| 1. |
- Ervasti, Jenni, et al.
(författare)
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Long working hours and risk of 50 health conditions and mortality outcomes : a multicohort study in four European countries
- 2021
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Ingår i: The Lancet Regional Health. - : Elsevier BV. - 2666-7762. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Background: Studies on the association between long working hours and health have captured only a narrow range of outcomes (mainly cardiometabolic diseases and depression) and no outcome-wide studies on this topic are available. To achieve wider scope of potential harm, we examined long working hours as a risk factor for a wide range of disease and mortality endpoints.Methods: The data of this multicohort study were from two population cohorts from Finland (primary analysis, n=59 599) and nine cohorts (replication analysis, n=44 262) from Sweden, Denmark, and the UK, all part of the Individual-participant Meta-analysis in Working Populations (IPD-Work) consortium. Baseline-assessed long working hours (≥55 hours per week) were compared to standard working hours (35-40 h). Outcome measures with follow-up until age 65 years were 46 diseases that required hospital treatment or continuous pharmacotherapy, all-cause, and three cause-specific mortality endpoints, ascertained via linkage to national health and mortality registers.Findings: 2747 (4·6%) participants in the primary cohorts and 3027 (6·8%) in the replication cohorts worked long hours. After adjustment for age, sex, and socioeconomic status, working long hours was associated with increased risk of cardiovascular death (hazard ratio 1·68; 95% confidence interval 1·08-2·61 in primary analysis and 1·52; 0·90-2·58 in replication analysis), infections (1·37; 1·13-1·67 and 1·45; 1·13-1·87), diabetes (1·18; 1·01-1·38 and 1·41; 0·98-2·02), injuries (1·22; 1·00-1·50 and 1·18; 0·98-1·18) and musculoskeletal disorders (1·15; 1·06-1·26 and 1·13; 1·00-1·27). Working long hours was not associated with all-cause mortality.Interpretation: Follow-up of 50 health outcomes in four European countries suggests that working long hours is associated with an elevated risk of early cardiovascular death and hospital-treated infections before age 65. Associations, albeit weak, were also observed with diabetes, musculoskeletal disorders and injuries. In these data working long hours was not related to elevated overall mortality.
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| 2. |
- Heikkilä, Katriina, et al.
(författare)
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Job Strain as a Risk Factor for Peripheral Artery Disease : A Multi-Cohort Study
- 2020
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Ingår i: Journal of the American Heart Association. - : Wiley-Blackwell. - 2047-9980 .- 2047-9980. ; 9:9
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Tidskriftsartikel (refereegranskat)abstract
- Background Job strain is implicated in many atherosclerotic diseases, but its role in peripheral artery disease (PAD) is unclear. We investigated the association of job strain with hospital records of PAD, using individual-level data from 11 prospective cohort studies from Finland, Sweden, Denmark, and the United Kingdom. Methods and Results Job strain (high demands and low control at work) was self-reported at baseline (1985-2008). PAD records were ascertained from national hospitalization data. We used Cox regression to examine the associations of job strain with PAD in each study, and combined the study-specific estimates in random effects meta-analyses. We used τ2, I2, and subgroup analyses to examine heterogeneity. Of the 139 132 participants with no previous hospitalization with PAD, 32 489 (23.4%) reported job strain at baseline. During 1 718 132 person-years at risk (mean follow-up 12.8 years), 667 individuals had a hospital record of PAD (3.88 per 10 000 person-years). Job strain was associated with a 1.41-fold (95% CI, 1.11-1.80) increased average risk of hospitalization with PAD. The study-specific estimates were moderately heterogeneous (τ2=0.0427, I2: 26.9%). Despite variation in their magnitude, the estimates were consistent in both sexes, across the socioeconomic hierarchy and by baseline smoking status. Additional adjustment for baseline diabetes mellitus did not change the direction or magnitude of the observed associations. Conclusions Job strain was associated with small but consistent increase in the risk of hospitalization with PAD, with the relative risks on par with those for coronary heart disease and ischemic stroke.
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| 3. |
- Lundh Hagelin, Carina, et al.
(författare)
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Factors influencing attitude toward care of dying patients in first-year nursing students.
