This study examined the relationship between spirituality/religiousness and quality of life and the moderating effect of comorbid illness in a sample of 308 long-term cancer survivors who had received an initial primary cancer diagnosis of breast, prostate, colorectal, and Hodgkin's disease at least 5 prior to the beginning of the study. In addition to the self-report measures assessing the variable of interest, participants completed a set of socio-demographic items and several questions related to their cancer treatment at entry into the study (T1) and at a second assessment 12 months later (T2). Results showed that each spirituality/religiousness and comorbidity was significantly related to various aspects of quality of life at both time points of assessment. More specifically, spirituality/religiousness was significantly associated with greater cancer benefits, enhanced general quality of life, lower sexual dysfunction, but unexpectedly, greater family-related distress at T1. Similarly, comorbidity significantly related to more financial problems, worries about appearance, and pain at both time points. Greater comorbidity was also significantly associated with more sexual dysfunction and lower general quality of life at T1. Findings also provided supported for the moderating role of comorbidity on various domains of quality of life both concurrently (i.e., family-related distress and appearance concerns) and prospectively (i.e., family-related distress and pain). In some cases, the direction of the interaction effect was in the predicted direction such that greater spirituality/religiousness related to lower family-related distress (prospectively) and more appearance concerns (concurrently at T2) among survivors with a new comorbidity, for example. In other cases, the direction of the interaction was contrary to expectations, such that higher spirituality/religiousness was associated with greater family-related distress (concurrently at T1) and more pain (prospectively) among the group of survivors with greater comorbidity. Possible explanations for the apparently inconsistent findings are offered as well as recommendations for future research.

Thesis (M. Soc. Sc.)--University of Hong Kong, 2006.

The background to the thesis is the high rate for sickness absence in Sweden since the end of the 1990s. In an international perspective, the Swedish sickness absence appears exceptionally high. This can appear paradoxical bearing in mind the high standard of living and the high average length of life in Sweden, and there is much to indicate that complex causal correlations are involved. The overall aim of the thesis is to study and analyse the return to work or transition to disability pension, for persons on long-term sick leave from their own perspective. The focus of the thesis is the individual in a social context. The theoretical frame of reference is within medical sociology and is about sickness concepts and models and on medicalisation. The concept of work capacity is also taken up based on the concepts of disability and impairment. The empirical material consists of four studies. Two of these are qualitative interview studies with women. One of them (I) is about Greek women who have been granted Swedish disability pension. The aim of this study is to find explanations why such a large number of Greek women have become disability pensioners in Sweden. The analysis indicated some important factors: the doctors, the family and the social insurance system. The women had unclear psychosomatic complaints, which had been medicalised. The other qualitative study (IV) concerned women who after sick leave and rehabilitation succeeded in returning to work. It was seen to be strong and stubborn women who had to struggle to get back to working life. They had also been well taken care of in rehabilitation. The other two studies (II and III) are quantitative, prospective cohort studies with persons on sick leave with unspecified back and neck complaints. One main aim of one study (III) was to investigate the importance of motivation for rehabilitation and return to work. Two specially designed forms were used. It was seen, among other things that the forecasts of the person on sick leave on return to work coincided quite well with a follow-up two years later. One important result was that those who had undergone rehabilitation measures had returned to work to a much lesser extent than those who had not. Overall, the results showed the importance of listening to the individual and taking their own assessments of obstacles and possibilities in the rehabilitation process into consideration. The results in study III indicated that rehabilitation had not been sufficiently effective and in many cases did not lead to a return to work.

After two decades of liberal prescribing of opioids, there has been an increasing recognition of problems connected to the prolonged use of opioids for chronic pain. The aim of my thesis was to explore some consequences of long-term opioid treatment for chronic pain such as problematic opioid use, endocrine disorders, tolerance and genetic variations in pain and opioid response. Sixty patients with severe pain and problematic opioid use were treated with a structured methadone programme. Risk factors were musculoskeletal pain, psychiatric co-morbidity and previous addiction. Treatment resulted in good pain relief and improved quality of life, but function was impaired by side effects indicating endocrine dysregulation. The possibility of opioid-induced endocrine dysfunction was explored in the second paper, where 40 pain patients treated with strong opioids and 20 pain patients without treatment of strong opioids were investigated. The opioid-treated patients had significantly higher incidence of endocrine disturbance affecting gonadal and adrenal function and prolactin levels. The functionality of the μ-receptor after long-term treatment with morphine, saline and naloxone was explored in a cell-line expressing the μ-receptor. After one and four weeks of treatment the binding was tested with morphine, methadone, fentanyl and DAMGO and function measured by GTP γ-assay. The binding of DAMGO was significantly diminished after 4 weeks in cells treated with morphine compared with saline and naloxone. Genetic variation in three genes with functional impact on opioid response and pain sensitivity was investigated in 80 patients with chronic low-back pain and differential opioid sensitivity and in 56 healthy controls. The results indicated a higher incidence of opioid-related side effects and gender differences in patients with the minor allele of the ABCB1 gene, a correlation between increased opioid sensitivity and the major CACNA2D2 allele and a possible relationship between intrinsic protection against chronic pain and the minor allele of OPRM1.

