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Andersdotter Sandström, A., Fjellman-Wiklund, A., Sandlund, M. & Eskilsson, T. (2023). Patients with stress-induced exhaustion disorder and their experiences of physical activity prescription in a group context. Global Health Action, 16(1), Article ID 2212950.
Open this publication in new window or tab >>Patients with stress-induced exhaustion disorder and their experiences of physical activity prescription in a group context
2023 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 16, no 1, article id 2212950Article in journal (Refereed) Published
Abstract [en]

Background: Physical activity is a useful means to improve symptoms and memory performance to some extent in individuals with stress-induced exhaustion disorder. Individuals in this group commonly do not need to reach the recommended levels of physical activity. Developing methods to support physical activity as a lasting behaviour is important.

Objective: The aim of the study was to explore the processes involved when using physical activity prescription as part of rehabilitation in a group context for individuals with stress-induced exhaustion disorder.

Method: A total of 27 individuals with stress-induced exhaustion disorder participated in six focus groups. The informants underwent a multimodal intervention including prescription of physical activity. The physical activity prescription had a cognitive behaviour approach and included information about physical activity, home assignments and goal setting. The data was analysed with grounded theory method using constant comparison.

Results: The analysis of the data was developed into the core category ‘trying to integrate physical activity into daily life in a sustainable way’, and three categories: ‘acceptance of being good enough’, ‘learning physical activity by doing’ and ‘advocation for physical activity in rehabilitation’. The informants identified that during the physical activity prescription sessions they learned what physical activity was, what was ‘good enough’ in terms of dose and intensity of physical activity, and how to listen to the body’s signals. These insights, in combination with performing physical activity during home assignments and reflecting with peers, helped them incorporate physical activity in a new and sustainable way. A need for more customised physical activity with the ability to adjust to individual circumstances was requested.

Conclusion: Prescription of physical activity in a group context may be a useful method of managing and adjusting physical activity in a sustainable way for individuals with stress-induced exhaustion disorder. However, identifying people who need more tailored support is important.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
Burnout, Physical activity, Focus groups, Goals, Grounded theory
National Category
Physiotherapy
Research subject
physiotherapy
Identifiers
urn:nbn:se:umu:diva-210098 (URN)10.1080/16549716.2023.2212950 (DOI)001005756700001 ()37314383 (PubMedID)2-s2.0-85163193261 (Scopus ID)
Available from: 2023-06-22 Created: 2023-06-22 Last updated: 2023-09-05Bibliographically approved
Nelson, A., Malmberg Gavelin, H., Andersson, M., Josefsson, M., Eskilsson, T., Slunga-Järvholm, L., . . . Boraxbekk, C.-J. (2023). Subjective cognitive complaints and its associations to response inhibition and neural activation in patients with stress-related exhaustion disorder. Stress, 26(1), Article ID 2188092.
Open this publication in new window or tab >>Subjective cognitive complaints and its associations to response inhibition and neural activation in patients with stress-related exhaustion disorder
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2023 (English)In: Stress, ISSN 1025-3890, E-ISSN 1607-8888, Vol. 26, no 1, article id 2188092Article in journal (Refereed) Published
Abstract [en]

