| 1. |
- Palmquist, Eva, 1977-
(författare)
-
Environmental intolerance : psychological risk and health factors
- 2017
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Environmental intolerance (EI) is an embracing term for a number of conditions characterized by a wide range of non-specific symptoms attributed to certain environmental exposures (e.g. pungent/odorous chemicals, residing in a certain building, electromagnetic fields and everyday sounds). EI often leads to lifestyle alterations (e.g. not taking part of activities formerly engaged in) and functional impairment (e.g. not being able to work, social deprivation). The etiology of the conditions is largely unknown, though there is growing empirical evidence for associations between mental ill-health and EI. However, mainly cross-sectional studies have been conducted which cannot demonstrate temporality. Further on, the prognosis for EI is not well-known.This thesis includes four studies based on cross-sectional (Study 1) and longitudinal (Study 2-4) data from the Västerbotten Environmental Health Study (VEHS). The VEHS contains data from three data collections performed on the same set of respondents in 2010 (T1; n=3406), 2013 (T2; n=2336) and 2016 (T3; n=1837). In Study 1 the co-prevalence between EI attributed to chemicals, certain buildings, EMFs and sounds was investigated. The co-prevalence between all types of self-reported EI was greater than predictions based on coincidence, indicating that the different types of EI are associated, possibly sharing the same pathogenesis or that the afflicted individuals share some common predisposition to acquire the conditions. In Study 2 coping strategies and social support in EI were investigated and particularly whether certain combinations of different types of coping and social support may be important in recovering from EI. The participants who recovered from EI showed different combinations of coping strategies and social support than those who did not recover. In Study 3 the temporality between EI (attributed to chemicals, buildings and sounds) and psychological factors was investigated. The results showed that stress, anxiety, depression and burnout are risk factors for EI attributed to chemicals and sounds, but not for EI attributed to buildings. Changing perspective, EI attributed to buildings was a significant predictor of burnout, whereas EI attributed to sounds and chemicals were not. In Study 4 the prognosis of EI during a six-year period was studied. The probability of recovering from a state of specific EI was 44.3%, the probability of a specific EI to spread to other types of EI was 12.8%, and the probability of relapse was 3.9%. The participants who recovered showed lower levels of emotional and behavioral disruption than those who did not recover. The participants who showed spreading from one to several EIs perceived more stress than those who remained in a state of a specific EI, but had lower levels of burnout.Based on the findings of the studies in the thesis it is suggested that psychotherapy focusing on reducing the emotional and behavioral reactions of exposure might be helpful. Even though the causation of EI is unknown, negative expectations about exposure might accumulate symptoms, setting a vicious circle into motion. The task of the psychologist might be to break this circle.
|
|
| 2. |
- Blåvarg, Christina
(författare)
-
The alluring nature of episodic odor memory : Sensory and cognitive correlates across age and sex
- 2016
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Episodic memory for olfactory information is still relatively uncharted. The overall purpose of this thesis is to investigate the sensory and cognitive causes of the well-established age-related decline in olfactory episodic odor memory and of the age-independent sex difference in olfactory episodic memory. The purpose of Study I was to investigate the causes of the sex difference in olfactory episodic memory. The results show that the female advantage in episodic recognition memory seems to be explained by women´s higher aptitude in odor identification for familiar odors. With this background, the purpose of Study II was to investigate the age-related decline in olfactory episodic memory, with a particular eye to the role of odor identification. When controlling for the sensory variables olfactory threshold and odor quality discrimination, and the cognitive factor mental speed, the age-related deterioration in odor identification was eliminated. This suggests that changes in basic sensory and cognitive abilities underlie the age-related impairment in odor identification. The purpose of Study III was to investigate the role of recollective experience and intention to memorize for age-related and sex-related differences in episodic odor memory. Younger adults reported more experiences of remembering, and the elderly adults more experiences of feeling of knowing. The participants benefited from intentionality at encoding when the odors were unfamiliar, but intentionality did not affect memory for the familiar odors. The purpose of Study IV was to investigate the role of subjectively perceived qualities of the encoded odors for episodic memory across age and sex. Odors perceived as unpleasant, intense, and irritable were more easily remembered throughout the adult life span. The oldest adults selectively recognized the odors they rated as highly irritable indicating compensatory use of trigeminal activation. Overall, the result suggests that episodic odor memory rely heavily on both sensory and cognitive abilities, but in a different manner depending on demographic factors. The age-related decline appears to be driven by a sensory flattening disabling adequate cognitive processing. The age-independent sex difference on the other hand, is mainly cognitively mediated and driven by cognitive factors such as the ability to verbalize olfactory information.
