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Att klara skolan när huvudet dunkar och kroppen värker: en studie om återkommande smärta och skolprestation bland skolbarn
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.ORCID iD: 0000-0002-0646-7184
2019 (Swedish)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Managing school while fighting aches and pains : a study about recurrent pain and academic achievement among school-aged children (English)
Abstract [sv]

Bakgrund Återkommande smärta är ett av de vanligaste folkhälsoproblemen bland skolbarn. Den höga förekomsten är ingen ny kunskap, trots det finns det lite beskrivet hur smärtan påverkar barnens funktion och då särskilt om det får konsekvenser för barnens skolprestationer.

Syfte Det övergripande syftet med avhandlingen var att studera och värdera evidensen för ett samband mellan återkommande smärta och skolprestation. Detta utifrån smärtans frekvens, lokalisation och utbredning, samt utifrån både subjektiva och objektiva mått på skolprestation. Därutöver studerades möjlig modertorer och mediatorer .

Metod Processen delades in i två steg. Steg 1 utgjordes av en systematisk litteraturöversikt (delstudie 1) som studerade den tillgängliga evidensen för sambandet mellan återkommande smärta och skolprestation bland skolbarn mellan 4 och 18 år. Samtliga delar med urval, dataextraktion, kvalitets- och evidensbedömningar utfördes systematisk. Några av de kunskapsluckor som upptäcktes i steg 1 blev grunden till Steg 2 som utgjordes av delstudie 2 och 3. Dessa studier baserades på en longitudinell totalpopulationsstudie från Umeå “The Study of Health in School-aged children from Umeå”. Urvalet bestod av 1524 respektive 1567 barn. Oberoende variabeln var återkommande smärta och beroende variablerna var upplevda problem med skolprestation, meritvärde och gymnasiebehörighet. I studie 2 och 3 analyserades data med hjälp av logistisk och linjär regression.

Resultat Steg 1: av 6 387 identifierade studier inkluderades 21 studier varav 13 kunde verifiera samband mellan återkommande smärta och nedsatta skolprestationer. Sammantaget fann översikten begränsat evidens för ett samband mellan återkommande smärta och objektiv skolprestation, samt otillräcklig evidens för ett samband mellan återkommande smärta och subjektiv skolprestation. Brister i de enskilda studiernas kvalitet och design bidrog till den låga evidensen. Steg 2: visade att smärta i årskurs 6 fördubblande oddsen för upplevda problem med skolprestation i årskurs 9, vilket gällde vid olika smärtfrekvenser, lokalisationer och antal smärtställen. Skolfrånvaro, koncentrations och sömnproblem kunde inte mediera sambandet mellan återkommande smärta och upplevda problem med skolprestation. Dessutom sågs ett samband mellan återkommande smärta i veckan i årskurs 6 och meritvärde i årskurs 9. Däremot fanns inget samband mellan smärta i årkurs 6 och gymnasiebehörighet, förutom bland flickor med magsmärta. Skolfrånvaro, koncentrationsproblem och upplevda skolprestation medierade delvis sambandet mellan smärta i årskurs 6 och lägre meritvärde i årskurs 9.

Slutsats Resultaten indikationer att återkommande smärta kan predicerar nedsatta betyg och en upplevelse av problem med att prestera i skolan. Resultatet kan lägga till grund för prioriteringar av preventiva insatser i skolan och inom hälso-och sjukvården och kan också bidra med underlag inför utvecklandet av insatser riktade till barn med återkommande smärta.

Abstract [en]

Background Recurrent pain is one of the most common public health issues among school-aged children. However, less is known about the consequences of recurrent pain, for instance in terms of academic achievement.

Aims The overall objective was to study and synthesize the evidence for an association between recurrent pain and academic achievement, across different pain locations, frequencies, and number of pain sites, and across different measures of academic achievement, while considering potentials moderators and mediators.

Method The objective of the thesis was investigated in two steps. Step 1 used a systematic review to capture the available evidence for an association between recurrent pain and academic achievement among school-aged children, aged 4 to 18 years. In step 2, knowledge-gaps identified in the review were further investigated in two empirical studies. These studies were based upon two longitudinal total population samples following children from grade 6 to 9 in elementary school. One study focused subjectively measured academic achievement and one objectively measured achievement. The participants in the two studies consisted of 1524 and 1567 children, respectively. The independent variable was recurrent pain and the dependent variables were perceived problem with academic achievement, overall grade points, and secondary school eligibility.