Aims: The starting point of this study was the experience of great problems with persons on long-term sick leave in the county of Västerbotten. In order to illuminate the situation we designed a study of the actors most involved who dealt with persons on long-term sick leave. These actors were the medical doctors; the employers: the social insurance officials; and members of the board of social insurance and persons reporting on the cases to the board. One aim was to describe and analyse the situation for persons on sick leave. Another aim was to describe and analyse the perception of the role the different actors played when dealing with persons on long-term sick leave. The third aim was to describe and analyse the different actors' views of each other, and of the co-operation around the persons on long-term sick leave. Method and material: Interviews with persons on sick leave, employers, social insurance officials and medical doctors. Questionnaires were sent to persons on sick leave, doctors and the members of the board of social insurance and those reporting on the cases. The interviews were audio- taped and transcribed word by word. Coding and analysis of collected data was done simultaneously by performing new interviews, using an adjusted form of grounded theory with the purpose of trying to find patterns and contexts. The aim was to describe the subjective experiences of how the actors look upon their situation and their way of coping with it. Results: The interviews with the employers showed great differences in attitudes and ways of treating employees, which also led to different models for dealing with work environment, sickness absence and rehabilitation. We divided the employers into five different "ideal types". Two of them could be described as "well-functioning" with regard to rehabilitation, and three of them as "less well-functioning". A high degree of flexibility characterises the successful employer, and he also takes good care of his personnel. The good employer also co-operates with other actors. The employers that are not well-functioning are not engaged in making adjustments, and have little confidence in their staff; the unions within their field are weak. Interviews with medical doctors revealed that they felt lonely, and that the demands were frustrating to them. They also had feelings of losing the locus of control. The doctors showed lack of knowledge of the labour market and the social insurance legislation, which made their work harder. They experienced that their lack of time made sickness periods longer. Among the results from the interviews with social insurance officials can be mentioned that they had good knowledge about laws, but sometimes it was difficult to use their knowledge and methods due to lack of flexibility. They experienced feelings of loneliness and had great difficulty in making decisions. Co-operation with partners often did not work out - the officials did not demand so much of their co-actors. The results of the questionnaire directed towards the members of the board of social insurance and those who reported on the cases did not show statistically significant differences between the three counties. The members of the board had almost the same proposals for decision as those who reported on the cases. There were no significant differences between men and women in decision-making. As a whole the members of the board seemed to be skilled in their knowledge of how to use the social insurance legislation. The results of the interviews with persons on sick leave showed that those persons had difficulties in asking for help and support. They felt such loyalty to their employers that they did not ask for adjustments of working places when needed. At the same time they were disappointed that the employers were not sufficiently involved in making it possible to come back to work again. More than half of the respondents had not received enough support from the employers, the medical doctors or the social insurance officials. Most of them felt frustrated, with little or no hope for the future. The results of the questionnaire to persons on long-term sick leave showed that women took a greater responsibility for their own rehabilitation, while the employers showed an earlier interest in sick male employees than in sick female employees. The employers were also keener to adjust the working places for men than for women. Despite those factors, women more often met their employers than men did, and they also had a more positive attitude to social insurance officials and doctors than men had. People with longer education took greater responsibility for their rehabilitation than those with shorter education. Compared to older people, younger persons were more optimistic about their future health and work, and also expressed that work was not so stressful. / digitalisering@umu

OBJECTIVE: The aim of this study was to analyse how people who return to the labour market after long-term sickness absenteeism and subsequent job loss differ in employability, work ability, health, educational level, age, and gender, compared to those who do not. PARTICIPANTS: The cohort consisted of 191 individuals, 20 men and 171 women, whose employment was terminated because they had not been able to return to their regular work after taking a long-term sick leave and rehabilitation measures. METHODS: This study is based on a postal questionnaire sent out to a cohort of previous employees in a Swedish municipality in 2008. RESULTS: At the time of the survey, 39% of the respondents had returned to the labour market and the remaining 61% had not. Return to the labour market after a long-term sick leave was positively associated with male gender, young age, and work ability, i.e. the ability to work with respect to health and work-related demands. Employability, educational level, and health were not significantly associated with a return to the labour market. CONCLUSIONS: In the discourse on employability, work ability is often neglected even though it is a central aspect of an individual's ability to obtain new employment.