|
|
| 3. |
- Höglund, Per, 1969-
(författare)
-
Stress, sleep disturbance, and related ill-health : from prevalence and risk-factors to indicated interventions
- 2024
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- With focus on stress-related ill-health and insomnia/sleep disturbance, the overall aim of this thesis was to determine severity and prevalence, risk factors and effectiveness of low-intensity group sessions. This was accomplished by taking epidemiological and quasi-experimental approaches. With the aim of examining symptom severity and prevalence of insomnia, burnout, anxiety, depression, and somatization across different age groups and sexes, Study I used cross-sectional data (n=3406) from the baseline data collection of the Västerbotten Environmental Health Study (VEHS). In comparison to men, women in most age groups exhibited higher levels of symptom severity and prevalence of caseness in various mental health conditions. Insomnia (28.6%) and burnout (17.3%) were common in the population.With focus on risk factors for insomnia and burnout, Study II used a longitudinal design and VEHS data (n=1702–1972) to compare a range of mental and somatic conditions in a general population. The results showed that all examined health conditions were risk factors for cases of insomnia and burnout. For example, insomnia can increase the risk of developing burnout (odds ratio: 2.67), and burnout increase the risk of developing insomnia (odds ratio: 2.73), underscoring the importance of early detection and prevention. The aim of Study III was to examine the effectiveness of four low-intensity group sessions for stress (n=274) and sleep disturbance (n=106) conducted by psychology students. A non-randomized controlled trial design was used in primary care with naturally occurring groups. A control group (n=221) was recruited via social media. Whereas effects were small at post-treatment, a substantial proportion of the patients showed a reliable improvement or recovery at 3-month follow-up. This thesis provides support for the assumption that severity and prevalence of insomnia, burnout, anxiety, depression, and somatization are common in the population. Burnout and insomnia are mutual risk factors and underscore the importance of indicated prevention in primary care. Low-intensity group interventions facilitated by non-experts can be effective and scalable for patients with stress and sleep disturbance.
|
|
| 4. |
- Andersson, John, et al.
(författare)
-
PM2.5 exposure and olfactory functions
- 2022
-
Ingår i: International Journal of Environmental Health Research. - : Taylor & Francis Group. - 0960-3123 .- 1369-1619. ; 32:11, s. 2484-2495
-
Tidskriftsartikel (refereegranskat)abstract
- Growing evidence indicates that air pollution can negatively impact cognitive functions. The olfactory system is interesting in this context as it is directly exposed to pollutants and also associated with cognitive functions. The aim of this study was to investigate long- and short-term PM2.5 exposure in association with olfactory functions. Scores from odor tests were obtained from the Betula project - a longitudinal cohort study. Estimates of annual mean PM2.5 concentrations at the participants' residential address were obtained from a dispersion-model. Daily mean PM2.5 concentrations were obtained from a measuring station close to the test location. We found a positive association between long-term PM2.5 exposure and odor identification, i.e. exposure was associated with a better ability to identify odors. We also found an interaction effect between PM2.5 and age on odor identification. We found no associations between any PM2.5 exposure and odor detection or between short-term PM2.5 exposure and olfactory functions.
|
|
| 5. |
- Andersson, Linus, 1979-
(författare)
-
Sick of smells : Empirical findings and a theoretical framework for chemical intolerance
- 2012
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Chemical intolerance (CI) is a term that refers to the surprisingly common phenomenon of persons getting ill from everyday chemicals. Although seemingly similar to asthma and allergies, CI sufferers do not react to exposures with increased histamine release. CI neither conforms to toxicological dose-response relationships as sufferers react to very low concentrations of chemicals assumed to be harmless. In addition, no particular chemical can be tied to any particular set of symptoms as in the case of other kinds of toxic injuries. The two overreaching goals of this thesis were to empirically investigate important hypotheses regarding CI, and to develop a theoretical framework that integrates previous theories of CI into a coherent whole.There are four empirical studies in this thesis. Utilizing event-related potentials (ERPs), magnitude estimations of perceived intensity, detection tests and functional magnetic resonance imaging (fMRI), the studies provided support for the following hypotheses: (1) persons with self-reported CI sensitize to olfactory and chemosomatosensory stimuli, whereas non-intolerant individuals habituate; (2) sensitization in CI is similar in terms of brain activation patterns to both non-clinical sensitization and other unexplained illnesses such as fibromyalgia; (3) persons with CI have an attention bias to chemical exposures, reflected by problems with withdrawing attention from such stimuli; (4) measures of peripheral hyperreactivity are correlated with chemosensory ERP measures; but failed to corroborate (5) the reactions of women resemble those found in persons with CI to a greater degree than the case in men.Three major theories of CI are also discussed. The neural sensitization theory describes CI as pathological and non-immunological increases in neural responsiveness. The conditioning theory describes CI as the result of basic associative learning mechanisms. The neurogenic inflammation theory describes CI as proliferation of sensory c-fibers and inflammatory responses carried to several parts of the body through axon reflexes and release of inflammatory mediators. The main point of the theoretical synthesis is that the theories offer different and complementary perspectives on CI, rather than presenting conflicting ontologies. With an integrated perspective, infected debates whether CI is a psychological or organic illness can hopefully be avoided.Finally, the unexplained characteristics of CI, the empirical findings and the theoretical accounts are described within the theoretical framework of signal detection theory. Several features of CI, e.g. sensitization and peripheral hyperreactivity, are described in terms of applying a low criterion (ß).