- 2016
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Ingår i: International journal of palliative nursing. - : Mark Allen Group. - 1357-6321 .- 2052-286X. ; 22:1, s. 28-36
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Tidskriftsartikel (refereegranskat)abstract
- To describe Swedish first-year undergraduate nursing students' attitudes toward care of dying patients. Possible influences such as age, earlier care experiences, care education, experiences of meeting dying patients and place of birth were investigated.
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| 4. |
- Lundh Hagelin, Carina, et al.
(författare)
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Teaching about death and dying : A national mixed-methods survey of palliative care education provision in Swedish undergraduate nursing programmes
- 2022
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Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 36:2, s. 545-557
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Tidskriftsartikel (refereegranskat)abstract
- Background: In coming decades, the number of people affected by illnesses who need palliative care will rise worldwide. Registered Nurses are in a central position in providing this care, and education is one of the necessary components for meeting coming requirements. However, there is a lack of knowledge about palliative care in undergraduate nursing education curricula, including the extent of the education provided and the related pedagogical methods. Aim: The aim was to investigate the extent, content and pedagogical methods used and to explore lecturers’ experiences of being responsible for teaching and learning about palliative care for undergraduate nursing students on nursing programmes at Swedish universities. Setting: All 24 universities responsible for providing undergraduate nursing education in Sweden participated. Participants: One lecturer with in-depth knowledge about palliative care or end-of-life care education participated in the quantitative (n = 24) and qualitative (n = 22) parts of the study. Method: A mixed-method research study with an explorative design was used. Descriptive statistics were used to analyse quantitative data, and content analysis for qualitative, with both also analysed integratively. Results: Few undergraduate nursing programmes included a specific course about palliative care in their curricula, however, all universities incorporated education about palliative care in some way. Most of the palliative care education was theoretical, and lecturers used a variety of pedagogical strategies and their own professional and personal experience to support students to understand the palliative care approach. Topics such as life and death were difficult to both learn and teach about. Conclusions: There is a need for substantial education about palliative care. Lecturers strive on their own to develop students’ understanding and increase the extent of palliative care education with innovative teaching strategies, but must compete with other topics. Palliative care teaching must be prioritised, not only by the universities, but also by the national authority.
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| 5. |
- Nyberg, Solja T., et al.
(författare)
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Association of Healthy Lifestyle With Years Lived Without Major Chronic Diseases
- 2020
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Ingår i: JAMA Internal Medicine. - : American Medical Association (AMA). - 2168-6106 .- 2168-6114. ; 180:5, s. 760-768
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Tidskriftsartikel (refereegranskat)abstract
- This cohort study examines disease-free life-years in participants with varying combinations of lifestyle risk factors.Question: Are different combinations of lifestyle factors associated with years lived without chronic diseases?Findings: In a multicohort study of 116 & x202f;043 participants, a statistically significant association between overall healthy lifestyle score and an increased number of disease-free life-years was noted. Of 16 different lifestyle profiles studied, the 4 that were associated with the greatest disease-free life years included body mass index lower than 25 and at least 2 of 3 factors: never smoking, physical activity, and moderate alcohol consumption.Meaning: Various healthy lifestyle profiles appear to be associated with extended gains in life lived without type 2 diabetes, cardiovascular and respiratory diseases, and cancer.Importance: It is well established that selected lifestyle factors are individually associated with lower risk of chronic diseases, but how combinations of these factors are associated with disease-free life-years is unknown.Objective: To estimate the association between healthy lifestyle and the number of disease-free life-years.Design, Setting, and Participants: A prospective multicohort study, including 12 European studies as part of the Individual-Participant-Data Meta-analysis in Working Populations Consortium, was performed. Participants included 116 & x202f;043 people free of major noncommunicable disease at baseline from August 7, 1991, to May 31, 2006. Data analysis