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1.	Schön, Thomas, et al. (författare) Antimicrobial susceptibility testing of Mycobacterium tuberculosis complex isolates - the EUCAST broth microdilution reference method for MIC determination 2020 Ingår i: Clinical Microbiology and Infection. - : ELSEVIER SCI LTD. - 1198-743X .- 1469-0691. ; 26:11, s. 1488-1492 Tidskriftsartikel (refereegranskat)abstract Scope: Several methods are used worldwide for antibiotic susceptibility testing (AST) for the Mycobacterium tuberculosis complex (MTBC). The variability in the results obtained with these methods hampers setting epidemiological cut-off (ECOFF) values and clinical breakpoints according to EUCAST guidelines. Methods for susceptibility testing and determination of the minimal inhibitory concentrations (MICs) need to be standardized for MTBC isolates for old and new agents. Our objective was to establish a standardized reference method for MIC determination for MTBC. Methods: The EUCAST antimycobacterial susceptibility testing subcommittee (AMST) compared protocols of MIC determination with regard to medium, inoculum preparation, antituberculous agent preparation, incubation, reading of the results and interpretation. Recommendations: The EUCAST reference method of MIC determination for MTBC is the broth microdilution method in Middlebrook 7H9-10% OADC medium. The final inoculum is a 105 CFU/mL suspension, obtained from a 10(-2) dilution of a 0.5 McFarland suspension prepared after vortexing bacterial colonies with glass beads before suspending them in sterile water. The culture is maintained in a U-shaped 96well polystyrene microtitre sterile plate with a lid incubated at 36 degrees +/- 1 degrees C. Reading is done using an inverted mirror as soon as the 1:100 diluted control (i.e. 10(3) CFU/mL suspension) shows visual growth. The MIC, expressed in mg/L, is the lowest concentration that inhibits visual growth. Mycobacterium tuberculosis H37Rv ATCC 27294 is used as the reference strain and its targeted MIC values are within the range 0.03-0.12 for isoniazid, 0.12-0.5 for levofloxacin and 0.25-1 mg/L for amikacin. Conclusions: The EUCAST reference method for MTBC was endorsed by EUCAST after public consultation and will from now on be used to define EUCAST ECOFFs and clinical breakpoints. This reference method is not primarily intended to be used under routine conditions and the AST methods will need to be calibrated against this reference method to be used with EUCAST breakpoints. Thomas Sch_on, Clin Microbiol Infect 2020;26:1488 (c) 2020 The Authors. Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).
2.	Schön, Thomas, 1973-, et al. (författare) Multicentre testing of the EUCAST broth microdilution reference method for MIC determination on Mycobacterium tuberculosis 2021 Ingår i: Clinical Microbiology and Infection. - : Elsevier. - 1198-743X .- 1469-0691. ; 27:2, s. 288.e1-288.e4 Tidskriftsartikel (refereegranskat)abstract OBJECTIVES: The first objective of the European Committee on Antimicrobial Susceptibility Testing (EUCAST) subcommittee for antimycobacterial susceptibility testing (AMST), launched in 2016, was to set a reference method for determining the MICs of antituberculous agents, since many protocols are used worldwide and a consensus one is needed for the determination of microbiological breakpoints.METHODS: During 2017 and 2018, MIC determination protocols were evaluated prospectively in a multicentre study within the four AMST laboratories. MIC results were obtained for isoniazid, levofloxacin and amikacin on the reference strain Mycobacterium tuberculosis H37Rv ATCC 27294. Broth microdilution (BMD) in Middlebrook 7H9 and solid medium dilution (SMD) in Middlebrook 7H10 were performed using two inoculum concentrations. MICs were interpreted with regard to visual and 99% inhibition after 7, 14 or 21 days of incubation for BMD and 21 days for SMD.RESULTS: Following the EUCAST reference protocol, intra- and inter-assay agreements were within ±1 MIC dilution for >95% of the observations for the three drugs in both methods. MIC values, presented as MIC mode (range) for BMD and SMD respectively, were: 0.03 (0.015-0.06) mg/L and 0.12 (0.06-0.25) mg/L for isoniazid, 0.25 mg/L (0.25-0.5) and 0.5 mg/L (0.12-0.5) for levofloxacin, and 0.5 mg/L (0.5-1.0) and 0.5 mg/L (0.5-1.0) for amikacin.CONCLUSIONS: Both SMD and BMD were reproducible and eligible as a reference method for MIC determination of the Mycobacterium tuberculosis complex (MTBC). BMD was finally selected as the EUCAST reference method. From now on it will be used to set epidemiological cut-off values and clinical breakpoints of new and old antituberculous agents.