Stress-related exhaustion is associated with cognitive deficits, measured subjectively using questionnaires targeting everyday slips and failures or more objectively as performance on cognitive tests. Yet, only weak associations between subjective and objective cognitive measures in this group has been presented, theorized to reflect recruitment of compensational resources during cognitive testing. This explorative study investigated how subjectively reported symptoms of cognitive functioning and burnout levels relate to performance as well as neural activation during a response inhibition task. To this end, 56 patients diagnosed with stress-related exhaustion disorder (ED; ICD-10 code F43.8A) completed functional magnetic resonance imaging (fMRI) using a Flanker paradigm. In order to investigate associations between neural activity and subjective cognitive complaints (SCCs) and burnout, respectively, scores on the Prospective and retrospective memory questionnaire (PRMQ) and the Shirom-Melamed burnout questionnaire (SMBQ) were added as covariates of interest to a general linear model at the whole-brain level. In agreement with previous research, the results showed that SCCs and burnout levels were largely unrelated to task performance. Moreover, we did not see any correlations between these self-report measures and altered neural activity in frontal brain regions. Instead, we observed an association between the PRMQ and increased neural activity in an occipitally situated cluster. We propose that this finding may reflect compensational processes at the level of basic visual attention which may go unnoticed in cognitive testing but are reflected in the experience of deficits in everyday cognitive functioning.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
National Category
Neurosciences Public Health, Global Health, Social Medicine and Epidemiology Psychiatry
Identifiers
urn:nbn:se:umu:diva-205760 (URN)10.1080/10253890.2023.2188092 (DOI)000953639900001 ()36883330 (PubMedID)2-s2.0-85150665693 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2009-0772Forte, Swedish Research Council for Health, Working Life and Welfare, 2020-01111)Region VästerbottenAFA InsuranceRiksbankens JubileumsfondThe Kempe Foundations
Available from: 2023-03-17 Created: 2023-03-17 Last updated: 2023-04-28Bibliographically approved
Stenberg, G., Fjellman-Wiklund, A., Strömbäck, M., Eskilsson, T., From, C., Enberg, B. & Wiklund, M. (2022). Gender matters in physiotherapy. Physiotherapy Theory and Practice, 38(13), 2316-2329
Open this publication in new window or tab >>Gender matters in physiotherapy
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2022 (English)In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 38, no 13, p. 2316-2329Article in journal (Refereed) Published
Abstract [en]

The World Health Organization states that gender has implications for health across the course of a person's life in terms of norms, roles and relations. It also has implications in rehabilitation. In this article, we argue the need of gender perspectives in the field of physiotherapy; gender matters and makes a difference in health and rehabilitation. We highlight a number of central areas where gender may be significant and give concrete examples of social gender aspects in physiotherapy practice and in diverse patient groups. We also discuss why it can be important to consider gender from an organizational perspective and how sociocultural norms and ideals relating to body, exercise and health are gendered. Further we present useful gender theories and conceptual frameworks. Finally, we outline future directions in terms of gender-sensitive intervention, physiotherapy education and a gendered application of the ICF model. We want to challenge physiotherapists and physiotherapy students to broaden knowledge and awareness of how gender may impact on physiotherapy, and how gender theory can serve as an analytical lens for a useful perspective on the development of clinical practice, education and research within physiotherapy.

Place, publisher, year, edition, pages
Taylor & Francis, 2022
Keywords
clinical practice, Gender, gender theory, physiotherapy, physiotherapy education, physiotherapy research
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-187700 (URN)10.1080/09593985.2021.1970867 (DOI)000692330800001 ()34470538 (PubMedID)2-s2.0-85114352521 (Scopus ID)
Funder
Umeå University
Available from: 2021-09-23 Created: 2021-09-23 Last updated: 2022-11-28Bibliographically approved
Norström, F., Slunga Järvholm, L. & Eskilsson, T. (2022). Healthcare utilisation among patients with stress-induced exhaustion disorder treated with a multimodal rehabilitation programme: a longitudinal observational study. BMC Psychiatry, 22(1), Article ID 642.
Open this publication in new window or tab >>Healthcare utilisation among patients with stress-induced exhaustion disorder treated with a multimodal rehabilitation programme: a longitudinal observational study
2022 (English)In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 22, no 1, article id 642Article in journal (Refereed) Published
Abstract [en]

Background: Stress-induced exhaustion disorder is a major challenge in Swedish working life. Despite its increase in prevalence, there is still limited knowledge about the effectiveness of different rehabilitation methods. In this study, we aim to describe the healthcare utilisation for patients with stress-induced exhaustion disorder before, during and after a multi-modal rehabilitation (MMR) programme, as well as the health-related quality of life, work ability, sick leave level and psychological measures, and their possible relations.

