic and to work with alternative approaches to healthcare, such as fitness training in sports medicine clinics.

Increasing physical activity, but persisting social gaps among middle-aged people: trends in Northern Sweden from 1990 to 2007

Background : Physical activity is identified as one important protective factor for chronic diseases. Physical activity surveillance is important in assessing healthy population behaviour over time. Many countries lack population trends on physical activity. Objective : To present trends in physical activity levels in Västerbotten County, Sweden and to evaluate physical activity among women and men with various educational levels. Methods : Population-based cross-sectional and panel data from the Västerbotten Intervention Programme (VIP) during 1990–2007 were used. All individuals in Västerbotten County who turned 40, 50, or 60 years old were invited to their local primary health care for a health screening. Physical activity during commuting, recreational activities, physical exercise, and socio-demographic data were collected using a self-administered questionnaire. Respondents were categorised as sedentary, moderate physically active, or physically active. Results : The prevalences of physically active behaviours increased from 16 to 24.2% among men and from 12.6 to 30.4% among women. Increases are observed in all educational groups, but gaps between educational groups widened recently. The level of sedentary behaviour was stable over the time period studied. The 10-year follow-up data show that the prevalences of physically active behaviours increased from 15.8 to 21.4% among men and 12.7 to 23.3% among women. However, 10.2% of men and 3.8% of women remained sedentary. Conclusion : Despite the promising evidence of increasing physical activity levels among the population in Västerbotten County, challenges remain for how to reduce the stable levels of sedentary behaviours in some subgroups. Persisting social gaps in physical activity levels should be addressed further. An exploration of peoples views on engaging in physical activity and barriers to doing so will allow better formulation of targeted interventions within this population.

Patterns of tobacco use: A 10-year follow-up study of smoking and snus habits in a middle-aged Swedish population

Aims: To study longitudinal patterns of tobacco use over a 10-year period among middle-aged men and women in Vaösterbotten County, Northern Sweden. Methods: The study is based on data from the 16,486 (8800 women and 7686 men) in the Vaösterbotten Intervention Programme (VIP) where people were invited to a health screening and counselling programme at 30, 40, 50 and 60 years of age. Results: Smoking decreased from 22.3% to 15.6% among women and from 18.5% to 12.7% among men. Use of snus (Swedish moist snuff) increased from 3.1% to 6.0% among women and from 24.6% to 26.3% among men. The number of people who used both snus and cigarettes was stable: 0.5% to 0.8% from baseline to follow-up for women, and 4.1% to 3.3% for men. The number of tobacco-free adults increased from 75.2% to 79.2% for women and from 61.1% to 64.3% for men. Of those who became smoke-free during the 10-year follow-up period, 80% of the women and 66% of the men quit smoking without transitioning to snus use. Conclusions: The majority of middle-aged Swedish men and women in this cohort that quit smoking did so without becoming snus dependent. In spite of an increasing use of snus, overall there was a decline in the number of people using tobacco products.

A stimulating, practice-based job facing increased stress – Clinical supervisors’ perceptions of professional role, physiotherapy education and the status of the profession

The aim was to study perceptions of professional role, education and the status of the profession among clinical physiotherapy supervisors. Five focus group discussions were conducted with 15 supervisors attached to four universities in Sweden. Qualitative analyses were carried out using constant comparisons. Triangulation of researchers was used to increase trustworthiness. The supervisors experienced themselves as being in the centre of two competing and changing fields – the academic setting and the clinic in healthcare organization. The contact with students and their updated knowledge base were the most positive aspects of being clinical supervisors. To create a good learning environment for the students was considered important, but lack of time in all aspects of the work created stress and dissatisfaction. Students’ hands-on skills and treatment techniques were regarded to be rather poor and there is too much emphasis on theoretical knowledge and research methods in the curriculum. The physiotherapy profession has potentials to develop in innovative fields such as health promotion and disease prevention outside the hospitals, but healthcare with its hierarchical organization is a hindrance for this development. Collaborative efforts to bridge the gap between university and clinical setting are needed.

Competent Women and Competing Professions - Physiotherapy Educators' Perceptions of the Field

Career choices are still strongly gendered in health care professions. In Sweden, physiotherapy is a middle-class womens profession that nowadays also attracts men. Career strategies and professio ...