3.	Davies Forsman, Lina, et al. (författare) Minimum Inhibitory Concentrations of Fluoroquinolones and Pyrazinamide Susceptibility Correlate to Clinical Improvement in Multidrug-resistant Tuberculosis Patients: A Nationwide Swedish Cohort Study Over 2 Decades 2019 Ingår i: Clinical Infectious Diseases. - : OXFORD UNIV PRESS INC. - 1058-4838 .- 1537-6591. ; 69:8, s. 1394-1402 Tidskriftsartikel (refereegranskat)abstract Background. Minimum inhibitory concentration (MIC) testing, unlike routine drug susceptibility testing (DST) at a single critical concentration, quantifies drug resistance. The association of MICs and treatment outcome in multidrug-resistant (MDR)-tuberculosis patients is unclear. Therefore, we correlated MICs of first- and second-line tuberculosis drugs with time to sputum culture conversion (tSCC) and treatment outcome in MDR-tuberculosis patients. Methods. Clinical and demographic data of MDR-tuberculosis patients in Sweden, including DST results, were retrieved from medical records from 1992 to 2014. MIC determinations were performed retrospectively for the stored individual Mycobacterium tuberculosis (Mtb) isolates using broth microdilution in Middlebrook 7H9. We fitted Cox proportional hazard models correlating MICs, DST results, and clinical variables to tSCC and treatment outcome. Results. Successful treatment outcome was observed in 83.5% (132/158) of MDR-tuberculosis patients. Increasing MICs of fluoroquinolones, diabetes, and age amp;gt;40 years were significantly associated with unsuccessful treatment outcome. Patients treated with pyrazinamide (PZA) had a significantly shorter tSCC compared to patients who were not (median difference, 27 days). Conclusions. Increasing MICs of fluoroquinolones were correlated with unsuccessful treatment outcome in MDR-tuberculosis patients. Further studies, including MIC testing and clinical outcome data to define clinical Mtb breakpoints, are warranted. PZA treatment was associated with shorter tSCC, highlighting the importance of PZA DST.
4.	Kuhlin, Johanna, et al. (författare) Genotypic resistance of pyrazinamide but not MIC is associated with longer time to sputum culture conversion in patients with multidrug-resistant tuberculosis 2021 Ingår i: Clinical Infectious Diseases. - : Oxford University Press. - 1058-4838 .- 1537-6591. ; 73:9, s. E3511-E3517 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: PZA resistance in multidrug-resistant tuberculosis (MDR-TB) is common and it is not clear how it affects interim and treatment outcomes. Although rarely performed, phenotypic drug susceptibility testing (pDST) is used to define PZA resistance but genotypic DST (gDST) and minimum inhibitory concentration (MIC) could be beneficial. We aimed to assess the impact of PZA gDST and MIC on time to sputum culture conversion (SCC) and treatment outcome in patients with MDR-TB.METHODS: Clinical, microbiological and treatment data was collected in this cohort study for all patients diagnosed with MDR-TB in Sweden 1992-2014. MIC, pDST and whole genome sequencing of the pncA, rpsA and panD genes were used to define PZA resistance. A Cox regression model was used for statistical analyses.RESULTS: Of 157 patients with MDR-TB, 56.1% (n=88) had PZA resistant strains and 49.7% (n=78) were treated with PZA. In crude and adjusted analyses, PZA gDST resistance was associated with a 29-day longer time to SCC (hazard ratio [HR] 0.57, 95% confidence interval [CI] 0.36-0.89, p=0.013 and HR 0.49, 95% CI 0.29-0.82, p=0.007, respectively). A two-fold decrease in dilutions of PZA MIC for PZA susceptible strains showed no association with SCC in crude or adjusted analyses (HR 0.98, 95% CI 0.73-1.31, p=0.89). Genotypic DST and MIC for PZA were not associated with treatment outcome.CONCLUSION: In patients with MDR-TB, gDST PZA resistance was associated with a longer time to SCC. Rapid PZA gDST is important to identify patients who may benefit from PZA treatment.
