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Stroke among people of working age: from a public health and working life perspective
Linköping University, Department of Department of Health and Society, National Centre for Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Stroke is a major cause of serious disability and death. In Sweden approximately 30,000 people suffer from stroke each year, and 20% of them are under 65 years of age.

Aim: The aim of this thesis was to study stroke among people aged 30-65 years. Specific aims were: a) to compare the incidence of stroke in Sweden between the periods 1989-1991 and 1998-2000 in persons aged 30-65 years, b) to explore sick leave, disability pension and health-care-seeking behaviour among people 30-65 years of age prior to their stroke in year 2001 in the county of Östergötland, Sweden, c) to explore whether organisational change and work-related stress, as measured by the Job Content Questionnaire, was associated with first-ever stroke among working people aged 30-65, d) to describe the experience of return to work (RTW) after stroke from the patient’s perspective in comparison with experiences of patients on long-term sick leave.

Material and methods: Studies I and II are based on retrospective register data. Study I is based on data from the SHDR and the CDR during 1989-2000, and NSR Östergötland during the period 1989-2000. Study II is based on data from the HCDWÖ and the social insurance office. Study III is a case–control study where the cases are obtained from four hospitals in the south-east of Sweden and the controls come from the base populations at each respective hospital. Studies IV and V are qualitative studies and the informants in study IV are cases from Linköping and Norrköping included in study III. Study V is a case study based upon a focus group interview with 7 women who had undergone a problem-based rehabilitation.

Results: Stroke incidence increased in Sweden for both men and women between 1989 and 2000, especially for women. Future stroke patients showed more sick leave compared with the general population. For men, accumulated sick leave of more than 29 days was associated with an increased risk of later stroke. Frequent health-care-seeking behaviour is not a tool for identifying women who develop stroke, while it may be an indicator for men. We found partial support for an association between organisational change, work-related stress and stroke. The likelihood of stroke was significantly lower for people in active job situations. The individual stroke patient’s capacity and ability to return to work was perceived as enhanced by motivation or ‘will’ and self-efficacy, in combination with external support. Self-efficacy was not only a personal trait or internal factor; it was enhanced and encouraged in interaction with contextual conditions. When the more medically oriented rehabilitation is finished, other aspects of the individual’s abilities should be in focus. There seem to be similarities between the RTW process and processes of health promotion.

Conclusion: Stroke among younger people in regard to work related risk factors and work related rehabilitation is a field where few studies have been carried out, and further research is needed in order to investigate risk factors and planning for prevention, health promotion and rehabilitation. The thesis also indicates the need for gender-specific studies.

Place, publisher, year, edition, pages
Linköping: Institutionen för hälsa och samhälle , 2006. , 94 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 930
Keyword [en]
Cerebrovascular accident, epidemiology, Cerebrovascular accident, Health promotion, Rehabilitation, Sick leave
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:liu:diva-7466ISBN: 91-85497-70-3 (print)OAI: oai:DiVA.org:liu-7466DiVA: diva2:22454
Public defence
2006-01-13, Aulan, Hälsans hus, Campus US, Linköpings Universitet, Linköping, 13:00 (English)
Opponent
Available from: 2006-09-28 Created: 2006-09-28 Last updated: 2012-10-23Bibliographically approved
List of papers
1. Increasing stroke incidence in Sweden between 1989 and 2000 among persons aged 30 to 65 years: evidence from the Swedish Hospital Discharge Register
Open this publication in new window or tab >>Increasing stroke incidence in Sweden between 1989 and 2000 among persons aged 30 to 65 years: evidence from the Swedish Hospital Discharge Register
2004 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 35, no 5, 1047-1051 p.Article in journal (Refereed) Published
Abstract [en]

Background and Purpose— Stroke mortality is decreasing in Sweden, as is the case in other Western European countries. However, both decreases and increases have been reported in Sweden for persons younger than age 65 years. The aim of this study was to compare the incidence of stroke in Sweden between the periods 1989 and 1991 and 1998 and 2000 in persons aged 30 to 65 years.

Methods— All first-ever stroke patients aged 30 to 65 years in the Swedish Hospital Discharge Register between 1989 and 2000 were included.

Results— The age-standardized, 3-year average incidence increased by 19%, from 98.9 to 118.0 per 100 000 among men, and by 33%, from 48.4 to 64.4 among women, between 1989 and 1991 and 1998 and 2000. The largest increase was seen among those younger than 60 years. On a county level, the change in age-standardized stroke incidence varied from small decreases (−3%) to large increases (82%).

Conclusion— Stroke incidence increased in Sweden for both men and women between 1989 and 2000. The increase was larger among women. This calls for action when it comes to studying risk factors and planning for prevention and health promotion and indicates the need for gender-specific studies.

Keyword
Epidemiology, Incidence, Stroke
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-45752 (URN)10.1161/01.STR.0000125866.78674.96 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13Bibliographically approved
2. Sick leave, disability pension and health-care-seeking behaviour prior to stroke, among people aged 30–65: a case–control study
Open this publication in new window or tab >>Sick leave, disability pension and health-care-seeking behaviour prior to stroke, among people aged 30–65: a case–control study
2007 (English)In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 21, no 5, 457-463 p.Article in journal (Refereed) Published
Abstract [en]

Primary objective: To explore sick leave, disability pension and health-care-seeking behaviour among people 30–65 years of age prior to their stroke in 2001 in the county of Östergötland, Sweden.