|
|
| 6. |
- Lind, Nina, 1989-
(författare)
-
Comorbidity, distress, coping and social support in asthma and allergy
- 2015
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Asthma and allergies are some of the most common illnesses worldwide that almost everybody will come in contact with. This thesis studied persons with allergic asthma, non-allergic asthma, allergic rhinitis and atopic dermatitis in a population-based sample. At an early stage, these illnesses were regarded as psychosomatic. Over time, as knowledge about asthma/allergy has increased more of a biomedical perspective was taken by the research field. In considering early documentations well as contemporary research, a psychobiosocial perspective was taken in this thesis when conducting the three studies. Thus, as psychological factors may affect the illness and be a result of the illness, it is important to incorporate these factors to better understand asthma and allergy. Study I examined the co- and multimorbidity in asthma/allergy with the environmental intolerances in the form of chemical and building-related intolerance. Study II investigated psychological distress in the four forms of asthma and allergy. Psychological distress was in this study defined as stress, burnout, anxiety, depression and environmental health worries. Study III examined usage of problem and emotion focused coping strategies and perceived social support from the surrounding in high and low asthma/allergy severity. All studies were performed using data from the Västerbotten Environmental Health Study, a questionnaire-based survey with focus on various environmental hypersensitivities and asthma and allergy. The result showed that the co- and multimorbidity with the environmental intolerances in asthma/allergy was larger than what was statistically excepted. Those with allergic asthma and atopic dermatitis experienced more stress, burnout and anxiety than those with non-allergic asthma, allergic rhinitis and non-asthma/allergy. Moreover, the most common way of coping with asthma and allergy was found to be strategies such as avoiding environments that are believed to affect health, and trying to accept the situation, independent of asthma/allergy severity. Finally, in general, those with asthma and allergy reported receiving most support from their partner, other family members and health care, and least support was perceived by those with low asthma/allergy severity.The findings suggest that co- and multimorbidity with environmental intolerances is relatively common in asthma and allergy, and should therefore be included in the clinical anamnesis for this patient group. The elevated level of distress in allergic asthma and atopic dermatitis evokes the question of use of therapies such as mindfulness maybe beneficial in certain afflicted persons. The results on coping and social support provide a foundation for further research regarding informing the asthma/allergy patient and family members about effective coping strategies and the importance of adequate social support. A metaperspective is taken in which interrelations between important variables in the thesis are discussed.