5.	Magnusson Hanson, Linda, 1977-, et al. (författare) Organisatorisk och psykosocial arbetsmiljö på den svenska arbetsmarknaden under coronapandemin : En del av regeringsuppdraget Coronapandemins konsekvenser för arbetsmiljön i Sverige 2023 Rapport (refereegranskat)abstract Introduktion och syfte med rapportenCoronapandemin (Covid-19 pandemin) innebar en rad restriktioner och en påföljande ekonomisk kris, som påverkade mångas arbetsliv och privatliv. Det finns emellertid fortfarande få svenska och internationella populationsbaserade studier om arbetsmiljöförändringarna i samband med coronapandemin, som fokuserar på olika sektorer utöver vård-/omsorgssektorn, och som är representativa för den arbetande befolkningen.Syftet med denna rapport är att undersöka hur upplevelsen bland den arbetande befolkningen i Sverige har förändrats i samband med coronapandemin, vad gäller den organisatoriska och psykosociala arbetsmiljön samt balans mellan arbetet och privatlivet. Syftet är även att undersöka om de eventuella förändringarna inom dessa arbetsmiljöområden skiljer sig åt beroende av bakgrundsfaktorer såsom kön, ålder, utbildningsnivå, socioekonomisk status, yrkesgrupp, samt distansarbete under coronapandemin.MetodUrvalet till analyserna i denna rapport är hämtat från den Svenska Longitudinella studien Om Sociala förhållanden, arbetsliv och Hälsa (SLOSH). Denna studie följer ett stort urval av initialt arbetande män och kvinnor ur Sveriges arbetande befolkning vartannat år med frågeformulär. Det genomfördes även en kompletterande webbundersökning i ett urval från SLOSH kallad ”SLOSH-corona” under 2021 (under ”mitten av coronapandemin”) och under 2022 (under ”slutet av coronapandemin”). Den fokuserade på arbetsmiljön, den sociala situationen, samt hälsan och hälsobeteenden i samband med coronapandemin.Denna rapport använder uppgifter från SLOSH-datainsamlingarna under våren 2018 (före coronapandemin), under våren 2020 (”i början av corona pandemin”), samt från SLOSH-corona 2021 och 2022. Det gäller uppgifter från totalt 1 345 individer som har deltagit i både SLOSH 2018 och 2020, samt som har arbetat både före coronapandemin och vid något av insamlingstillfällena under coronapandemin. De svarande i urvalet är representativa för hela Sverige och den svenska arbetsmarknaden. Men de bestod bland annat av en något större andel kvinnor än män, samt av en övervägande andel medelålders eller äldre personer i arbetslivet, gifta eller sammanboende personer, personer med en universitetsutbildning, samt tjänstemän. Frågeformulären innehöll uppgifter om en rad arbetsmiljöfaktorer som indelats i kategorierna; den organisatoriska arbetsmiljön, krav och resurser, den sociala arbetsmiljön, samt balans mellan arbete och privatliv.Eventuella förändringar över tid undersöktes i huvudsak genom regressionsanalyser. Dessa jämförde svaren på frågorna från någon av de insamlingar som gjordes under coronapandemin, med svaren på samma frågor från insamlingarna före coronapandemin. De svarande rapporterade själva för några faktorer, om de upplevde en förändring jämfört med före coronapandemin. Resultaten består därmed av både beskrivande och analytisk statistik samt tester av om de eventuella arbetsmiljöförändringarna över tid skilde sig åt beroende av ett antal bakgrundsfaktorer, samt på grund av om arbete skett från en ordinarie arbetsplats eller på distans/hemifrån.ResultatOrganisatorisk arbetsmiljöJämfört med före coronapandemin, så visade de övergripande analyserna i hela urvalet främst på:en betydligt högre andel som arbetade på distans/hemifrån under coronapandemin.en lägre andel som jobbade långa arbetstider (mer än 40 timmar per vecka) under coronapandemin.att en relativt stor andel upplevde