<p>During the last decade, there has been a renewed interest in physicians´ working conditions at a time when health care is undergoing major structural and financial changes. Physicians report decreasing work satisfaction and at the same time increasingly contemplate on leaving their profession. Despite an increasing proportion of female physicians, they are underrepresented in management positions. Very often, female physicians also report worse personal health and less organisational influence than their male colleagues. Management programs have been viewed as an important vehicle to improve working conditions and career development for female physicians.</p><p>The aim of the present thesis was to evaluate the effects on individual health, professional development, perception of organisational structure and career development. Fifty-two female physicians participated in structured 1-year management programs. The control group consisted of 52 physicians not participating in any formal management education during the study period. The female physicians were compared with 157 male physicians in order to evaluate possible gender and manager-reported differences on individual and organisational well-being. The study also assessed occupational predictors of individual well-being, health and professional development for managers.</p><p>Participants in management programs reported a clearer organisational structure and improved professional development and influence. However, there were no significant effects with regard to health, sickness absenteeism, nor career development. Male and female physicians differed in several areas when assessed as a group, but stratifying for management level, most of the gender-related differences disappeared. When managers rated clearer organisational structure, this was associated with higher ratings on individual well-being and professional development.</p><p>Management programs for female physicians might have some beneficial effects but these programs need to be better defined and targeted to the most important issues at hand to recruit future managers. Furthermore, these programs must be better integrated with other processes to create efficient and able managers.</p>

<p>This thesis presents hormonal, emotional, physical and visual status changes in female fibromyalgia (FMS) patients after treatment with the Creative Art therapy; dance/movement therapy, compared to controls. FMS is a syndrome of chronic pain involving musculoskeletal aches, stiffness and pain where perturbations in the stress-axis and high scores on somatic anxiety and muscular tension also have been found. The study comprises thirty-six female FMS patients divided in treatment- and control group. Serum concentrations of the hormones prolactin, dehydroepiandrosterone sulphate (DHEA-S), cortisol and neuropeptide Y (NPY) in plasma and cortisol in saliva were analysed. Different verbal self-rating scales concerning well-being, pain, personality and life events among other things have been used. Assessments of the condition of the FMS patients affected by video-viewing were evaluated together with interviews about the self-perception phenomenon of video viewing (a phenomenological hermeneutic method). </p><p>The results of the study show that six months of dance/movement therapy appears sufficient to improve both psychological and physical function, as indicated by the visual analyses. The video interpretation technique (VIT) and self-figure drawings captured treatment effects that were not evident from verbal scales or reflected in hormone levels. The biological markers probably need a longer treatment period to activate the HPA axis and its inter-related hormones and peptides. </p><p>The use of different assessment techniques most likely has affected the treatment outcome. Difficulties perceiving information through verbal/cognitive modalities as well as alexithymia are factors discussed. The VIT may be useful for early identification of maladaptive movement patterns and as a mirror of facial and bodily expressions of emotions. In conclusion, this study indicates that both the dance/movement therapy and the VIT have had great influence on the FMS patient’s well-being, self-perception and perception of pain. </p>

This thesis presents hormonal, emotional, physical and visual status changes in female fibromyalgia (FMS) patients after treatment with the Creative Art therapy; dance/movement therapy, compared to controls. FMS is a syndrome of chronic pain involving musculoskeletal aches, stiffness and pain where perturbations in the stress-axis and high scores on somatic anxiety and muscular tension also have been found. The study comprises thirty-six female FMS patients divided in treatment- and control group. Serum concentrations of the hormones prolactin, dehydroepiandrosterone sulphate (DHEA-S), cortisol and neuropeptide Y (NPY) in plasma and cortisol in saliva were analysed. Different verbal self-rating scales concerning well-being, pain, personality and life events among other things have been used. Assessments of the condition of the FMS patients affected by video-viewing were evaluated together with interviews about the self-perception phenomenon of video viewing (a phenomenological hermeneutic method). The results of the study show that six months of dance/movement therapy appears sufficient to improve both psychological and physical function, as indicated by the visual analyses. The video interpretation technique (VIT) and self-figure drawings captured treatment effects that were not evident from verbal scales or reflected in hormone levels. The biological markers probably need a longer treatment period to activate the HPA axis and its inter-related hormones and peptides. The use of different assessment techniques most likely has affected the treatment outcome. Difficulties perceiving information through verbal/cognitive modalities as well as alexithymia are factors discussed. The VIT may be useful for early identification of maladaptive movement patterns and as a mirror of facial and bodily expressions of emotions. In conclusion, this study indicates that both the dance/movement therapy and the VIT have had great influence on the FMS patient’s well-being, self-perception and perception of pain.

