Domestic Workload and Multiple Roles. Epidemiological findings on health and sickness absence in women

Aim: The objective of this thesis was to analyse the importance of specific exposures in women’s lives to health and sickness absence; more precisely to study the association between domestic work, multiple roles and the experience of being sick-listed, and self-rated health, psychiatric disorders and sickness absence. Method: The thesis was based on two datasets. ‘Women’s health and living conditions’ (WHL) is a cross-sectional study on 1 417 employed women aged 17 to 64 years old. Data was collected with a questionnaire, and register and employee data on sickness absence. ‘Women and alcohol in Göteborg’ (WAG) is a prospective cohort study on 1 799 women in eight age cohorts born from 1925 to 1980. Data was collected with a screening questionnaire, interviews and register-based sickness absence. Several aspects of domestic work, multiple roles and experience of sickness absence were analysed in relation to self-rated health (SF-36), psychiatric disorders (DSM-III and IV) and sickness absence. The study on multiple roles emanated from the role strain and role enhancement hypotheses and roles were analysed as single roles and as combinations of roles. Changes in self-rated physical health were assessed in relation to experience of sickness absence over five year. Cross-sectional and longitudinal analyses were conducted using multivariate regressions analyses. Results: Domestic job strain and a lack of domestic work equity and marital satisfaction were associated with lower self-rated health particularly vitality and mental health. The former was not associated to sickness absence, but the latter was. Women with domestic workload due to children and adults with special needs had higher odds for medium-long sick-leave spells, while parental responsibility gave lower odds for any sick-leave spell. Occupation was related to lower odds for poor self-rated physical health and sickness absence, while the parental role was associated with higher odds for sickness absence. Compared with women who had all three roles women with occupation and partner role had lower odds for negative health outcomes. Support was found for the role strain hypothesis in the cross-sectional analyses of role combinations while neither of the hypotheses was supported in the five year follow up. A lower proportion of those who had experience of being sick-listed reported good health at both baseline and follow up. Women with psychiatric disorders had higher odds for a change from poor to good self-rated physical health over the five years if they had been sick-listed. Conclusion: Domestic workload was associated to health and sickness absence in women, but there were inconsistencies in the findings on children and being a parent and on multiple roles. From a public health perspective, deeper knowledge on the importance of women’s engagement domestic work and its different dimensions is important for promoting women’s health. A multidimensional assessment of domestic work is important and the content and complexity of domestic work and of different roles needs to be further explored in relation to health and sickness absence in women

Insomnia Symptoms, Sleep Duration, and Disability Pensions: a Prospective Study of Swedish Workers.

BACKGROUND: Previous studies have found insomnia and long sleep duration to be independently associated with subsequent disability pension (DP). However, the issue of a possible gender-based pattern in this context has received little attention. PURPOSE: This study aims to assess the impact of insomnia symptoms and sleep duration on the DP rates among Swedish women and men during a 12-year follow-up period. METHOD: The participants, from the general population of Malmö, Sweden, were enrolled from 1992 to 1994 (n = 4,319; participation rate 41 %), aged 45-64, healthy, and employed ≥30 h per week. Baseline inquiry data concerning psychosocial circumstances and self-reported sleep habits were compared with official register-based DP rates. RESULTS: Five hundred and nine persons were granted a DP. Insomnia symptoms, affirmed by 33 % of the men and 41 % of the women, were associated with receiving a DP; the hazard ratios in the fully adjusted model were 1.4 for both men [95 % confidence interval (CI) 1.1, 1.9] and women (95 % CI 1.1, 1.7). The fully adjusted hazard ratio for women sleeping ≥9 h was 7.8 (95 % CI 3.7, 16.6) for DP due to a mental disorder. In the age-adjusted analyses, the sub-domain "difficulties falling asleep" was related to DP due to mental disorders in men and DP due to cardiovascular diseases in women. CONCLUSION: The findings suggest that preventing and treating insomnia symptoms could reduce DP and that disease mechanisms linking sleep disturbances to DP may differ by gender

Can high psychological job demands, low decision latitude, and high job strain predict disability pensions? A 12-year follow-up of middle-aged Swedish workers.

OBJECTIVES: The aim of this study was to investigate whether job strain, psychological demands, and decision latitude are independent determinants of disability pension rates over a 12-year follow-up period. METHODS: We studied 3,181 men and 3,359 women, all middle-aged and working at least 30 h per week, recruited from the general population of Malmö, Sweden, in 1992. The participation rate was 41 %. Baseline data include sociodemographics, the Job Content Questionnaire, lifestyle, and health-related variables. Disability pension information was obtained through record linkage from the National Health Insurance Register. RESULTS: Nearly 20 % of the women and 15 % of the men were granted a disability pension during the follow-up period. The highest quartile of psychological job demands and the lowest quartile of decision latitude were associated with disability pensions when controlling for age, socioeconomic position, and health risk behaviours. In the final model, with adjustment also for health indicators and stress from outside the workplace, the hazard ratios for high strain jobs (i.e. high psychological demands in combination with low decision latitude) were 1.5 in men (95 % CI, 1.04-2.0) and 1.7 in women (95 % CI, 1.3-2.2). Stratifying for health at baseline showed that high strain tended to affect healthy but not unhealthy men, while this pattern was reversed in women. CONCLUSIONS: High psychological demands, low decision latitude, and job strain were all confirmed as independent risk factors for subsequent disability pensions. In order to increase chances of individuals remaining in the work force, interventions against these adverse psychosocial factors appear worthwhile

Upplevelsen av den goda vårdrelationen mellan vårdare och personer med demens : En litteraturstudie