att arbetsuppgifterna ökade, och framför allt från början till mitten av coronapandemin.Förändringar i den organisatoriska arbetsmiljön skilde sig främst åt beroende på aspekter som utbildning och socioekonomi. Exempelvis så ökade förekomsten av distansarbete tydligare bland högutbildade personer och tjänstemän. Förekomsten av långa arbetstider minskade samtidigt mer markant i dessa grupper. Förekomsten av långa arbetstider ökade däremot i stället bland personer med yrken som fokuserar på vården/omsorgen och andra kontaktyrken.Krav och resurserJämfört med före coronapandemin, visade de övergripande analyserna främst på:något lägre nivåer av psykologiska krav i arbetet under coronapandemin.något högre nivåer av kontroll/beslutsutrymme i arbetet under coronapandemin.en lägre andel med spänt arbete (höga psykologiska krav och en låg kontroll/ett lågt beslutsutrymme) under coronapandemin.att en relativt stor andel upplevde en ökad arbetsmängd och en psykisk arbetsbelastning (vilket skulle kunna handla om en anpassning och en hantering av sina känslor i olika arbetssituationer) under coronapandemin.marginellt högre nivåer av anställningsotrygghet, men endast under början av coronapandemin.En ökning av anställningsotryggheten var tydligare bland personer med yrken som fokuserar på materiell tillverkning i början av pandemin (såsom yrken inom byggverksamhet och tillverkning, maskinell tillverkning och transport, lantbruk, trädgård, skogsbruk, samt fiske). En ökad arbetsmängd och en psykisk arbetsbelastning var tydligast bland kvinnor och personer som arbetar inom yrken med fokus på vården/omsorgen och grundskolan/barnomsorgen. De med yrken inom vården/omsorgen, upplevde emellertid även att beslutsutrymmet ökat i en större utsträckning. Det var även de personer som hade arbetet på sin ordinarie arbetsplats under coronapandemin som i en högre grad upplevde att arbetsmängden och den psykiska arbetsbelastningen hade ökat. De personer som delvis eller mestadels arbetade på distans/hemifrån upplevde en ökad kontroll/ett ökat beslutsutrymme i en högre grad, samt ett ökat inflytande.Social arbetsmiljöJämfört med före coronapandemin, visade de övergripande analyserna främst på:en lägre nivå av ett socialt stöd i arbetet under slutet av coronapandemin.att en relativt hög andel deltagare upplevde ökade konflikter med andra (t.ex. patienter, kunder, elever, passagerare) under coronapandemin.att en relativt hög andel deltagare upplevde en försämrad stämning och ett försämrat samarbete på arbetsplatsen under coronapandemin.Socialt stöd hade minskat speciellt för vården och omsorgspersonalen, samt bland de personer som hade jobbat på sin ordinarie arbetsplats under coronapandemin. Ökade konflikter med andra var även tydligast bland de som jobbat på sin ordinarie arbetsplats under coronapandemin. En försämrad stämning på arbetsplatsen var tydligast bland de personer som jobbade inom yrken med ett fokus på grundskolan och barnomsorgen, samt inom andra kontaktyrken och bland högutbildade. Det var tydligare med en försämrad sammanhållning och ett försämrat samarbete på arbetsplatsen bland högutbildade personer och tjänstemän, samt bland de som arbetat på distans/hemifrån.Balans mellan arbete och privatlivAtt arbetssituationen under coronapandemin påverkade privatlivet på ett positivt sätt var en vanligare upplevelse än att det hade en negativ påverkan. Det var även vanligare med en upplevelse av att privatlivet påverkade arbetssituationen på ett positivt sätt, än på ett negativt.Det var vanligare bland de som arbetat på distans under coronapandemin, att arbetssituationen påverkade privatlivet på ett positivt sätt, eller att privatlivet påverkade arbetssituationen på ett positivt sätt. För de