During the last decade, there has been a renewed interest in physicians´ working conditions at a time when health care is undergoing major structural and financial changes. Physicians report decreasing work satisfaction and at the same time increasingly contemplate on leaving their profession. Despite an increasing proportion of female physicians, they are underrepresented in management positions. Very often, female physicians also report worse personal health and less organisational influence than their male colleagues. Management programs have been viewed as an important vehicle to improve working conditions and career development for female physicians. The aim of the present thesis was to evaluate the effects on individual health, professional development, perception of organisational structure and career development. Fifty-two female physicians participated in structured 1-year management programs. The control group consisted of 52 physicians not participating in any formal management education during the study period. The female physicians were compared with 157 male physicians in order to evaluate possible gender and manager-reported differences on individual and organisational well-being. The study also assessed occupational predictors of individual well-being, health and professional development for managers. Participants in management programs reported a clearer organisational structure and improved professional development and influence. However, there were no significant effects with regard to health, sickness absenteeism, nor career development. Male and female physicians differed in several areas when assessed as a group, but stratifying for management level, most of the gender-related differences disappeared. When managers rated clearer organisational structure, this was associated with higher ratings on individual well-being and professional development. Management programs for female physicians might have some beneficial effects but these programs need to be better defined and targeted to the most important issues at hand to recruit future managers. Furthermore, these programs must be better integrated with other processes to create efficient and able managers.

<p>This thesis reports on the effects of stress management on long-term pain patients and on a healthy sample from IT and media companies; two groups that are commonly exposed to high stress levels. Even if there are important differences between these two groups, there are similarities such as the necessity for effective stress management. Stress-related and musculoskeletal disorders are major public health issues in most industrialized countries and are expected to become increasingly common during the coming decades. The pathogenic plastic changes in the CNS and immune system caused by long-term stress pose severe burdens to individuals, organizations as well as society in general. Thus, stress management may be essential to maintain and improve long-term health and wellbeing and to proactively counteract stress-related ill-health.</p><p>This thesis is based on four papers: Paper I assessed the effects of massage as compared to relaxation tapes in long-term pain patients. Paper II validated some of the Visual Analogue Scale questions that were to be used in paper III and IV. Paper III assessed the effects on mental and physical wellbeing and biological stress markers from a web-based stress management and health promotion tool. Paper IV aimed at mapping out predictors for trends (improvement vs. worsening) in self-rated health (SRH) over a period of one year.</p><p>The overall results indicate that individually focused stress management interventions in long-term pain patients as well as on a healthy, working population may have short-term beneficial effects on psychological and physiological stress, health and wellbeing. On a long-term basis the beneficial changes seem to revert. In paper four, it is indicated that the stress management intervention is not a significant predictor of long-term changes in SRH. Rather, other factors such as health perception, sleep quality and sense of coherence predicted improvement in SRH over time.</p>

This thesis reports on the effects of stress management on long-term pain patients and on a healthy sample from IT and media companies; two groups that are commonly exposed to high stress levels. Even if there are important differences between these two groups, there are similarities such as the necessity for effective stress management. Stress-related and musculoskeletal disorders are major public health issues in most industrialized countries and are expected to become increasingly common during the coming decades. The pathogenic plastic changes in the CNS and immune system caused by long-term stress pose severe burdens to individuals, organizations as well as society in general. Thus, stress management may be essential to maintain and improve long-term health and wellbeing and to proactively counteract stress-related ill-health. This thesis is based on four papers: Paper I assessed the effects of massage as compared to relaxation tapes in long-term pain patients. Paper II validated some of the Visual Analogue Scale questions that were to be used in paper III and IV. Paper III assessed the effects on mental and physical wellbeing and biological stress markers from a web-based stress management and health promotion tool. Paper IV aimed at mapping out predictors for trends (improvement vs. worsening) in self-rated health (SRH) over a period of one year. The overall results indicate that individually focused stress management interventions in long-term pain patients as well as on a healthy, working population may have short-term beneficial effects on psychological and physiological stress, health and wellbeing. On a long-term basis the beneficial changes seem to revert. In paper four, it is indicated that the stress management intervention is not a significant predictor of long-term changes in SRH. Rather, other factors such as health perception, sleep quality and sense of coherence predicted improvement in SRH over time.

