Among adolescents, the day-to-day functioning of the hypothalamo-pituitary-adrenal-axis (HPA-axis) and of the autonomic nervous system (ANS) and their relationships with stress, subjective health complaints and psychological factors such as self-esteem, studied in naturalistic settings, have been largely unexplored. This thesis aimed to investigate the diurnal activity of the HPA-axis (Studies I &amp; II) in terms of salivary cortisol and the ANS/SNS system (Study III) in terms of salivary alpha-amylase (sAA) in mid-adolescent girls and boys. Additionally, linkages between self-reported stress, self-esteem, recurrent pain and biomarkers were investigated. A further aim was to describe potential differences between girls and boys respectively. Study I showed that both girls and boys exhibited the typical diurnal cortisol profile with high levels in the morning that decreased throughout the day. Girls had higher total cortisol levels, while no differences emerged for measures of the cortisol increase. Study II showed no significant linkages between self-ratings of stress and cortisol. However, stress was associated with recurrent pain in girls. Study III showed that, for girls, both self-esteem and self-reported stress were related to morning levels of both cortisol and sAA, to the diurnal sAA output and to a conjoint measure of amylase over cortisol, AOC. To conclude, the findings suggest that both stress and self-esteem may be linked to different measures of ANS and HPA-axis activity, but also to measures of ANS and HPA-axis dysregulation, particularly among mid-adolescent girls. / <p>At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 2: Manuscript. Paper 3: Manuscript.</p>

<p>The overall aim of this thesis was to describe (1) needs for occupational therapy among persons with self-perceived activity limitations and/or participation restrictions due to long-term/recurrent pain, and (2) treatment interventions in occupational therapy to meet demonstrated needs. The Liss’ model for assessing health care needs was used as a structural scheme. A randomly selected sample (n=10,000) from the Swedish general population aged 18-58 years was the foundation for the study population with and without pain. In addition, occupational therapists were included (n=109). Data collection was made by postal questionnaires. The results showed a prevalence of 26 % and an incidence rate of 0.07. Demographic characteristics of the sample were female gender, ages 40-58 years and fewer years of education than those without pain. Pain in shoulders/lower back of searing/aching/gnawing character was the most frequently reported. A majority of the respondents reported affective/emo-tional effects of pain mainly of depressive character and they had previously been on sick leave due to pain. Women reported higher frequencies of self-perceived activity limitations/ participation restrictions due to pain, more difficulties with intermediate ADL, perceived higher job demands and had longer sick leave than men. Men perceived poorer social support than did women. Needs for occupational therapy were reported mainly as a consequence of activity and temporal imbalance. High health care consumers reported higher frequencies of needs/problems than did low health care consumers. The main goals and interventions suggested by occupational therapists to meet the needs in pain management focused on increased knowledge of handling daily occupations with the purpose to reduce pain, maintain competence/improve performance of home maintenance, reduce consequences of pain and increase knowledge how to handle effects of pain.</p>

The overall aim of this thesis was to describe (1) needs for occupational therapy among persons with self-perceived activity limitations and/or participation restrictions due to long-term/recurrent pain, and (2) treatment interventions in occupational therapy to meet demonstrated needs. The Liss’ model for assessing health care needs was used as a structural scheme. A randomly selected sample (n=10,000) from the Swedish general population aged 18-58 years was the foundation for the study population with and without pain. In addition, occupational therapists were included (n=109). Data collection was made by postal questionnaires. The results showed a prevalence of 26 % and an incidence rate of 0.07. Demographic characteristics of the sample were female gender, ages 40-58 years and fewer years of education than those without pain. Pain in shoulders/lower back of searing/aching/gnawing character was the most frequently reported. A majority of the respondents reported affective/emo-tional effects of pain mainly of depressive character and they had previously been on sick leave due to pain. Women reported higher frequencies of self-perceived activity limitations/ participation restrictions due to pain, more difficulties with intermediate ADL, perceived higher job demands and had longer sick leave than men. Men perceived poorer social support than did women. Needs for occupational therapy were reported mainly as a consequence of activity and temporal imbalance. High health care consumers reported higher frequencies of needs/problems than did low health care consumers. The main goals and interventions suggested by occupational therapists to meet the needs in pain management focused on increased knowledge of handling daily occupations with the purpose to reduce pain, maintain competence/improve performance of home maintenance, reduce consequences of pain and increase knowledge how to handle effects of pain.