Conceptions of diabetes and diabetes care in young people with minority backgrounds.

Adolescents with type 1 diabetes (T1DM) need stable self-care routines for good metabolic control to minimize future cardiovascular health complications. These routines are demanding, and might be particularly challenging in underprivileged groups. The aim of this study was to gain in-depth knowledge on the experience of adolescents with T1DM and a non-Swedish background regarding factors that might influence their ability to take care of themselves; in particular, factors that might influence diabetes management routines, their social situation, and the support they receive from caregivers. We interviewed 12 adolescents with T1DM and minority backgrounds. The results indicated resources and constraints in the adolescents' social context and in the health care organization. The adolescents developed conceptions that helped to explain and excuse their self-care failures, and their successes. These findings highlight the importance of integrating T1DM as part of the individual's personal prerequisites. We discuss implications for the organization of diabetes care for adolescents.

Inequalities in maintenance of health and performance between young adult women and men in higher education.

BACKGROUND: Because of ageing populations, most high-income countries are facing an imminent scarcity of labour. Maintenance of health and performance in young adults therefore becomes a crucial prerequisite for sustainable societies. One major obstruction to this accomplishment is the striking health inequalities between young women and young men. Previously these inequalities have mainly been studied in a cross-sectional way, focusing on ill-health. In this study, we compared the prevalence of maintained health and performance between young adult women and men and the predictors for this outcome. METHODS: The cohort consisted of 1266 participants from a homogenous sample of university students in Sweden. A combined assessment of self-rated 'very good' health and un-impaired performance took place at three time points (i.e. maintained health and performance). Potential predictors covered stable conditions in health-related behaviours, conditions at work/school and work-home interference. RESULTS: Young women had less maintained health and performance than young men. No major differences in predictors were found. However, there was a tendency for psychosocial factors to be the most important predictors, especially in women. CONCLUSIONS: That young women had less maintained health and performance in a homogenous sample beyond well-known differentiating factors suggests explanations other than observable structural differences between the sexes. This was also indicated by the importance attached to perceived demands, and work-home interference, especially in women. The combination of less scheduled, and more unscheduled, schoolwork (i.e. time-flexibility) negatively affected the maintenance of health and performance in our study population, suggesting a focus for future studies.

The impact of systematic occupational health and safety management for occupational disorders and long-term work attendance.

Despite several years of conducting formalized systematic occupational health and safety management (SOHSM), as required by law in Sweden and most other industrialized countries, there is still little evidence on how SOHSM should be approached to have an impact on employees' health. The aim of this study was to investigate the importance of SOHSM, considering structured routines and participation processes, for the incidence of occupational disorders and the prevalence of long-term work attendance among home care workers (HCWs). Municipal human service organizations were compared concerning (a) their structured routines and participation processes for SOHSM and (b) employee health, i.e. the municipal five-year incidence of occupational disorders and prevalence of work attendance among HCWs. National register-based data from the whole population of HCWs (n=154 773) were linked to register-data of occupational disorders and prevalence of long-term work attendance. The top managers and safety representatives in selected high- and low-incidence organizations (n=60) answered a questionnaire about structure and participation process of SOHSM. The results showed that prevalence of long-term work attendance was higher where structure and routines for SOHSM (policy, goals and plans for action) were well organized. Highly structured SOHSM and human resource management were also related to high organizational incidence of reported occupational disorders. Allocated budget and routines related to HCWs' influence in decisions concerning performance of care were also related to long-term work attendance. The participation processes had a weak effect on occupational disorders and work attendance among HCWs. Reporting occupational disorders may be a functional tool to stimulate the development of effective SOHSM, to improve the work environment and sustainable work ability.

Leaders' strategies for dealing with own and their subordinates' stress in public human service organisations.