Mortality statistics are much used although their accuracy is often questioned. Producers of mortality statistics check for errors in death certification but current methods only capture obvious mistakes. This thesis investigates whether non-obvious errors can be found by linking death certificates to hospital discharge data. Data: 69,818 deaths in Sweden 1995. Paper I: Analysing differences between the underlying cause of death from the death certificate (UC) and the main discharge condition from the patient’s last hospitalization (MDC). Paper II: Testing whether differences can be explained by ICD definitions of UC and MDC. Paper III: Surveying methods in 44 current studies on the accuracy of death certificates. Paper IV: Checking death certificates against case summaries for: i) 573 deaths where UC and MDC were the same or the difference could be explained; ii) 562 deaths where the difference could not be explained. Results: In 54% of deaths the MDC differed from the UC. Almost two-thirds of the differences were medically compatible since the MDC might have developed as a complication of the UC. Of 44 recent evaluation studies, only 8 describe the methods in such detail that the study could be replicated. Incompatibility between MDC and UC indicates a four-fold risk that the death certificate is inaccurate. For some diagnostic groups, however, death certificates are often inaccurate even when the UC and MDC are compatible. Conclusion: Producers of official mortality statistics could reduce the number of non-obvious errors in the statistics by collecting additional information on incompatible deaths and on deaths in high-risk diagnostic groups. ICD conventions contribute to the quality problem since they presuppose that all deaths are due to a single underlying cause. However, in an ageing population an increasing number of deaths are due to an accumulation of etiologically unrelated conditions.

The number of persons who are not employed has increased in Sweden since the early 1990s. Unemployment has been found to influence health, especially when unemployment rates are low. The extent to which unemployment affects health when unemployment is high is less clear, and this needs to be further studied. To improve health in the population, the health care system should offer equal access to health care according to need. It is important to study whether the employment status hinders the fulfilment of this goal. This thesis is based on four papers: Paper I and II aimed at analysing self-rated health versus mortality risk in relation to employment status, during one period of low unemployment and one period of high unemployment. Paper III and IV assessed the use of medical health care services and unmet care needs among persons who were unemployed or otherwise not employed. The goal was to analyse what health problems lead people to either seek or abstain from seeking care, and what factors encumber or facilitate this process. The overall results indicate that being unemployed or outside the labour force was associated with an excess risk of poor self-rated health, symptoms of depression, mental and physical exhaustion and mortality. The differences in self-rated health between the unemployed and employed were larger when unemployment levels were high, than when they were low. More groups of the unemployed were also afflicted with poor health when unemployment was high. Thus, poor health among the unemployed seems to be a public health problem during high levels of unemployment. Lack of employment was related to abstaining from seeking care, despite perceiving a need for care, and this was related to psychological symptoms. To deal with the needs of the unemployed and others who are outside the labour force it would be useful to develop and implement interventions within the health care system. These should focus on psychological and psychosocial problems. Future research should analyse how to facilitate health-promoting interventions among persons who are not anchored in the labour market.

No description available.

Sammanfattning Syftet med studien är att undersöka vilka motivationsfaktorer som finns bland kvinnor som endast styrketränar på gemensam del och bland kvinnor som styrketränar på tjejdel på gym i Stockholm samt om det skiljer sig åt mellan grupperna. Vad motiveras kvinnor av som styrketränar på gymanläggningar? Vad motiveras kvinnor av som endast styrketränar på den gemensamma delen på gymanläggningar? Vad motiveras kvinnor av som styrketränar på tjejdel på gymanläggningar? Finns det någon/några skillnader i motivationsfaktorer bland kvinnor som endast styrketränar på gemensam del och kvinnor som styrketränar på tjejdel på gymanläggning? Metod En kvantitativ studiedesign valdes för att besvara studiens syfte och frågeställningar. Urvalsmetoden som användes i denna studie var bekvämlighetsurval som syftar till att respondenterna ska vara lättillgängliga. Utdelningen av enkäterna skedde på två olika gymanläggningar i Stockholms innerstad vid två olika tidpunkter, en tidig morgon och en sen eftermiddag. Enkäten som användes i studien var den validerade enkäten Exercise Motivations Inventory (EMI-2). Enkäten sammanställdes genom att addera siffrorna från varje påstående i 14 underkategorier som därefter kunde delas in i fem nya överkategorier. Testerna som användes för att besvara studiens frågeställningar var Friedman-, Wilcoxon- och Mann-Whitneytest. Resultat Gruppen som endast styrketränade på den gemensamma delen och gruppen som styrketränade på tjejdelen, det vill säga kvinnor i Stockholm, motiverades mest av Fitnessmotiv och minst av Personliga motiv. Ingen skillnad kunde ses mellan vad som motiverar kvinnor till att styrketräna, oberoende av vilken del kvinnor använder på gymanläggningarna i Stockholm. Slutsats Motivation var inte en anledning till att kvinnor valde att styrketräna på tjejdelen på gymanläggning. Anledningen till att kvinnor valde att styrketräna på tjejdelen på gymanläggningar är fortfarande obesvarat.