Methods: In this longitudinal observational study, 53 patients who were part of an MMR programme at the Stress Rehabilitation Clinic participated with survey data, and among them 43 also contributed with healthcare data. Data were collected from one year before start of MMR to one year after the end of it. The patients also answered a questionnaire at the start of, end of and at a one-year follow-up of the MMR, which included questions about health-related quality of life, work ability, clinical burnout, sick leave level, anxiety and depression.

Results: There was a statistically significant increase in healthcare consumption during MMR, if including visits to the Stress Rehabilitation Clinic, while it decreased if excluding such visits, when comparing with before and after MMR. During the follow-up period there was a non-statistically significant (p=0.11), but still rather large difference (15.4 compared with 12.0 visits per patient), in healthcare consumption in comparison with the period before MMR, when excluding follow-up visits at the Stress Rehabilitation Clinic. Health-related quality of life was rated as poor before MMR (mean 0.59). There was a statistically significant improvement, but values were still below normal at the end of follow-up (mean 0.70). In addition, the level of sick leave, the work ability and signs of clinical burnout improved statistically significantly after MMR, but were not fully normalised at the end of follow-up. Individual healthcare consumption was related to residual health problems.

Conclusions: Patients with stress-induced exhaustion disorder have not reduced their healthcare consumption notably after MMR, and residual health problems remain for some patients. More studies are needed for a deeper understanding of the individual effectiveness of MMR, and also of its cost-effectiveness.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2022
Keywords
Clinical burnout, Health-related quality of life, Healthcare consumption, Northern Sweden
National Category
Psychiatry Public Health, Global Health, Social Medicine and Epidemiology Occupational Health and Environmental Health
Research subject
Occupational and Environmental Medicine
Identifiers
urn:nbn:se:umu:diva-200605 (URN)10.1186/s12888-022-04300-8 (DOI)000867664400002 ()36229810 (PubMedID)2-s2.0-85139940996 (Scopus ID)
Funder
AFA Insurance, 150274Region Västerbotten
Available from: 2022-10-27 Created: 2022-10-27 Last updated: 2024-01-17Bibliographically approved
Eskilsson, T., Norlund, S., Lehti, A. & Wiklund, M. (2021). Enhanced Capacity to Act: Managers' Perspectives When Participating in a Dialogue-Based Workplace Intervention for Employee Return to Work. Journal of occupational rehabilitation, 31(2), 263-274
Open this publication in new window or tab >>Enhanced Capacity to Act: Managers' Perspectives When Participating in a Dialogue-Based Workplace Intervention for Employee Return to Work
2021 (English)In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 31, no 2, p. 263-274Article in journal (Refereed) Published
Abstract [en]

Purpose: To explore if and how a dialogue-based workplace intervention with a convergence dialogue meeting can support a return to work process from the managers' perspective.

Methods: Individual interviews were conducted with 16 managers (10 women and 6 men) who had an employee on sick leave because of stress-induced exhaustion disorder. The manager and employee participated in a dialogue-based workplace intervention with a convergence dialogue meeting that was guided by a healthcare rehabilitation coordinator. The intervention aimed to facilitate dialogue and find concrete solutions to enable return to work. The interviews were analyzed by the Grounded Theory method.

Results: A theoretical model was developed with the core category enhancing managerial capacity to act in a complex return to work process,where the managers strengthened their agential capacity in three levels (categories). These levels werebuilding competence, making adjustments, andsharing responsibilitywith the employee. The managers also learned to navigate in multiple systems and by balancing demands, control and support for the employee and themselves. An added value was that the managers began to take preventive measures with other employees. When sick leave was caused only by personal or social issues (not work), workplace actions or interventions were difficult to find.

Conclusions: From the managers' perspective, dialogue-based workplace interventions with a convergence dialogue meeting and support from a rehabilitation coordinator can strengthen managerial competence and capacity to act in a complex return to work process.