Despite the acknowledged key role of leaders for psychosocial work environment, few studies focus on how leaders can decrease work-related stress. To gain deeper knowledge of leaders' perceptions and strategies for dealing with their own and their subordinates' stress in public human service organisations (HSO), qualitative interviews were made with leaders from hospitals and regional social insurance offices (n=21), and analysed in line with grounded theory method. The leaders handled subordinates' stress and perceived leadership demands by acting as shock absorber (core category) and used strategies characterised as leading in continuous change whilst maintaining trustworthiness. To cope with their own stress from perceived leadership demands, they tried to sustain their own integrity (core category) by either identifying with or distancing themselves from the leader role. The strategies for dealing with leaders' own and subordinates' exposures to stressors was pervaded by perceived leadership demands and are probably influencing each other. Supportive structures and improved communication about everyday dilemmas seem to be needed in order, not just to prevent stress reactions, but to improve the basic conditions for practicing leadership in HSO.

Early inequalities in excellent health and performance among young adult women and men in Sweden.

BACKGROUND: Although health inequality between young adult women and men has been strikingly evident in symptoms of ill health, we found no studies examining these inequalities with a focus on positive health and performance. OBJECTIVE: The aim of the present study was to examine possible inequalities between young adult women and men in a combined assessment of positive health and health-related performance. METHODS: Women and men aged 18 to 25 years studying medicine or computer science at 6 colleges/universities in 5 cities in Sweden were recruited for this study. All respondents answered a Web-based questionnaire regarding health, health-related performance, information and communication technology exposure, mood, and individual factors. A combined assessment of excellent health and health-related performance (EHHP) was defined and tested. Prevalence ratios (PRs) with 95% CIs of EHHP were calculated separately for female and male respondents. To assess potential determinants of EHHP, differences in the relationships between EHHP and the explanatory factors were compared for both sexes. RESULTS: In a study group of young adult students consisting of 1046 women and 1312 men, women were less likely than men to have EHHP (PR 0.90 [95% CI, 0.83-0.98]). This inequality was even stronger within each course of study (medicine or computer science). Health-related factors showed similar patterns of relationship to EHHP for women and men; however, the strength of these relationships differed between the sexes. Logical relationships were observed between EHHP and almost all of the symptoms as well as between EHHP, the mood index, and health-related behavior. CONCLUSIONS: The well-known inequality in symptoms of ill health between young adult women and men was prevalent even in a combined assessment of positive health and health-related performance. That this inequality was prevalent in a relatively homogeneous sample of young adults indicates the importance of gender-based psychological and psychosocial factors beyond the more well-known structural gender-differentiating factors of vertical and horizontal segregation and disproportional responsibilities for domestic work. It may therefore be essential to emphasize these gender-based psychological and psychosocial factors when designing future studies and health promotion programs.

An intervention method for occupational safety in farming -- evaluation of the effect and process.

In order to increase safety in Swedish farming an intervention methodology to influence attitudes and behaviour was tested. Eighty eight farmers and farm workers in nine groups gathered on seven occasions during 1 year. The basic concept was to create socially supportive networks and encourage discussions and reflection, focusing on risk manageability. Six of the groups made structured incident/accident analyses. Three of the latter groups also received information on risks and accident consequences. Effects were evaluated in a pre-post questionnaire using six-graded scales. A significant increase in safety activity and significant reduction in stress and risk acceptance was observed in the total sample. Risk perception and perceived risk manageability did not change. Analysing incidents/accidents, but not receiving information, showed a more positive outcome. Qualitative data indicated good feasibility and that the long duration of the intervention was perceived as necessary. The socially supportive network was reported as beneficial for the change process.

The relationship between patient safety climate and occupational safety climate in healthcare - A multi-level investigation.

