| 21. |
- Gustafsson Sendén, Marie, et al.
(författare)
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What makes physicians go to work while sick : A comparative STUDY of Sickness presenteeism in four European countries (HOUPE)
- 2013
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Ingår i: Swiss Medical Weekly. - : SMW Supporting Association. - 1424-7860 .- 1424-3997. ; 143
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Tidskriftsartikel (refereegranskat)abstract
- QUESTIONS UNDER STUDY: Sickness presenteeism is common in the health sector, especially among physicians, leading to high costs in terms of medical errors and loss in productivity. This study investigates predictors of sickness presenteeism in university hospitals, which might be especially exposed to competitive presenteeism. The study included comparisons of university hospitals in four European countries. METHODS: A cross-sectional survey analysis of factors related to sickness behaviour and work patterns in the field of academic medicine was performed among permanently employed physicians from the HOUPE (Health and Organisation among University Physicians Europe) study: (Sweden n = 1,031, Norway n= 354, Iceland n = 242, Italy n = 369). The outcome measure was sickness presenteeism. RESULTS: Sickness presence was more common among Italian physicians (86%) compared with physicians in other countries (70%-76%). Country-stratified analyses showed that sickness presenteeism was associated with sickness behaviour and role conflicts in all countries. Competition in the form of publishing articles was a predictor in Italy and Sweden. Organisational care for physician well-being reduced sickness presenteeism in all countries. CONCLUSION: Sickness presenteeism in university hospitals is part of a larger behavioural pattern where physicians seem to neglect or hide their own illness. Factors associated with competitive climate and myths about a healthy doctor might contribute to these behaviours. Importantly, it is suggested that managers and organisations should work actively to address these questions since organisational care might reduce the extent of these behaviours.
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| 22. |
- Horsten, M, et al.
(författare)
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Depressive symptoms and lack of social integration in relation to prognosis of CHD in middle-aged women - The Stockholm Female Coronary Risk Study
- 2000
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Ingår i: European Heart Journal. - Karolinska Inst, Dept Publ Hlth Sci, Div Prevent Med, Stockholm, Sweden. Harvard Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USA. Beth Israel Deaconess Med Ctr, Div Cardiovasc, Boston, MA USA. Karolinska Hosp, Dept Cardiol, S-10401 Stockholm, Sweden. : W B SAUNDERS CO LTD. - 0195-668X .- 1522-9645. ; 21:13, s. 1072-1080
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Tidskriftsartikel (refereegranskat)abstract
- Aims Several studies have reported that women with coronary heart disease have a poorer prognosis than men. Psychosocial factors, including social isolation and depressive symptoms have been suggested as a possible cause. However. little is known; about these factors and their independent predictive value in women. Therefore, we investigated the prognostic impact of depression, lack of social integration and their interaction in the Stockholm Female Coronary Risk Study. Methods and Results Two hundred and ninety-two women patients aged 30 to 65 years and admitted for an acute coronary event between 1991 and 1994, were followed for 5 years from baseline assessments, which were performed between 3 and 6 months after admission. Lack of social integration and depressive symptoms, assessed at baseline by standardized questionnaires, were associated with recurrent events. including cardiovascular mortality, acute myocardial infarction and revascularization procedures (percutaneous transluminal coronary angioplasty and coronary artery bypass grafting). Adjusting for age, diagnosis at index event. symptoms of heart failure, diabetes mellitus, high density lipoprotein (HDL) cholesterol, history of hypertension, systolic blood pressure, smoking, sedentary lifestyle, body mass index, and severity of angina pectoris symptoms. the hazard ratio associated with low (lowest quartile) as compared to high social integration (upper quartile) was 2.3 (95% CI 1.2-4.5) and the hazard ratio associated with two or more (upper three quartiles) as compared to one or no depressive symptoms was 1.9 (95% CI 1.02-3 6). Conclusions The presence of two or more depressive symptoms and lack of social integration independently predicted recurrent cardiac events in women with coronary heart disease. Women who were free of both these risk factors, had the best prognosis. (C) 2000 The European Society of Cardiology.
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| 23. |
- Horsten, M, et al.
(författare)
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Psychosocial factors and heart rate variability in healthy women.
- 1999
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Ingår i: Psychosomatic Medicine. - : Ovid Technologies (Wolters Kluwer Health). - 0033-3174 .- 1534-7796. ; 61:1, s. 49-57
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This study was conducted to investigate associations between psychosocial risk factors, including social isolation, anger and depressive symptoms, and heart rate variability in healthy women. METHODS: The study group consisted of 300 healthy women (median age 57.5 years) who were representative of women living in the greater Stockholm area. For the measurement of social isolation, a condensed version of the Interpersonal Support Evaluation List was used and household size assessed. Anger was measured by the anger scales previously used in the Framingham study and depressive symptoms by a questionnaire derived from Pearlin. Health behaviors were measured by means of standard questionnaires. From 24-hour ambulatory electrocardiographic monitoring, both time and frequency domain measures were obtained: SDNN index (mean of the SDs of all normal to normal intervals for all 5-minute segments of the entire recording), VLF power (very low frequency power), LF power (low frequency power), HF power (high frequency power), and the LF/HF ratio (low frequency by high frequency ratio) were computed. RESULTS: Social isolation and inability to relieve anger by talking to others were associated with decreased heart rate variability. Depressive symptoms were related only to the LF/HF ratio. Adjusting for age, menopausal status, exercise and smoking habits, history of hypertension, and BMI did not substantially change the results. CONCLUSIONS: These findings suggest heart rate variability to be a mediating mechanism that could explain at least part of the reported associations between social isolation, suppressed anger, and health outcomes.
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| 24. |
- Horsten, M, et al.