was conducted from May 22, 2018, to January 21, 2020.Exposures: Four baseline lifestyle factors (smoking, body mass index, physical activity, and alcohol consumption) were each allocated a score based on risk status: optimal (2 points), intermediate (1 point), or poor (0 points) resulting in an aggregated lifestyle score ranging from 0 (worst) to 8 (best). Sixteen lifestyle profiles were constructed from combinations of these risk factors.Main Outcomes and Measures: The number of years between ages 40 and 75 years without chronic disease, including type 2 diabetes, coronary heart disease, stroke, cancer, asthma, and chronic obstructive pulmonary disease.Results: Of the 116 & x202f;043 people included in the analysis, the mean (SD) age was 43.7 (10.1) years and 70 & x202f;911 were women (61.1%). During 1.45 million person-years at risk (mean follow-up, 12.5 years; range, 4.9-18.6 years), 17 & x202f;383 participants developed at least 1 chronic disease. There was a linear association between overall healthy lifestyle score and the number of disease-free years, such that a 1-point improvement in the score was associated with an increase of 0.96 (95% CI, 0.83-1.08) disease-free years in men and 0.89 (95% CI, 0.75-1.02) years in women. Comparing the best lifestyle score with the worst lifestyle score was associated with 9.9 (95% CI 6.7-13.1) additional years without chronic diseases in men and 9.4 (95% CI 5.4-13.3) additional years in women (P < .001 for dose-response). All of the 4 lifestyle profiles that were associated with the highest number of disease-free years included a body-mass index less than 25 (calculated as weight in kilograms divided by height in meters squared) and at least 2 of the following factors: never smoking, physical activity, and moderate alcohol consumption. Participants with 1 of these lifestyle profiles reached age 70.3 (95% CI, 69.9-70.8) to 71.4 (95% CI, 70.9-72.0) years disease free depending on the profile and sex.Conclusions and Relevance: In this multicohort analysis, various healthy lifestyle profiles appeared to be associated with gains in life-years without major chronic diseases.
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| 6. |
- van Laere, Joeri, 1974-, et al.
(författare)
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A simulation-game to explore collective critical infrastructure resilience
- 2018
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Ingår i: Safety and Reliability – Safe Societies in a Changing World. - London : CRC Press. - 9780815386827 - 9781351174664 - 9781351174657 ; , s. 1305-1312
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Konferensbidrag (refereegranskat)abstract
- Resilience of interdependent infrastructures increasingly depends on collaborative responses from actors with diverse backgrounds that may not be familiar with cascade effects into areas beyond their own sector. A simulation-game can enable societal actors to obtain a deeper understanding of the interdependencies between their infrastructures and their respective crisis responses. Following a design science approach, a simulation-game has been developed that combines role-playing simulation and computer simulation. The simulation-game challenges participants to address the interaction between payment disruptions, food and fuel supply, security problems (riots, robberies) and communication challenges (preventing hoarding). A number of crucial design choices were handled while developing the simulation-game. The main design challenges were: How to validate an unthinkable escalation scenario?; How to give the simulation a sufficient level of detail on all aspects and keep the complexity graspable so it can be played instantly?; and How much time should each playing round take?
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| 7. |
- van Laere, Joeri, 1974-, et al.
(författare)
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Analyzing the Implications of Design Choices in Existing Simulation-Games for Critical Infrastructure Resilience
- 2018
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Ingår i: Simulation Gaming: Applications for Sustainable Cities and Smart Infrastructures. - Cham : Springer. - 9783319919010 - 9783319919027 ; , s. 15-23
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Bokkapitel (refereegranskat)abstract
- A literature study has identified the major impacts of importantdesign choices in simulation models and simulation-games that model criticalinfrastructure resilience. The four major groups of design choices discussed inthis article are: (1) the chosen learning goal (system understanding or collaborationtraining), (2) realism and time scale of the scenario, (3) design of playerroles and communication rules, (4) number of action alternatives, replay-abilityand richness of performance feedback while playing. Researchers and practitionerswho build simulation-games for studying critical infrastructure resiliencecan use the accumulated insights on these four aspects to improve the quality oftheir game design and the quality of the simulation models the game participantsinteract with.
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| 8. |
- van Laere, Joeri, 1974-, et al.