INTRODUCTION: Patient safety climate/culture is attracting increasing research interest, but there is little research on its relation with organizational climates regarding other target domains. The aim of this study was to investigate the relationship between patient safety climate and occupational safety climate in healthcare. METHOD: The climates were assessed using two questionnaires: Hospital Survey on Patient Safety Culture and Nordic Occupational Safety Climate Questionnaire. The final sample consisted of 1154 nurses, 886 assistant nurses, and 324 physicians, organized in 150 work units, within hospitals (117units), primary healthcare (5units) and elderly care (28units) in western Sweden, which represented 56% of the original sample contacted. RESULTS: Within each type of safety climate, two global dimensions were confirmed in a higher order factor analysis; one with an external focus relative the own unit, and one with an internal focus. Two methods were used to estimate the covariation between the global climate dimensions, in order to minimize the influence of bias from common method variance. First multilevel analysis was used for partitioning variances and covariances in a within unit part (individual level) and a between unit part (unit level). Second, a split sample technique was used to calculate unit level correlations based on aggregated observations from different respondents. Both methods showed associations similar in strength between the patient safety climate and the occupational safety climate domains. CONCLUSIONS: The results indicated that patient safety climate and occupational safety climate are strongly positively related at the unit level, and that the same organizational processes may be important for the development of both types of organizational climate. PRACTICAL APPLICATIONS: Safety improvement interventions should not be separated in different organizational processes, but be planned so that both patient safety and staff safety are considered concomitantly.

Health care to empower self-care in adolescents with type 1 diabetes mellitus and an immigrant minority background.

BACKGROUND: The pediatric diabetes team aims to support health, quality of life, and normal growth and development among adolescents with type 1 diabetes mellitus. Adolescents with an immigrant background have been found less successful in self-care. Previous research indicated that adolescents who had integrated the disease as a part of their self-image reasoned differently about their self-care to those who had not. OBJECTIVE: The aim of this study was to identify elements in the patient-pediatrician consultations that might influence such integration of the disease among adolescents with type 1 diabetes mellitus. METHODS: A total of 12 pediatrician-adolescent consultations were video-recorded and analyzed. The adolescents all had an immigrant background. RESULTS: Integration of the disease appeared enabled when responsibility was shared; when hope, autonomy, and emotions were confirmed; and when the pediatrician asked probing questions. Letting objective data dominate the adolescent's experiences, using risk as a motivator, neutralizing emotions in relation to having diabetes, and confirming forgetfulness, may instead inhibit disease integration. CONCLUSION: An extended person-centered approach with focus on the adolescent's experiences of everyday life with a chronic disease and less attention on physical parameters in the pediatrician-adolescent consultations may increase integration of the disease.

Are simple feedback interventions involving workplace data associated with better working environment and health? A cluster randomized controlled study among Swedish VDU workers.

OBJECTIVE: To test whether feedback and discussion of ergonomic and psychosocial working environment data during 1 short session with individual, groups, or supervisors of VDU workers had effects on (1) the quality of implemented modifications in workplace design, working technique, or psychosocial aspects; (2) psychological demands, decision latitude, and social support; (3) comfort during computer work, emotional stress, and prevalence of musculoskeletal symptoms or eye discomfort. METHODS: Thirty-six workgroups from 9 organizations were randomized to 3 feedback conditions (individual, workgroup, supervisor) or control. Follow-up was 6 months after intervention. Questionnaire data aggregated on the workgroup level were used. RESULTS: Effect (positive) on social support was indicated from feedback to supervisors. CONCLUSION: Feedback and discussion of ergonomic and psychosocial working environment data with supervisors of white-collar VDU workers may have positive effect on social support measured as a group characteristic. Sources of potential bias are discussed.

Dissociation of dysfunctional breathing and odour intolerance among adults in a general-population study.

BACKGROUND: Many patients present with a mixture of respiratory problems such as shortness of breath, heavy breathing, coughing and odour intolerance. If these patients are diagnosed as asthma, it might sometimes be a false diagnosis. Concepts such as sensory hyperreactivity, hyperventilation, asthma-like symptoms, odour intolerance and dysfunctional breathing are used to refer to these patients. Non-respiratory symptoms such as headache, fatigue and bloating are sometimes also part of the clinical picture. Our aim was to use factor analysis to increase our understanding of breathing-related symptoms in a general-population frame. METHODS: A respiratory questionnaire was answered by 10 108 subjects in a general-population sample. Items aiming to identify individuals with breathing-related symptoms and asthma were included. We used factor analysis with Varimax rotation to extract discriminatory components (i.e. groups of symptoms), based on the questionnaire items. The aim was to find groups of items (factors) as distinct as possible, still allowing overlap and showing the importance of each item in the separated factor. RESULTS: Five distinct factors were identified in the factor analysis, representing dysfunctional breathing, odour intolerance, asthma, bronchitis and a group with mixed symptoms, respectively. These five factors explained 55% of the variance. CONCLUSIONS: Based on our findings, we conclude that non-asthmatic breathing-related symptoms may be separated into at least two categories in a general population, odour intolerance and dysfunctional breathing. These two categories seem to be two distinct groups of subjects with breathing-related symptoms and may represent different clinical entities separated from asthma and bronchitis.