(författare)
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Social relations and the metabolic syndrome in middle-aged Swedish women
- 1999
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Ingår i: Journal of Cardiovascular Risk. - Karolinska Inst, Novum, Div Prevent Med, Dept Publ Hlth Sci, S-14157 Huddinge, Sweden. Beth Israel Deaconess Med Ctr, Div Cardiovasc, Boston, MA USA. Harvard Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USA. Karolinska Hosp, Dept Cardiol, S-10401 Stockholm, Sweden. : LIPPINCOTT WILLIAMS & WILKINS. - 1350-6277 .- 1473-5652 .- 1741-8267 .- 1741-8275. ; 6:6, s. 391-397
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Tidskriftsartikel (refereegranskat)abstract
- Background Both social isolation and the metabolic syndrome are independently associated with greater than normal cardiovascular risk. Design A population-based cross-sectional study of middle-aged Swedish women. Methods The study group consisted of 300 healthy women (aged 31-65 years) who were representative of women living in the greater Stockholm area. Social isolation was measured by using a condensed Version of the Interpersonal Support Evaluation List. Health behaviours were assessed and a full serum-lipid-level and haemostatic profile was obtained by standardized methods, The metabolic syndrome was defined as the presence of two or more of these components: fasting serum level of glucose greater than or equal to 7.0 mmol/l, arterial blood pressure greater than or equal to 160/90 mmHg, fasting serum level of triglycerides greater than or equal to 1.7 mmol/l or high-density lipoprotein < 1.0 mmol/l, or both, and central obesity (waist:hip ratio > 0.85 or body mass index > 30 kg/m(2), or both), Results After adjustment for age, menopausal status, educational level, smoking, exercise habits and consumption of alcohol, the risk ratio for the metabolic syndrome for women in the lower compared with women in the upper social-support quartile was 3.5 (95% confidence interval 1.1-11.4), whereas that of women in the two middle quartiles was 2.2 (95% confidence interval 0.67-7.2; P for trend 0.02). Conclusions Social isolation was associated with the metabolic syndrome for these middle-aged women. The findings suggest that the metabolic syndrome and its components may be mediators of the reported association between social isolation and cardiovascular disease, (C) 1999 Lippincott Williams & Wilkins.
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| 25. |
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| 26. |
- Janszky, I., et al.
(författare)
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Heart rate variability in long-term risk assessment in middle-aged women with coronary heart disease : The Stockholm Female Coronary Risk Study
- 2004
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Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 255:1, s. 13-21
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. Low heart rate variability (HRV) is associated with poor prognosis after acute coronary events in men. In women, the prognostic impact is not well documented. The objective of this study was to assess the long-term predictive power of HRV on mortality amongst middle-aged women with coronary heart disease (CHD). Design, Settings and Subjects. Consecutive women below 65 years hospitalized for an acute coronary syndrome during a 3-year period in Stockholm were examined for cardiovascular prognostic factors including HRV, and followed for a median of 9 years. An ambulatory 24-h electrocardiograph was recorded during normal activities, 3-6 months after hospitalization. SDNN index (mean of the standard deviations of all normal to normal intervals for all 5-min segments of the entire recording) and the following frequency domain parameters were assessed: total power, high-frequency (HF) power, low-frequency (LF) power, very-low frequency (VLF) power and LF/HF ratio. Using Cox proportional hazards regression, the hazard ratios (HR) for each 25% decrease of the HRV parameters were assessed. Results. After controlling for the independent, significant predictors of mortality amongst the clinical variables, the following HRV parameters were found to be significant predictors of all-cause mortality: SDNN index [HR 1.56, 95% confidence intervals (CI) 1.19-2.05], total power (HR 1.21, 95% CI 1.08-1.35), VLF power (HR 1.22, 95% CI 1.09-1.36), LF power (HR 1.18 95%, CI 1.07-1.30) and HF power (HR 1.18, 95% CI 1.05-1.33). The results were essentially the same when cardiovascular mortality was used as end-points. The HRV parameters were stronger predictors of mortality in the first 5 years following the index event. Conclusion. Low HRV is a predictor of long-term mortality amongst middle-aged women with CHD when measured 3-6 months after hospitalization for an acute coronary syndrome, even after controlling for established clinical prognostic markers.
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| 27. |
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| 28. |
- Koertge, J C, et al.
(författare)
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Vital exhaustion in relation to lifestyle and lipid profile in healthy women
- 2003
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Ingår i: International Journal of Behavioral Medicine. - : LAWRENCE ERLBAUM ASSOC INC. - 1070-5503 .- 1532-7558. ; 10:1, s. 44-55
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Tidskriftsartikel (refereegranskat)abstract
- "Vital exhaustion," characterized by fatigue, irritability, and demoralization, precedes new and recurrent coronary events. Biological mechanisms explaining this association are not fully understood. The objective was to investigate the relationship between vital exhaustion, lifestyle, and lipid profile. Vital exhaustion, smoking, body mass index (BMI), alcohol consumption, exercise capacity, and serum lipids were determined in 300 healthy women, aged 56.4 +/- 7.1 years. No statistically significant associations were found between vital exhaustion and lifestyle variables. Divided into quartiles, vital exhaustion was inversely related to high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A1 in a linear fashion after adjustment for age, BMI, exercise capacity, and alcohol consumption. A multivariate-adjusted vital exhaustion-score in the top quartile, as compared to one in the lowest, was associated with 12% lower HDL-C and 8% lower apolipoprotein A1 (p < .05). In conclusion, alterations in lipid metabolism may be a possible mediating mechanism between vital exhaustion and coronary heart disease. The impact of lifestyle variables was weak.
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| 29. |
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