personer som hade yrken fokuserade inom vården/omsorgen och inom grundskolan/barnomsorgen var det vanligare med en upplevelse av att arbetssituationen påverkade privatlivet på ett negativt sätt.SlutsatserResultaten från dessa analyser tyder på flera förändringar inom den organisatoriska arbetsmiljön, i samband med coronapandemin. Det gäller främsten generell ökning av distansarbete, och en generell minskning av arbetstider. Resultaten var mindre tydliga vad gäller krav och resurser i arbetet. De psykologiska kraven minskade något, medan kontroll/beslutsutrymme ökade något. Det innebar en lägre andel deltagare med spänt arbete under pandemin, vilket kan tyda på en generell förbättring av balans mellan denna typ av krav och resurser. Det fanns samtidigt indikationer på en ökning av vissa typer av krav åtminstone för vissa grupper på arbetsmarknaden, till exempel vad gäller arbetsmängden och den psykiska arbetsbelastningen. Resultaten tyder vidare på en generell försämring i den sociala arbetsmiljön, och en relativt god balans mellan arbetet och privatlivet. Det finns emellertid betydande skillnader framför allt beroende av yrkesgrupper och distansarbete. Resultaten tyder exempelvis på en ökning av vissa typer av krav, och en försämring av vissa typer av sociala arbetsmiljöfaktorer bland de som arbetat inom hälso-/ sjukvårds- och utbildningssektorn, samt bland de som arbetat på sin ordinarie arbetsplats. Vidare så tyder resultaten på en relativt god balans mellan arbetet och privatlivet, men på en försämring av andra sociala arbetsmiljöfaktorer bland högutbildade personer och tjänstemän, samt bland de som arbetat på distans/hemifrån.
6.	Magnusson Hanson, Linda, 1977-, et al. (författare) Work-related violence or harassment and sickness absence due to common mental disorders : A prospective twin study 2023 Ingår i: <em>Innovation in Aging</em>, Volume 7, Issue Supplement_1, December 2023. - : Oxford University Press. ; , s. 1152-1153 Konferensbidrag (refereegranskat)abstract The aim of the present study was to investigate the association between exposure to unacceptable behaviors and practices or threats thereof in working life that result in or aim to result in physical, psychological, sexual or economic harm, such as violence and harassment including unwelcome conduct based on e.g. sex or gender (gender-based harassment/discrimination), and future sickness absence due to common mental disorders among Swedish twins. The study included 8795 twins, from the Swedish Study of Twin Adults: Genes and Environment, asked to report exposure to work-related violence or threats of violence and harassment or bullying and whom were followed-up for certified sickness absence (min 12 years of follow-up). Standard logistic regression indicated that exposure increased the odds of sickness absence due to common mental disorders (adjusted OR 2.11; 95% CI 1.52-2.95 for violence/threats, adjusted OR 1.52; 95% CI 1.10-2.11 for harassment/bullying). A co-twin control analyses based on conditional logistic regression restricted to twin pairs discordant for exposure, in which a co-twin control was used as reference, however, resulted in attenuated ORs (2.0; 0.79-5.07 and 1.56; 0.66-3.66, respectively). This indicates that the relationships could be at least partially confounded by familial factors, such as genetics and shared environment. These results suggests that more work is needed to clarify whether there is a causal association between these types of unacceptable behaviors/practices and mental health outcomes considering familial/genetic factors, and whether prevention of such behaviors/practices can keep individuals increasingly healthy, active on the labor market and promote healthy aging.