Place, publisher, year, edition, pages
Springer, 2021
Keywords
Workplace intervention, Return to work, Exhaustion, Burnout, Qualitative research
National Category
Work Sciences Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-174016 (URN)10.1007/s10926-020-09914-x (DOI)000554349500001 ()32737671 (PubMedID)2-s2.0-85088868062 (Scopus ID)
Note

Published online: 31 July 2020

Available from: 2020-08-18 Created: 2020-08-18 Last updated: 2021-12-30Bibliographically approved
Nelson, A., Malmberg Gavelin, H., Boraxbekk, C.-J., Eskilsson, T., Josefsson, M., Slunga Järvholm, L. & Neely, A. S. (2021). Subjective cognitive complaints in patients with stress-related exhaustion disorder: a cross sectional study. BMC Psychology, 9(1), Article ID 84.
Open this publication in new window or tab >>Subjective cognitive complaints in patients with stress-related exhaustion disorder: a cross sectional study
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2021 (English)In: BMC Psychology, E-ISSN 2050-7283, Vol. 9, no 1, article id 84Article in journal (Refereed) Published
Abstract [en]

Background: Stress-related exhaustion is associated with cognitive impairment as measured by both subjective cognitive complaints (SCCs) and objective cognitive test performance. This study aimed to examine how patients diagnosed with exhaustion disorder differ from healthy control participants in regard to levels and type of SCCs, and if SCCs are associated with cognitive test performance and psychological distress.

Methods: We compared a group of patients with stress-related exhaustion disorder (n = 103, female = 88) with matched healthy controls (n = 58, female = 47) cross-sectionally, concerning the type and magnitude of self-reported SCCs. We furthermore explored the association between SCCs and cognitive test performance as well as with self-reported depression, anxiety and burnout levels, in the patient and the control group, respectively.

Results: Patients reported considerably more cognitive failures and were more likely than controls to express memory failures in situations providing few external cues and reminders in the environment. In both groups, SCCs were associated with demographic and psychological factors, and not with cognitive test performance.

Conclusion: Our findings underline the high burden of cognitive problems experienced by patients with exhaustion disorder, particularly in executively demanding tasks without external cognitive support. From a clinical perspective, SCCs and objective cognitive test performance may measure different aspects of cognitive functioning, and external cognitive aids could be of value in stress rehabilitation.

Trial registration: Participants were recruited as part of the Rehabilitation for Improved Cognition (RECO) study (ClinicalTrials.gov: NCT03073772). Date of registration: 8 March 2017

Place, publisher, year, edition, pages
BioMed Central, 2021
Keywords
Burnout, Cognition, Exhaustion, Stress, Stress-induced, Subjective cognitive complaints
National Category
Psychology
Identifiers
urn:nbn:se:umu:diva-183883 (URN)10.1186/s40359-021-00576-9 (DOI)000655581200003 ()34006315 (PubMedID)2-s2.0-85106193025 (Scopus ID)
Available from: 2021-06-03 Created: 2021-06-03 Last updated: 2023-09-05Bibliographically approved
Eskilsson, T., Fjellman-Wiklund, A., Ek Malmer, E., Stigsdotter Neely, A., Malmberg Gavelin, H., Slunga-Järvholm, L., . . . Nordin, M. (2020). Hopeful struggling for health: Experiences of participating in computerized cognitive training and aerobic training for persons with stress-related exhaustion disorder. Scandinavian Journal of Psychology, 61(3), 361-368
Open this publication in new window or tab >>Hopeful struggling for health: Experiences of participating in computerized cognitive training and aerobic training for persons with stress-related exhaustion disorder
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2020 (English)In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 61, no 3, p. 361-368Article in journal (Refereed) Published
Abstract [en]

It is important to understand how people with exhaustion disorder (ED) perceive interventions aiming to facilitate cognitive functioning. Therefore, the overall aim of this study was to explore experiences from persons with ED after participating in a 12-week intervention of either computerized cognitive training or aerobic training. Both interventions were performed in addition to a multimodal rehabilitation programme. Thirteen participants, 11 women and 2 men, were interviewed about pros and cons with participating in the training. The interviews were analysed with Qualitative Content Analysis. The analyses resulted in the theme hopeful struggling for health and the categories support, motivation and sensations. It was hard work recovering from ED. Support from others who are in the same situation, family members, and technology and routines for the training were strongly emphasized as beneficial for recovery. Timing, i.e., matching activities to the rehabilitation programme, getting feedback and perceiving joy in the training were important for motivation. Participants in both interventions experienced positive sensations with improved memory performance, everyday life functioning and increased faith in the prospect of recovery. However, it is important to consider various aspects of support and motivation in both computerized cognitive training and aerobic training to enable participants to pursue their participation.