Demenssjukdomen tillhör en av våra stora folksjukdomar och är ett samlingsnamn på sjukdomar som i första hand angriper centrala nervsystemet. Symtom som minnesförlust, agnosi, apraxi och dysfasi är övergripande för demenssjukdomar. Vårdrelationen mellan vårdare och personer med demens är därför komplicerad. Denna studie syftade till att belysa vad som kännetecknar en god vårdrelation mellan vårdare och personer med demenssjukdom på vårdboende. Metoden som använts var en litteraturstudie där kvalitativa studier sammanställts. Artiklarna analyserades efter Granheim & Lundman (2004) modell för innehållsanalys. Fem kategorier framkom i analysen; Fokus på den unika personen, Bekräftelse och respekt, Interaktion i vårdandet, Kunskap och förståelse hos vårdarna och Känslan av gemenskap och samhörighet. Positiva situationer uppstod när vårdare mötte vårdtagaren som en unik person trots sjukdomens svårigheter. God kontakt kunde skapas genom att lyssna och visa förståelse. Lugn, tålamod och att ge kärlek och värme var väsentliga komponenter i vårdandet. Slutsatsen var att vårdrelationen bör anpassas efter individen, situationen och ses som något unikt. Den goda vårdrelationen med vårdtagaren får aldrig tas för given och bör alltid problematiseras och reflekteras över

Upplevelsen av den goda vårdrelationen mellan vårdare och personer med demens : En litteraturstudie

Demenssjukdomen tillhör en av våra stora folksjukdomar och är ett samlingsnamn på sjukdomar som i första hand angriper centrala nervsystemet. Symtom som minnesförlust, agnosi, apraxi och dysfasi är övergripande för demenssjukdomar. Vårdrelationen mellan vårdare och personer med demens är därför komplicerad. Denna studie syftade till att belysa vad som kännetecknar en god vårdrelation mellan vårdare och personer med demenssjukdom på vårdboende. Metoden som använts var en litteraturstudie där kvalitativa studier sammanställts. Artiklarna analyserades efter Granheim & Lundman (2004) modell för innehållsanalys. Fem kategorier framkom i analysen; Fokus på den unika personen, Bekräftelse och respekt, Interaktion i vårdandet, Kunskap och förståelse hos vårdarna och Känslan av gemenskap och samhörighet. Positiva situationer uppstod när vårdare mötte vårdtagaren som en unik person trots sjukdomens svårigheter. God kontakt kunde skapas genom att lyssna och visa förståelse. Lugn, tålamod och att ge kärlek och värme var väsentliga komponenter i vårdandet. Slutsatsen var att vårdrelationen bör anpassas efter individen, situationen och ses som något unikt. Den goda vårdrelationen med vårdtagaren får aldrig tas för given och bör alltid problematiseras och reflekteras över

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Neuroplasticity following Nerve Transfer of the Anterior Interosseous Nerve for Proximal Ulnar Nerve Injuries

Background: Injuries to the ulnar nerve at or above proximal forearm level result in poor recovery despite early microsurgical repair, especially concerning the intrinsic motor function of the hand. To augment the numbers of regenerating axons into the targeted muscles, a nerve transfer of the distal branch of the median nerve, the anterior interosseous nerve, to the ulnar motor branch has been described. Methods: Two patients with severe atrophy of the intrinsic hand muscles following an initial proximal ulnar nerve repair had surgery with an end-to-side transfer of the anterior interosseous nerve to the ulnar motor branch at the wrist level. Outcome and neuroplasticity were prospectively studied using questionnaires, clinical examinations, electroneurography, electromyography, somatosensory evoked potentials at pre nerve transfer and 3-, 12-, and 24-months post nerve transfer as well as navigated transcranial magnetic stimulation at pre nerve transfer and 3- and 12-months post nerve transfer. Results: Successively improved motor function was observed. Complete reinnervation of intrinsic hand muscles was demonstrated at 12- to 24-months follow-up by electroneurography and electromyography. At the cortical level, navigated transcranial magnetic stimulation detected a movement of the hot-spot for the abductor digiti mini muscle, originally innervated by the ulnar nerve and the size of the area from where responses could be elicited in this muscle changed over time, indicating central plastic processes. An almost complete reinnervation of the pronator quadratus muscle was also observed. Conclusion: Both central and peripheral plastic mechanisms are involved in muscle reinnervation after anterior interosseous nerve transfer for treatment of proximal ulnar nerve injuries

Employment Sustainability for People with Intellectual Disability : A Systematic Review

Purpose Previous reviews about employment for people with intellectual disability (ID) have left questions about employment sustainability unanswered. Therefore, the aim of this systematic review was to identify and analyse research regarding employment sustainability for people with ID. The research questions were: What research about employment sustainability for people with ID has been published internationally between 2010 and 2020? In the identified studies, how is employment sustainability defined and measured and what are the main findings regarding employment sustainability? Methods A systematic review was conducted using eight databases from various disciplines including medical, health, and social sciences. After a selection process, 10 articles remained, and a framework matrix was created to analyse them. An employment sustainability definition was used as an analytical tool. Results Ten articles were identified as being about employment sustainability for people with ID. Five of them used qualitative designs and five used quantitative designs. Only four out of ten contained a definition of employment sustainability, and there was an inconsistency in measurement methods. The reported findings in the studied articles were categorised into three types: proportions of long-term employed individuals within the studied population, facilitators and barriers to long-term employment. Conclusions There is only a limited amount of research about employment sustainability for people with ID. Nevertheless, a few facilitators and barriers could be identified. There is no consensus about how to define or measure employment sustainability, making comparisons difficult. © The Author(s) 202