|
|
| 7. |
- Nordin, Maria, 1967-
(författare)
-
Low social support and disturbed sleep : epidemiological and psychological perspectives
- 2006
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The Swedish work force underwent dramatic changes during an economic crisis in the 1990s. In the aftermath, sick leave increased at an unprecedented rate and stress-related disorders, such as burnout, depression, and sleep disturbances replaced earlier work-related diagnoses. Sleep disturbances have been demonstrated to both precede and succeed mental and physical illnesses, including burnout, depression, anxiety, and cardiovascular disease. Disturbed sleep is also a common complaint in Sweden as well as in the rest of the Western world. Sleep has been shown to easily be disturbed by cognitive, emotional, and physiological arousal (stress). However, several studies have demonstrated that social support has a protective effect against the adverse effects of stress as well as a generally beneficial effect on health. Other studies, though, suggest that lack of social support may increase the risk for mental and physical ill-health. The purpose of this thesis was therefore to investigate the association between social support and disturbed sleep; foremost in working populations.Epidemiological methods were applied to investigate the association between social support and disturbed sleep. Three studies were used; a cross-sectional (MONICA, n = 1,179), a longitudinal (WOLF, n = 2,479), and a case-referent (SHEEP and VHEEP in conjunction, n = 6,231) study. The data was obtained by questionnaires, and social support was operationalized as network and emotional support. Disturbed sleep was defined as difficulties falling asleep, difficulties maintaining sleep, repeated awakenings, and disturbed sleep. Gender was taken into consideration throughout the studies.Foremost, low network support was found to increase the risk for contracting disturbed sleep. Which source the network support was derived from did not alter the association between low network support and disturbed sleep—low network support at work increased the risk for disturbed sleep as did low network outside work. Prolonged low network support and impaired emotional support did also increase the risk for sleep disturbances in men who were under strain at work. Furthermore, open coping buffered against low network support in the association with disturbed sleep five years later in women, whereas low network support increased the risk for developing disturbed sleep at a later date when interacting with covert coping both in women and in men. Moreover, disturbed sleep was shown to mediate low network support in myocardial infarction in women.In conclusion, the association between social support and disturbed sleep is complex and includes both interactions with other personality variables and mediating associations. Previous research on negative effects of low social support was confirmed as was previously observed gender differences in social support.
|
|
| 8. |
- Näslund, Ulf, et al.
(författare)
-
Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA) : a pragmatic, open-label, randomised controlled trial
- 2019
-
Ingår i: The Lancet. - : Elsevier. - 0140-6736 .- 1474-547X. ; 393:10167, s. 133-142
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Primary prevention of cardiovascular disease often fails because of poor adherence among practitioners and individuals to prevention guidelines. We aimed to investigate whether ultrasound-based pictorial information about subclinical carotid atherosclerosis, targeting both primary care physicians and individuals, improves prevention.METHODS: Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA) is a pragmatic, open-label, randomised controlled trial that was integrated within the Västerbotten Intervention Programme, an ongoing population-based cardiovascular disease prevention programme in northern Sweden. Individuals aged 40, 50, or 60 years with one or more conventional risk factors were eligible to participate. Participants underwent clinical examination, blood sampling, and ultrasound assessment of carotid intima media wall thickness and plaque formation. Participants were randomly assigned 1:1 with a computer-generated randomisation list to an intervention group (pictorial representation of carotid ultrasound plus a nurse phone call to confirm understanding) or a control group (not informed). The primary outcomes, Framingham risk score (FRS) and European systematic coronary risk evaluation (SCORE), were assessed after 1 year among participants who were followed up. This study is registered with ClinicalTrials.gov, number NCT01849575.FINDINGS: 3532 individuals were enrolled between April 29, 2013, and June 7, 2016, of which 1783 were randomly assigned to the control group and 1749 were assigned to the intervention group. 3175 participants completed the 1-year follow-up. At the 1-year follow-up, FRS and SCORE differed significantly between groups (FRS 1·07 [95% CI 0·11 to 2·03, p=0·0017] and SCORE 0·16 [0·02 to 0·30, p=0·0010]). FRS decreased from baseline to the 1-year follow-up in the intervention group and increased in the control group (-0·58 [95% CI -0·86 to -0·30] vs 0·35 [0·08 to 0·63]). SCORE increased in both groups (0·13 [95% CI 0·09 to 0·18] vs 0·27 [0·23 to 0·30]).INTERPRETATION: This study provides evidence of the contributory role of pictorial presentation of silent atherosclerosis for prevention of cardiovascular disease. It supports further development of methods to reduce the major problem of low adherence to medication and lifestyle modification.