(författare)
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Mitigating Escalation of Cascading Effects of a Payment Disruption Across Other Critical Infrastructures : Lessons Learned in 15 Simulation-Games
- 2020
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Ingår i: Critical Information Infrastructures Security. - Cham : Springer. - 9783030376697 - 9783030376703 ; , s. 110-121
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Bokkapitel (refereegranskat)abstract
- A disruption in one critical infrastructure can quickly lead to cascading effects in several other ones. Much research has been done to analyze dependencies between different critical infrastructures, but little is known about how to mitigate escalation and cascading effects across several critical infrastructures, i.e. how to develop collective critical infrastructure resilience. This research presents the results of 15 simulation-games where groups of 6 to 8 field experts from different sectors were challenged to collaboratively manage a disruption in the payment system that quickly affected food distribution, fuel distribution, transport, health care et cetera. Teams discussed possible strategies, which next were implemented in a computer simulation. Teams could influence the sequence of events on 4 decision points during a 10 day scenario, and play the same scenario several times to test alternative solutions. Each simulation-game session lasted a full day. Data analysis involved the recorded team discussions as well as computer simulation logs of the implemented decisions and their impacts. The results show how escalation and the severity of cascading effects largely depends on the quality of the early crisis response and not so much on the initial disruption. Also, it is shown how cross sectorial collaboration is required. Responses where groups focus too much on cascading effects in one area lead too poor overall performance for society at large. Groups tend to overbalance their mitigating strategies initially, until they arrive at a more balanced strategy that covers challenges in several different critical infrastructures from an integral perspective.
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| 9. |
- Virtanen, Marianna, et al.
(författare)
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Long working hours and change in body weight : analysis of individual-participant data from 19 cohort studies
- 2020
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Ingår i: International Journal of Obesity. - : Nature Publishing Group. - 0307-0565 .- 1476-5497. ; 44:6, s. 1368-1375
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To examine the relation between long working hours and change in body mass index (BMI). Methods: We performed random effects meta-analyses using individual-participant data from 19 cohort studies from Europe, US and Australia (n = 122,078), with a mean of 4.4-year follow-up. Working hours were measured at baseline and categorised as part time (<35 h/week), standard weekly hours (35–40 h, reference), 41–48 h, 49–54 h and ≥55 h/week (long working hours). There were four outcomes at follow-up: (1) overweight/obesity (BMI ≥ 25 kg/m2) or (2) overweight (BMI 25–29.9 kg/m2) among participants without overweight/obesity at baseline; (3) obesity (BMI ≥ 30 kg/m2) among participants with overweight at baseline, and (4) weight loss among participants with obesity at baseline. Results: Of the 61,143 participants without overweight/obesity at baseline, 20.2% had overweight/obesity at follow-up. Compared with standard weekly working hours, the age-, sex- and socioeconomic status-adjusted relative risk (RR) of overweight/obesity was 0.95 (95% CI 0.90–1.00) for part-time work, 1.07 (1.02–1.12) for 41–48 weekly working hours, 1.09 (1.03–1.16) for 49–54 h and 1.17 (1.08–1.27) for long working hours (P for trend <0.0001). The findings were similar after multivariable adjustment and in subgroup analyses. Long working hours were associated with an excess risk of shift from normal weight to overweight rather than from overweight to obesity. Long working hours were not associated with weight loss among participants with obesity. Conclusions: This analysis of large individual-participant data suggests a small excess risk of overweight among the healthy-weight people who work long hours.
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| 10. |
- Ye, Zhoufeng, et al.
(författare)
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Core competencies for injury prevention among public health students and an advocacy for curriculum development in the medical universities in China : A cross-sectional study
- 2020
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Ingår i: Injury Prevention. - : BMJ Publishing Group Ltd. - 1353-8047 .- 1475-5785. ; 26:6, s. 555-561
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To assess the current status of injury prevention (IP) core competency among medical students majoring in public health in China and to advocate for incorporating IP in the medical curriculum. Methods: The study used purposive sampling in eight medical universities in China in 2017, including 420 undergraduates and 763 graduates, using self-Administered questionnaires based on the core competency instrument for IP with five domains (31 items): A) injury analysis and assessment (8 items), B) IP project planning and implementation (7 items), C) communication (6 items), D) community practice (5 items), and E) leadership and systematic thinking (5 items). The higher score indicated the higher level of proficiency of the ability (scores ranged from 1 to 5). We used linear regression model to test the effect of IP course experience on the core competency mean score after adjusting for potential confounders. Results: The total mean score was 2.78 (SD=0.76, median=2.9, range=1-4.55) and 2.68 (SD=0.75, median=2.81, range=1-4.45) for undergraduates and graduates, respectively. There were 60% and 36% of undergraduates and graduates who have ever taken IP course, respectively. IP course class hours were positively associated with core competency level (P<0.05) across five domains (except for domain D) and the total. Conclusion: The core competency level is relatively low among public health students in China. Setting IP courses should be considered as an effective way to improve students' core competency. It is a step moving towards the IP education promotion, and further boosting the field of public health.
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