7.	Wijkander, Maria, et al. (författare) A Prospective Twin Study Investigating the Role of Genetics, Early Environment and Neuroticism in the Association Between Exposure to Work-Related Offensive Behaviours and Sickness Absence due to Common Mental Disorders 2024 Ingår i: Book of Proceedings. - : European Academy of Occupational Health Psychology. - 9780992878672 ; , s. 502-502 Konferensbidrag (refereegranskat)abstract Introduction: Sickness absence (SA) has been shown to be associated with several negative consequences, both for the affected individual as well as for society on the whole, in terms of economic loss. The most common reason for SA is SA due to common mental disorders (CMDs). Previous studies have indicated that there is an association between exposure to work-related offensive behaviours, such as harassment, bullying, violence and threats of different kinds and CMDs. However, the mechanistic pathway in this association is still largely unknown. For example, the associations between exposure to offensive or abusive behaviours and health outcomes may partially be explained by individual characteristics, including genetic predispositions and early experiences. The aim of the present study was to investigate the role of familial factors (genetics and shared early-life environment) and neuroticism in the associations between exposure to work-related violence/threats and harassment/bullying, and SA due to CMDs.Method: The study sample included 8795 twin individuals from the Swedish Twin project of Disability pension and Sickness absence (STODS), including survey data from the Study of Twin Adults: Genes and Environment (STAGE) linked to national register data. Self-reported work-related violence and/or threats and work-related harassment including bullying and register data on SA due to CMDs were analysed using logistic regression on the whole sample, and conditional logistic regression among complete same-sex twin pairs discordant on exposures. Individuals were followed for a maximum of 13 years or until their first incident SA spell due to CMD. Interactions between neuroticism and exposures were assessed using both multiplicative and additive interaction analyses.Results: Exposure to work-related violence/threats were associated with higher odds of SA due to CMDs when adjusting for age, sex, marital status, children living at home, education, type of residential area, work characteristics, and symptoms of depression and burnout (OR 2.11, 95% CI 1.52-2.95). Higher odds of SA due to CMDs were also found for exposure to harassment/bullying (OR 1.52, 95% CI 1.10-2.11) and a combined indicator of exposure to either of the kinds of exposure or exposure to both kinds, i.e. violence/threats and/or harassment/bullying (OR 1.98 95% CI 1.52-2.59), compared with the unexposed. Analyses of twin pairs discordant on exposure, using the unexposed twin sibling as reference, showed somewhat reduced ORs that were no longer statistically significant for all exposures. No multiplicative interaction was found between neuroticism and exposure to work-related violence/threats, or harassment. However, a statistically significant additive interaction was found between neuroticism and exposure to violence/threats, with higher odds of SA due to CMDs in the group scoring lower on neuroticism.Conclusion: Exposure to work-related offensive behaviours were associated with SA due to CMDs. The results of the matched twin pair analysis indicated that these associations may be confounded by familial factors. In addition, an interaction effect between violence/threats and neuroticism was found. Thus, future studies investigating associations and causality between offensive behaviours at work and mental health-related outcomes should, when possible, consider familial factors and neuroticism.
8.	Wijkander, Maria, et al. (författare) Exposure to work-related violence and/or threats of violence as a predictor of certified sickness absence due to mental disorders : a prospective cohort study of 16,339 Swedish men and women in paid work 2023 Ingår i: International Archives of Occupational and Environmental Health. - : Springer Nature. - 0340-0131 .- 1432-1246. ; 96:2, s. 225-236 Tidskriftsartikel (refereegranskat)abstract Objectives The aim of this prospective cohort study was to investigate if exposure to work-related violence and/or threats of violence predict certified sickness absence due to mental disorders.Methods Information on work-related exposure to violence and/or threats of violence were derived from the biannual Swedish Longitudinal Occupational Survey of Health (SLOSH) study 2012-2016, including individuals in paid work across Sweden and from different occupations/sectors (n = 16,339). Certified sickness absence due to mental disorders were ascertained from register data from the Swedish Social Insurance Agency. Odds ratios of certified sickness absence due to mental disorders according to exposure to work-related violence were estimated using multiple logistic regression. Several potential confounding variables, such as demographic and socio-economic factors, age, sex, cohabitation, children living at home, socio-economic status, educational level, as well as other types of psychosocial work environmental factors, were adjusted for in the analyses.Results In the total study sample, 9% reported exposure to violence and/or threats of violence and the prevalence of sickness absence due to mental disorders was 5%. Exposure to work-related violence and/or threats of violence was associated prospectively with certified sickness absence due to mental disorders (odds ratio 1.46, 95% confidence interval 1.17-1.82, p < 0.01). Analysis of possible interaction showed no difference in association when comparing women to men and different age groups.Conclusions Exposure to work-related violence and/or threats of violence appear to increase the odds of certified sickness absence due to mental disorders. Preventive measures aiming to lower the risk of exposure is thus of great importance.