Place, publisher, year, edition, pages
John Wiley & Sons, 2020
Keywords
Exhaustion disorder, burnout, exercise, qualitative research, rehabilitation
National Category
Physiotherapy Applied Psychology
Identifiers
urn:nbn:se:umu:diva-167762 (URN)10.1111/sjop.12623 (DOI)000509854500001 ()31995652 (PubMedID)2-s2.0-85078781363 (Scopus ID)
Available from: 2020-02-03 Created: 2020-02-03 Last updated: 2023-03-23Bibliographically approved
Wahlström, V., Fjellman-Wiklund, A., Harder, M., Slunga-Järvholm, L. & Stenlund, T. (2020). Implementing a Physical Activity promoting program in a flex-office: A Process Evaluation with a Mixed Methods Design. International Journal of Environmental Research and Public Health, 17(1), Article ID 23.
Open this publication in new window or tab >>Implementing a Physical Activity promoting program in a flex-office: A Process Evaluation with a Mixed Methods Design
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2020 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 17, no 1, article id 23Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to investigate facilitating and hindering factors when implementing a physical activity (PA)-promoting program among office workers moving to a flex office, by conducting a process evaluation. Additionally, we evaluated self-reported and perceived PA behaviors. With a mixed methods design, analyses were based upon data from interviews with 70 employees and repeated questionnaires from 152 employees. The PA-promoting program was fully implemented and supported by management. There was a strong health promoting culture, encouraging PA in the organization already at the start of the study. The lecture and the office design were rated as the most motivating program components. The use of stairs, breaks during meetings and social acceptance for standing and walking at work increased. Employees described a strive for variation, and how managers, the office environment, productivity and ergonomic aspects influenced sedentary behavior (SB) and PA. The need for the PA-promoting program was questioned, and the timing of the program was debated. To conclude, a strong organizational health culture combined with a facilitating physical environment can create sustainable positive PA behaviors in office settings. A thorough understanding of organizational needs and a participatory process are needed to tailor organizational interventions to decrease SB.

Place, publisher, year, edition, pages
MDPI, 2020
Keywords
activity-based work, ergonomics, longitudinal, office design, office workers, sedentary behavior, workstation
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-164706 (URN)10.3390/ijerph17010023 (DOI)000509391500023 ()31861424 (PubMedID)2-s2.0-85076988539 (Scopus ID)
Note

Originally included in thesis in manuscript form.

Available from: 2019-10-28 Created: 2019-10-28 Last updated: 2023-03-24Bibliographically approved
Malmberg Gavelin, H., Stigsdotter Neely, A., Dunås, T., Eskilsson, T., Slunga Järvholm, L. & Boraxbekk, C.-J. (2020). Mental fatigue in stress-related exhaustion disorder: structural brain correlates, clinical characteristics and relations with cognitive functioning. NeuroImage: Clinical, 27, Article ID 102337.
Open this publication in new window or tab >>Mental fatigue in stress-related exhaustion disorder: structural brain correlates, clinical characteristics and relations with cognitive functioning
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2020 (English)In: NeuroImage: Clinical, E-ISSN 2213-1582, Vol. 27, article id 102337Article in journal (Refereed) Published
Abstract [en]

