| 1. |
- Carlerby, Heidi, 1967-
(författare)
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Health and Social Determinants Among Boys and Girls in Sweden : Focusing on Parental Background
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The majority of Swedish boys and girls have good psychosomatic health. Despite that the risk of mental health problems such as nervousness, feeling low and sleeping difficulties has increased steadily in recent decades. Moreover, previous surveys on health and well-being indicate that boys and girls of foreign extraction in Sweden are at increased risk of ill health compared to boys and girls of Swedish background. The main aim of this thesis was to analyse health and social determinants among boys and girls of foreign extraction in Sweden. The factors explored in papers I–IV include parental background, family affluence and gender and their associations with subjective health complaints, psychosomatic problems or health risk behaviours. Other included risk factors for ill health were involvement in bullying, low participation and discrimination at school. This thesis takes an intersectional perspective, with ambitions to be able to emphasize the interplay between different power relations (i.e. gender, social class and parental background). Two sets of cross-sectional data were used. Three papers were based on the Swedish part of the World Health Organization’s Health Behaviour in School-Aged Children. The sample consisted of 11,972 children (boys n = 6054; girls n = 5918) in grades five, seven and nine from the measurement years 1997/98, 2001/02 and 2005/06. The response rate varied between 85 and 90%. About one fifth of the included children were of foreign extraction. For the fourth paper regional data from Northern Sweden were used. Boys (n = 729) and girls (n = 798) in grades six to nine answered a questionnaire in 2011 and the response rate was 80%. About 14% of the included children were of foreign extraction. Statistical methods used were chi-square test, correlation analyses, logistic regression analyses, cluster analyses and test of mediating factor. The results showed that girls of foreign background were at increased risk of subjective health complaints (SHC) and boys of mixed background were at increased risk of psychosomatic problems (PSP). Increased risk of allocation to the cluster profile of multiple risk behaviour was shown in boys and girls of mixed background, in girls of foreign background and in girls of low family affluence. Increased risk of allocation to the cluster profile of inadequate tooth brushing was shown in boys and girls of foreign background and in girls of low family affluence. General risk factors for increased risk of ill health for boys and girls in Sweden were: any form of bullying involvement, low family affluence, low participation and discrimination at school, of which the latter also was a mediating factor for ill health. Living with a single parent was a risk factor for ill health among girls. The results can function as a basis for developing health promotion programmes at schools that focus on social consequences of foreign extraction, family affluence, participation as well as health risk behaviours and gender.
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| 2. |
- Fahlén, Göran, 1953-
(författare)
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Aspects of the Effort-reward imbalance model of psychosocial stress in the working life
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Fahlén, G. (2008). Aspects on the Effort-reward Imbalance model of psychosocial stress in the work environments. Sundsvall, Sweden: Mid Sweden University, Department of Health Sciences. ISBN 978-91-85317-94-3. Since the late 1970s, work related stress has increasingly been recognized as an important determinant for ill-health and disease. One of the most influential stress models is the Effort-Reward Imbalance model (ERI), which stipulates that an imbalance between the perceived effort spent at work and rewards received results in noxious stress. Those with a coping behaviour called Work-related Overcommitment (WOC), including an inability to withdraw from work obligations are especially vulnerable. The model has shown strong explanatory value for a large numbers of harmful health outcomes. The general aim of this thesis was to contribute to the development of the ERI model by exploring the properties of this model in relation to its theoretical assumptions, construct, and application and to improve the knowledge of validity of the ERI-model. The study sample that was used in three papers emanated from the WOLF study (Work, Lipids and Fibrinogen). The analyses were confined to the subset of individuals who answered the ERI questions (n=1174) with complete answers. In one paper, data from the SKA study (Sick leave, Culture and Attitudes) were used and they comprised all employees at the Swedish Social Insurance Agency responsible for management and compensation of illness in the working population (n=5700). All data are based on questionnaires. The results indicate that ERI and WOC are risk factors for sleep disturbances and fatigue. A palpable threshold effect was seen between quartile three and four. Since these symptoms are strongly stress related, our results support the utility of the ERI and WOC scales in assessing stress in working life. Agreement between single questions in the original and an approximate instrument for measuring ERI were low, whereas the agreement between the two ERI scales was reasonable. When approximate instruments are used, questions and scales must be presented thoroughly to facilitate comparisons and the results should be interpreted with caution. Today there are no reasons to use such instruments in the ERI model. One statement in the ERI model is that individuals with the coping behaviour characterised as WOC are particularly vulnerable to an imbalance between perceived effort and reward; i.e., that ERI and WOC interact. No such effect was shown in relation to disturbed sleep and fatigue. There is no convincing evidence that ERI and WOC interact in synergy. Analysis demonstrated that WOC was relatively stable in perceived unchanged conditions as measured by the original, more comprehensive instrument as well as by the present, shortened instrument. Positively or negatively perceived changes in ERI correspond to changes in WOC. This result suggests that WOC, at least in part, may act as not only a coping strategy but also as an outcome from ERI. Taken together, these results concerning WOC, suggest that studies to clarify the role of the WOC dimension are needed. The ERI model states that, when individuals stay in unfavourable conditions characterised as ERI, because there are few alternatives on the labour market or when the individual is at risk of being laid off or of facing downward mobility, they are in a “locked in position” (LIP). A strong association between LIP and ERI was shown, supporting this statement.
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| 3. |
- Hermansson, Jonas
(författare)
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Shift work and cardiovascular disease
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Shift work is often defined as working time outside daytime hours (06:00 to 18:00). In recent years, shift work has been associated with an increased risk of cardiovascular disease (CVD), type II diabetes, and the metabolic syndrome. While some studies support the associations, others do not. Therefore, more research is needed. The aim of this thesis was to further study the association between shift work and CVD. This was addressed by performing four studies, one analysed if shift workers had an increased risk of ischemic stroke, the second study analysed whether shift workers had an increased risk of short-term mortality (case fatality)after a myocardial infarction (MI). The third study analysed if shift work interacts with other risk factors for MI and the fourth study analysed if parental history of CVD interacted with shift work on the risk of MI. The studies were performed using logistic regression analyses and additive interaction analyses in two different case-control databases. Shift workers did not have an increased risk of ischemic stroke. Male shift workers had an increased risk of death within 28 days after a MI. Shift work interacts with some CVD risk factors and interacts with paternal history of CVD and the risk of MI for males. The findings from this thesis provide new evidence showing that shift work is in different ways associated with an increased risk of MI and related mortality, but not with ischemic stroke. However, more research is needed to clarify and characterise these results.
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