Results Step 1: of the 6387 studies identified in the systematic review, 21 met the inclusion criteria’s, and 13 verified an association between recurrent pain and academic achievement. However, the literature held numerous methodological drawbacks. Thus, the systematic review overall found low evidence for an association between recurrent pain and objectively measured academic achievement, as well as very low evidence for an association between recurrent pains and subjectively measured academic achievement. Step 2: showed that recurrent pain in school-year 6 doubled the odds for perceived problem with academic achievement three years later. This was true across different pain frequencies, pain locations, and number of pain sites. Problem with concentration, sleep and school-absenteeism, did not mediated the relationship between recurrent pain and perceived problem with academic achievement. Moreover, an association was seen between recurrent pain in grade 6 and overall grade points in grade 9. Finally, problem with concentration, school- absenteeism, and perceived problem with academic achievement partly mediated this association.

Conclusion The findings indicated that recurrent pain may predicts low overall grade points and may also impair children’s perception of their academic performance in school. These results may serve as a base for priority setting in the school health services and other health care settings. They may also contribute with knowledge needed for the development of future interventions targeting children with recurrent pain.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2019. , p. 122
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2063
Keywords [sv]
återkommande smärta, skolprestation, skolbarn, ungdomar, recurrent pain, academic achievement, school-failure, school-aged children, adolescents
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-166596ISBN: 978-91-7855-161-3 (print)OAI: oai:DiVA.org:umu-166596DiVA, id: diva2:1380143
Public defence
2019-01-17, Hörsal D Unod T 9, Umeå Universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Note

122 numrerade + 26 onumrerade sidor

Available from: 2019-12-20 Created: 2019-12-18 Last updated: 2019-12-19Bibliographically approved
List of papers
1. Recurrent Pain and Academic Achievement in School-Aged Children: A Systematic Review
Open this publication in new window or tab >>Recurrent Pain and Academic Achievement in School-Aged Children: A Systematic Review
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2019 (English)In: Journal of School Nursing, ISSN 1059-8405, E-ISSN 1546-8364Article, review/survey (Refereed) Epub ahead of print
Abstract [en]

Recurrent pain and school failures are common problems in children visiting the school nurses office. The overall aim of the current study was to investigate the relationship between recurrent pain and academic achievement in school-aged children. Literature was searched in seven electronic databases and in relevant bibliographies. Study selection, data extraction, and study and evidence quality assessments were performed systematically with standardized tools. Twenty-one studies met the inclusion criteria and 13 verified an association between recurrent pain (headache, stomachache, and musculoskeletal pain) and negative academic achievement. Two longitudinal studies indicated a likely causal effect of pain on academic achievement. All studies had substantial methodological drawbacks and the overall quality of the evidence for the identified associations was low. Thus, children’s lack of success in school may be partly attributed to recurrent pain problems. However, more highquality studies are needed, including on the direction of the association and its moderators and mediators.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
recurrent pain, school-aged children, school failure, school nursing
National Category
Nursing Public Health, Global Health, Social Medicine and Epidemiology Learning
Identifiers
urn:nbn:se:umu:diva-157030 (URN)10.1177/1059840519828057 (DOI)
Available from: 2019-03-06 Created: 2019-03-06 Last updated: 2019-12-18
2. Perceived problems with academic achievement in school-aged children with recurrent pain - a longitudinal study.
Open this publication in new window or tab >>Perceived problems with academic achievement in school-aged children with recurrent pain - a longitudinal study.
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2019 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, article id 1403494819889260Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aims: The overall aim was to explore the relationship between recurrent pain and perceived problems with academic achievement among boys and girls in middle and late elementary school. Methods: This 3-year follow-up study was based on data from the Study of Health in School-aged Children from Umeå (Sweden) and included children attending grade 6 in years 2003 and 2006, and a follow-up 3 years later in grade 9 (n = 1524, participation rate 90%). Results: Recurrent pain (head, stomach or back) at least doubled the odds of concurrent- and subsequent perceived problems with academic achievement. This applied for pain on a monthly and weekly basis, from single and multiple sites, and from each of the three studied pain sites. The odds increased with increasing pain frequency and number of pain sites. Problems with sleep, concentration or school absenteeism did not explain the association. Conclusions: Recurrent pain seems to be a potential predictor of perceived problems with academic achievement for school-aged children. This emphasises the importance of early identification and prevention of recurrent pain problems.

Keywords
Recurrent pain, backache, elementary school, headache, perceived academic achievement, school-aged children, stomachache
National Category
Public Health, Global Health, Social Medicine and Epidemiology Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-166495 (URN)10.1177/1403494819889260 (DOI)31826713 (PubMedID)
Available from: 2019-12-16 Created: 2019-12-16 Last updated: 2019-12-18
3. Academic achievement in school-aged children with recurrent pain: a longitudinal study
Open this publication in new window or tab >>Academic achievement in school-aged children with recurrent pain: a longitudinal study
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(English)Manuscript (preprint) (Other academic)
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-166595 (URN)
Available from: 2019-12-18 Created: 2019-12-18 Last updated: 2019-12-18

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