Emerging evidence suggests that mental fatigue is a central component of the cognitive and clinical characteristics of stress-related exhaustion disorder (ED). Yet, the underlying mechanisms of mental fatigue in this patient group are poorly understood. The aim of this study was to investigate cortical and subcortical structural neural correlates of mental fatigue in patients with ED, and to explore the association between mental fatigue and cognitive functioning. Fifty-five patients with clinical ED diagnosis underwent magnetic resonance imaging. Mental fatigue was assessed using the Concentration subscale from the Checklist Individual Strength. Patients with high levels of mental fatigue (n = 30) had smaller caudate and putamen volumes compared to patients with low-moderate levels of mental fatigue (n = 25). No statistically significant differences in cortical thickness were observed between the groups. Mediation analysis showed that mental fatigue mediated the relationship between caudate volume and working memory; specifically, smaller caudate volume was associated with higher level of mental fatigue and mental fatigue was positively associated with working memory performance. Our findings demonstrate that the structural integrity of the striatum is of relevance for the subjective perception of mental fatigue in ED, while also highlighting the complex relationship between mental fatigue, cognitive performance and its neural underpinnings.

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Burnout, Exhaustion disorder, Mental fatigue, Striatum, Working memory
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-173983 (URN)10.1016/j.nicl.2020.102337 (DOI)000562965000016 ()32652491 (PubMedID)2-s2.0-85087517111 (Scopus ID)
Available from: 2020-08-11 Created: 2020-08-11 Last updated: 2024-01-17Bibliographically approved
Strömbäck, M., Fjellman-Wiklund, A., Keisu, S., Sturesson, M. & Eskilsson, T. (2020). Restoring confidence in return to work: A qualitative study of the experiences of persons with exhaustion disorder after a dialogue-based workplace intervention. PLOS ONE, 15(7), Article ID e0234897.
Open this publication in new window or tab >>Restoring confidence in return to work: A qualitative study of the experiences of persons with exhaustion disorder after a dialogue-based workplace intervention
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2020 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 15, no 7, article id e0234897Article in journal (Refereed) Published
Abstract [en]

Background: Stress-induced exhaustion disorder (SED) is a primary cause for sickness absence among persons with mental health disorders in Sweden. Interventions involving the workplace, and supporting communication between the employee and the supervisor, are proposed to facilitate return to work (RTW). The aim of this study was to explore experiences of persons with SED who participated in a dialogue-based workplace intervention with a convergence dialogue meeting performed by a rehabilitation coordinator.

Methods: A qualitative design based on group interviews with 15 persons with SED who participated in a 24-week multimodal rehabilitation program was used. The interviews were analyzed with the methodology of grounded theory.

Results: The analysis resulted in a theoretical model where the core category, restoring confidence on common ground, represented a health promoting process that included three phases: emotional entrance, supportive guidance, and empowering change. The health promoting process was represented in participant experiences of personal progress and safety in RTW.

Conclusions: The intervention built on a health-promoting pedagogy, supported by continuous guidance from a rehabilitation coordinator and structured convergence dialogue meetings that enhanced common communication and collaboration with the supervisor and others involved in the RTW process. The intervention balanced relationships, transferred knowledge, and changed attitudes about SED among supervisors and colleagues in the workplace. The inclusion of a rehabilitation coordinator in the intervention was beneficial by enhancing RTW and bridging the gaps between healthcare, the workplace, and other organizational structures. In addition, the intervention contributed to a positive re-orientation towards successful RTW instead of an endpoint of employment. In a prolonged process, a dialogue-based workplace intervention with convergence dialogue meetings and a rehabilitation coordinator may support sustainable RTW for persons with SED. 

Place, publisher, year, edition, pages
Public Library of Science, 2020
National Category
Occupational Therapy
Identifiers
urn:nbn:se:umu:diva-174785 (URN)10.1371/journal.pone.0234897 (DOI)000569367100006 ()32735586 (PubMedID)2-s2.0-85088861182 (Scopus ID)
Available from: 2020-09-07 Created: 2020-09-07 Last updated: 2021-07-12Bibliographically approved
Projects
Sustainable encounters in large preschool playgrounds [2020-00988]; Umeå University; Publications
Nilsson, E. & Sundberg, J. (2022). Neutral natur och könskodad design?: En studie av könande processer i förskolans utemiljöer. (Student paper). Umeå universitet
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-2402-562x

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