Research design: A register-based, retrospective case–control study for the period 1 January 1998–31 December 2000. Cases (n = 212): patients aged 30–65 with first-ever stroke in 2001. Controls (n = 4606): people aged 30–65, randomly selected from the same base population.

Main outcomes and results: More than 91 days of accumulated sick leave among women was associated with increased likelihood of developing stroke (OR = 1.89). Among men, 29–90 days and more than 91 days on sick leave increased the likelihood of stroke (OR = 2.34 and OR = 3.43, respectively).

Conclusion: Frequent health-care-seeking behaviour is not a tool for identifying women who develop stroke, while it may be an indicator for men. Accumulated sick leave may be a tool for identifying men and women with higher risk of stroke.

Read More: http://informahealthcare.com/doi/abs/10.1080/02699050701317643

Keyword
Sick-leave, stroke, public health, health-care seeking behaviour
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-38631 (URN)10.1080/02699050701317643 (DOI)45108 (Local ID)45108 (Archive number)45108 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13Bibliographically approved
3. Organisational change, job strain and increased risk of stroke?: a pilot study
Open this publication in new window or tab >>Organisational change, job strain and increased risk of stroke?: a pilot study
2008 (English)In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 31, no 4, 443-449 p.Article in journal (Refereed) Published
Abstract [en]

Aims: The objective of this pilot study was to explore whether organisational change and work-related stress, as measured by the Job Content Questionnaire, were associated with first-ever stroke among working people aged 30–65.

Methods: In a case-control study a total of 65 consecutive cases, aged 30–65 years of age, with first-ever stroke were recruited from four hospitals in Sweden during 2000–2002. During the same period, 103 random population controls in the same age interval were recruited. Data on job-related stress and traditional medical risk factors were collected by a questionnaire.

Results: In the multivariate analyses, organisational change (OR 3.38) increased the likelihood of stroke, while experiencing an active job (OR 0.37) decreased the likelihood of stroke. Regarding risk factors outside work, age (OR 1.11), low physical activity (OR 5.21), low education (OR 2.48) and family history of stroke (OR 2.59) were associated with increased likelihood of stroke.

Conclusion: This study suggests an association between organisational change, work-related stress and stroke. The likelihood of stroke was lower for people in active job situations.

Keyword
Stroke, downsizing, work-related stress
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16715 (URN)
Available from: 2009-02-14 Created: 2009-02-13 Last updated: 2017-12-14Bibliographically approved
4. Stroke patients' experiences of return to work
Open this publication in new window or tab >>Stroke patients' experiences of return to work
2006 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 28, no 17, 1051-1060 p.Article in journal (Refereed) Published
Abstract [en]

Purpose. The aim of this study was to describe the experience of return to work (RTW) after stroke from the patient's perspective.

Method. Six patients who had their first ever stroke in 2001, were <65 years of age and were working at the time of their stroke were included. Information was obtained via an open-ended interview. The material was transcribed verbatim and analysed using Giorgi's empirical phenomenology.

Results. Rehabilitation was perceived as primarily aimed at restoring bodily functions and a return to everyday activities, rather than at promoting a return to work. It was not experienced as adapted to the participants' needs or their age. The workplace was experienced as very important in the rehabilitation process. When the informants experienced that the rehabilitation professionals were not taking action, they took control of the situation themselves. The informants expressed pride in their own capacity to take the initiative and in their ability to take action. Both self-employed and employed informants said they had possibilities and opportunities to take action since their work situation was flexible. The informants' adaptation to a new role at work was perceived as facilitated by the understanding and positive attitude of co-workers.

Conclusion. Among this group of stroke patients, the individual patient's capacity and ability to return to work was enhanced by motivation or “will” and self-efficacy in combination with external support. Self-efficacy was not only a personal trait or internal factor; it was enhanced and encouraged in interaction with contextual conditions. There are similarities between the RTW process and processes of health promotion.

Keyword
Return-to-work, rehabilitation, stroke
National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-36610 (URN)10.1080/09638280500494819 (DOI)31744 (Local ID)31744 (Archive number)31744 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13Bibliographically approved
5. Health promotion and rehabilitation: a case study
Open this publication in new window or tab >>Health promotion and rehabilitation: a case study
2003 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 25, no 16, 908-915 p.Article in journal (Refereed) Published
Abstract [en]

Background: Since the number of people in Sweden on long-term sick leave has rapidly increased since 1996, new non-biomedical models of occupational rehabilitation are at stake. A group of seven women who had finished medical treatment and rehabilitation but were still on sick leave or temporary disability pension for several years, worked in a problem-based rehabilitation group for 6 months. Focus for the group was on a process of change towards health and work ability.

Purpose: The aim of this case study was to improve understanding of effects of a problem-based rehabilitation model (PBR) on health promoting processes amongst a group of women on long-term sick leave. Method: Data source was a focus group interview. The analysis follows the guidelines of qualitative analysis that emerges from grounded theory.

Results: The pedagogical model of PBR enhanced the participant's internal resources such as self-confidence and ability to act in a social setting. External resources such as social support were improved. An individual follow-up was conducted 2 years after the rehabilitation process and four out of seven women had returned to work.

Conclusion: Among this group of women PBR launched health-promoting processes. When the more medically oriented treatment is finished or is not able to contribute further to the individual's recovery, other aspects of the individuals abilities and health resources will be focused upon.

National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-26255 (URN)10.1080/0963828031000122212 (DOI)10761 (Local ID)10761 (Archive number)10761 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved

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