"Pushing oneself too hard": performance-based self-esteem as a predictor of sickness presenteeism among young adult women and men--a cohort study.

OBJECTIVE: To examine whether young adults with highly performance-based self-esteem (PBSE) were present at work/studies when ill more frequently than were others. METHODS: By using data from a Swedish cohort of young adults aged 20 to 25 years (n = 5582 at baseline), we examined the association between PBSE and sickness presenteeism (SP) >5 times/yr (retrospectively at 1-year follow-up). RESULTS: PBSE was a predictor of SP even when adjusting for general health, psychological demands, physical demands, economic problems, and main occupation. A synergy effect was also observed between PBSE and environmental and personal factors in relation to SP. The effect of PBSE on SP was four times higher among individuals with poor health, compared to individuals with good health. CONCLUSIONS: These results provide support for the role of personality characteristics as a predictor of frequent SP.

Feedback of workplace data to individual workers, workgroups or supervisors as a way to stimulate working environment activity: a cluster randomized controlled study.

OBJECTIVE: To test whether feedback and discussion of ergonomic and psychosocial working-environment data during one short session with individual, groups or supervisors of white-collar computer workers had an effect on activity to modify workplace design, working technique and psychosocial aspects of work. METHODS: A total of 36 workgroups from nine organizations representing different trades was randomized (stratified for organization) to three feedback conditions or control with no feedback. Data were collected 1 month before and 6 months after feedback sessions. The effects studied were: (1) change in the proportion of workgroup members who reported any modification regarding workplace design or working technique; (2) change in the proportion of workgroup members who reported any modification regarding psychosocial aspects; (3) average number of modification types regarding workplace design or working technique per individual in a workgroup; (4) average number of modification types regarding psychosocial aspects per individual in a workgroup. RESULTS: All feedback conditions differed positively from controls regarding change in the proportion of workgroup members who reported any modification in workplace design or working technique. No such effect was found for psychosocial aspects. For change in average number of psychosocial modification types per individual in a workgroup an effect was observed for feedback to supervisors. No intervention effect was observed for the average number of modifications in workplace design or working technique per individual in a workgroup. CONCLUSION: Feedback and discussion of ergonomic and psychosocial working-environment data during one short session with individual, groups or supervisors of white-collar computer workers may have a positive effect on how many people in a workgroup modify (or have modifications done regarding) workplace design and working technique. Feedback to supervisors may have an effect on the average number of psychosocial modification types per individual in a workgroup. Feedback to group supervisors appeared to be the most cost-effective variant.

Assessment of hearing and hearing disorders in rock/jazz musicians.

The aim of this study was to assess hearing and hearing disorders among rock/jazz musicians. One hundred and thirty-nine (43 women and 96 men) musicians participated. The results are based on pure-tone audiometry and questionnaire responses. According to our definition of hearing loss, tinnitus, hyperacusis, distortion and/or diplacusis as hearing disorders, we found disorders in 74%, of the rock/jazz musicians studied. Hearing loss, tinnitus and hyperacusis were most common, and the latter two were found significantly more frequently than in different reference populations. The women showed bilateral, significantly better hearing thresholds at 3-6 kHz than the men. Hyperacusis, and the combination of both hyperacusis and tinnitus, were found to be significantly more frequent among women than among men. Hearing loss and tinnitus were significantly more common among men than among women. It is important to evaluate all kinds of hearing problems (other than hearing loss) in musicians, since they represent an occupational group especially dependent on optimal, functional hearing. On the basis of our results, we suggest that hearing problems such as tinnitus, hyperacusis, distortion and/or diplacusis should, in addition to hearing loss, be defined as hearing disorders.