No description available.

Past research advocates the need for long-term care (LTC) facilities to adopt a person-centred model of care to optimize residents quality of life. The construct of quality of life in LTC has been defined by satisfaction with a set of domains identified by Kane and colleagues (2003). One goal of this study was to determine which domain is the most predictive of overall well-being among LTC residents in a rural setting. Based on past research and on Deci and Ryans (1985; 1991) self-determination theory, satisfaction with autonomy was predicted to emerge as most predictive of overall well-being. The present study also examined the relation between resident quality of life and well-being, and the degree of routinization (i.e., adherence to a rigid, inflexible daily schedule) within the LTC environment. Routinization is conceptually at odds with a person-centred model of care, yet its relation to the well-being of care recipients had not been examined prior. One hundred and ninety-eight residents from 15 LTC facilities in rural Saskatchewan participated in individual interviews to measure their satisfaction with 11 quality of life domains (Kane et al., 2003), and their overall well-being (using the Memorial University of Newfoundland Scale of Happiness; MUNSH; Kozma & Stones, 1980). One hundred and thirty-one staff from the 15 facilities completed a questionnaire designed to assess routinization within the LTC environment. Contrary to predictions, autonomy failed to emerge as a significant predictor of overall well-being among sample residents. The domain of meaningful activity received residents lowest satisfaction rating of the 11 domains, and also accounted for the most unique variance in overall well-being. Routinization was negatively related to resident quality of life, with staff rating routinization higher in facilities which residents reported lower satisfaction with quality of life. Results provide focus for improving the quality of life of LTC residents, and point to areas for further study.

The purpose of this dissertation was to explore the experience of long term grief following a perinatal loss. In particular, the processes of meaning reconstruction and self-changes stemming from perinatal loss were explored by listening to parents in-depth narratives of their experiences of loss and grief. A narrative methodology was used, based on a constructivist epistemology that suggests that people are storytellers by nature and we attempt to organize and make sense of our life experiences by constructing coherent narratives. Participants were 4 couples and 8 individuals whose losses occurred 1 to 35 years before the interview. Interviews followed a reflexive-dyadic interview model. Analysis of the narratives was approached in two ways: First, a voice-centered relational approach was used for initial interpretation and identification of prevalent voices in the stories. Second, five of the stories were written as evocative narratives, which served as a way of incorporating the authors personal experience of perinatal loss, as well as to evoke an empathic understanding of the experience of perinatal loss. The interpretation and discussion of the stories focused on meaning-making that was evident on both an individual level as well as across the larger group of participants. In particular, meaning-making influences and strategies were identified, including influences of the medical establishment and social networks which either served to disenfranchise parents losses or to comfort and ease parents in their grief. The impact of meaning-making on long-term grief was considered, as well as parents reports of positive and negative self-changes that emerged from their struggle with grief. The unique contribution of this project lies in its elaboration of the meaning reconstruction process in the context of perinatal loss; its demonstration of both positive and negative self-changes in a group of perinatally-bereaved parents; its exploration of grief several years to decades following a perinatal loss; its inclusion of the researchers self as both an additional source of data and as a validity check on the presentation and interpretation of participants stories; and the use of evocative narratives to evoke an empathic understanding of a historically disenfranchised form of loss.

Oral health has dramatically improved in most industrialized countries over the latter half of the 20th century. However, profound oral health disparities still exist especially for those most at risk of developing oral diseases and associated systemic consequences such as populations residing in long-term care facilities. Despite the growing body of literature that supports the link between oral microflora and the importance of oral hygiene in limiting the risk of pneumonia development, there are still gaps in our knowledge to effectively manage this risk. The research included in this dissertation sought to further our understanding of oral health and oral care in the context of pneumonia pathogenesis (chapter 3) and, by exploring the perspective of various stakeholders in oral health, we sought to further understand the factors that influence care provision (chapter 5). Additionally, a novel knowledge translation approach was tested to challenge traditional oral care interventions in order to promote improvements in front-line oral care practices (chapter 6). The relationship between oral microflora, oral care and pneumonia was found to be complex. It directs us to consider converging risk factors including a patient’s health status, health behaviours and access to oral care services. Different professional groups were found to possess different definitions of oral health, which influenced both their motivation to provide care as well as their focus of care. Definitions of oral health could also potentially influence the saliency of different types of oral care information to different targeted groups; therefore, this should be considered in developing education and training initiatives aimed at improving the provision of oral care. An appreciative knowledge translation approach was found to be effective in bridging the gap between oral care knowledge and the provision of care. Regardless of the type of intervention chosen, organizations were reported to play a crucial role in promoting oral health and supporting the successful implementation of oral care programs.