9.	Wijkander, Maria, et al. (författare) The role of familial factors and neuroticism in the association between exposure to offensive behaviors at work and long-term sickness absence due to common mental disorders : a prospective twin study 2024 Ingår i: BMC Public Health. - : Springer Nature. - 1471-2458. ; 24:1 Tidskriftsartikel (refereegranskat)abstract Objectives: The aim of this study was to investigate associations between exposure to work-related violence/threats and harassment, and future sickness absence (SA) due to common mental disorders (CMDs), taking familial factors (shared genetics and early-life environment) and neuroticism into account. Methods: The study sample included 8795 twin individuals from the Swedish Twin Project of Disability Pension and Sickness Absence (STODS), including survey data from the Study of Twin Adults: Genes and Environment (STAGE). Self-reported work-related violence and/or threats as well as work-related harassment (including bullying) and national register data on SA due to CMDs were analyzed using standard logistic regression, and conditional logistic regression among complete twin pairs discordant on exposures. Individuals were followed for a maximum of 13 years. Interactions between neuroticism and exposures were assessed using both multiplicative and additive interaction analyses. Results: Exposure to work-related violence/threats was associated with higher odds of SA due to CMDs when adjusting for age, sex, marital status, children, education, type of living area, work characteristics, and symptoms of depression and burnout (OR 2.11, 95% CI 1.52-2.95). Higher odds of SA due to CMDs were also found for exposure to harassment (OR 1.52, 95% CI 1.10-2.11) and a combined indicator of exposure to violence/threats and/or harassment (OR 1.98, 95% CI 1.52-2.59), compared with the unexposed. Analyses of twins discordant on exposure, using the unexposed co-twin as reference, showed reduced ORs. These ORs were still elevated but no longer statistically significant, potentially due to a lack of statistical power. No multiplicative interaction was found between neuroticism and exposure to work-related violence/threats, or harassment. However, a statistically significant additive interaction was found between neuroticism and exposure to violence/threats, indicating higher odds of SA due to CMDs in the group scoring lower on neuroticism. Conclusions: Exposure to work-related offensive behaviors was associated with SA due to CMDs. However, the results indicated that these associations may be partly confounded by familial factors. In addition, an interaction between exposure and neuroticism was suggested. Thus, when possible, future studies investigating associations and causality between offensive behaviors at work and mental health-related outcomes, should consider familial factors and neuroticism.
10.	Wijkander, Maria, et al. (författare) The role of familial factors and neuroticism in the association between exposure to offensive behaviors at work and long-term sickness absence due to common mental disorders - a prospective twin study 2024 Ingår i: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 24:1 Tidskriftsartikel (refereegranskat)abstract Objectives The aim of this study was to investigate associations between exposure to work-related violence/threats and harassment, and future sickness absence (SA) due to common mental disorders (CMDs), taking familial factors (shared genetics and early-life environment) and neuroticism into account.Methods The study sample included 8795 twin individuals from the Swedish Twin Project of Disability Pension and Sickness Absence (STODS), including survey data from the Study of Twin Adults: Genes and Environment (STAGE). Self-reported work-related violence and/or threats as well as work-related harassment (including bullying) and national register data on SA due to CMDs were analyzed using standard logistic regression, and conditional logistic regression among complete twin pairs discordant on exposures. Individuals were followed for a maximum of 13 years. Interactions between neuroticism and exposures were assessed using both multiplicative and additive interaction analyses.Results Exposure to work-related violence/threats was associated with higher odds of SA due to CMDs when adjusting for age, sex, marital status, children, education, type of living area, work characteristics, and symptoms of depression and burnout (OR 2.11, 95% CI 1.52-2.95). Higher odds of SA due to CMDs were also found for exposure to harassment (OR 1.52, 95% CI 1.10-2.11) and a combined indicator of exposure to violence/threats and/or harassment (OR 1.98, 95% CI 1.52-2.59), compared with the unexposed. Analyses of twins discordant on exposure, using the unexposed co-twin as reference, showed reduced ORs. These ORs were still elevated but no longer statistically significant, potentially due to a lack of statistical power. No multiplicative interaction was found between neuroticism and exposure to work-related violence/threats, or harassment. However, a statistically significant additive interaction was found between neuroticism and exposure to violence/threats, indicating higher odds of SA due to CMDs in the group scoring lower on neuroticism.Conclusions Exposure to work-related offensive behaviors was associated with SA due to CMDs. However, the results indicated that these associations may be partly confounded by familial factors. In addition, an interaction between exposure and neuroticism was suggested. Thus, when possible, future studies investigating associations and causality between offensive behaviors at work and mental health-related outcomes, should consider familial factors and neuroticism.

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