|
|
| 9. |
- Olofsson, Jonas, 1978-
(författare)
-
Odor identification in aging and dementia : Influences of cognition and the ApoE gene
- 2008
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Olfactory function is impaired in aging and dementia. The general aim of this thesis was to identify variables that predict olfactory function and dysfunction (assessed with an odor identification test) in middle-aged and elderly adults. The thesis investigated whether odor identification performance was associated with demographic variables, cognitive function, the ApoE gene, dementia, and other health-related variables. The ApoE-ε4 allele is associated with cognitive impairment and Alzheimer’s disease, the most common form of dementia. The studies included in this thesis used data from the Betula study, a large-scale, population-based prospective study on aging, memory, and health. Study 1 investigated demographic and cognitive predictors of odor identification ability in non-demented participants. The results showed that younger age, female sex, and high education contributed to better odor identification ability. Cognitive speed and vocabulary had a small additional influence. Study 2 included information about ApoE genotypes, dementia and other health-related variables. The results indicated that the ApoE-ε4 allele was associated with odor identification impairment among the elderly, but not middle-aged adults. Participants who were demented at the time of testing or became demented within five years after testing exhibited olfactory impairments. Interestingly, the age-related olfactory impairment in ε4-carriers was independent of clinical dementia within five years. In Study 3, decline in global cognitive status over a five-year test-retest interval was predicted in a sample of elderly participants. The major result was a three-way interaction reflecting that odor identification impairment, old age, in combination with the ε4 allele predicted a larger cognitive decline. However, odor identification impairment did not predict cognitive change in elderly who were non-carriers of the ε4 allele. Overall, the results indicate that odor identification impairment in elderly is related to ApoE-ε4, cognitive decline, and clinical and pre-clinical stages of dementia. Theoretical and practical implications of the results are discussed. Furthermore, it is proposed that in order to effectively predict clinical dementia or cognitive decline from olfactory assessment in the elderly, variables that mediate (e.g. neuropathology) or moderate (e.g. age) the associations between olfactory function, the ε4 allele, and dementia need to be further evaluated, preferably in studies using longitudinal assessment.
|
|
| 10. |
- Paulin, Johan, 1979-
(författare)
-
Sound intolerance : characteristics, psychosocial work factors and reactions to exposure
- 2019
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Sound intolerance refers to an adverse reaction to sounds at sound pressure levels most people do not find bothersome. It is sometimes associated with hearing loss and tinnitus, but neither conditions are a prerequisite for being intolerant to sounds. The processes underlying the heightened reactions to sound, or how sound intolerance is related to other afflictions is not fully known, and research in this area can still be described as being in an early stage. This thesis aims to broaden the knowledge about sound intolerance and the sub-category of hyperacusis by using cross-sectional epidemiological and quasi-experimental methods of inquiry.The thesis consists of three studies, each approaching the subject from a different perspective with the aim to better understand various characteristics of sound intolerance in general, its relation to psychosocial factors in the work environment, and its effects during noise exposure. Studies I & II are cross-sectional studies using two different data sets with similar design. Study I was based on data from a stratified sample in the Västerbotten Environmental Health Study. It examined the characteristics, background descriptions and comorbidities of self-reported and physician diagnosed individuals with hyperacusis, and compared them to a healthy referent group. Analyses revealed that a majority of both hyperacusis groups actively tried to avoid sound sources, and experienced that they for the most part could affect the environment to make it less noisy. There were significantly increased risks for other diagnosed illnesses in the hyperacusis groups compared to the healthy referent group, with large odds ratios (ORs) for the psychiatric illnesses anxiety, depression, post-traumatic stress disorder and exhaustion syndrome. Other common illnesses were tinnitus, hearing impairment and musculoskeletal disorders. Study II used data from the Österbotten Environmental Health Study and focused on the psychosocial work environment for people with hyperacusis. Working participants with hyperacusis who were employed/on leave of absence/paternal leave/long-term sick listed were compared to a working sample without hyperacusis on measures of effort-reward imbalance, work over commitment, emotional and social support and worry at work. The hyperacusis group scored significantly higher on worry, social support, and reward, whereas the groups did not differ significantly with respect to emotional support, over commitment or effort. In the final study, a quasi-experimental design was employed to investigate how individuals with sound intolerance react to noise exposure over time, in terms of perceived sound intensity, unpleasantness, rated distractibility, symptoms, heart rate variability and cognitive performance. Participants were divided into three groups of equal size based on their self-rated sound intolerance, which resulted in low, medium, and high sound intolerance groups. Results revealed large variations across individuals in several outcome variables. Compared to the other two groups, the high sound intolerance group perceived the noise as more unpleasant, stronger, and more distracting. They further rated the symptoms as higher in intensity, showed deviations in heart rate variability, and performed poorer on a cognitive task selected to measure inhibition.In conclusion, the results suggest that persons with sound intolerance have relatively poor general health and hearing as well as high odds of comorbidity with various symptoms, including psychiatric diagnoses and functional somatic syndromes. In a working population, the sound intolerant show high odds for worrying about things at work, perceiving low social support at work and not feeling rewarded at work. Finally, the results suggest that persons with high sound intolerance have increased distractibility, sound unpleasantness, symptoms over time as well as lowered heart rate variability and cognitive performance when exposed to sounds.
|
|
