| 1. |
- Ahonen, Hanna, et al.
(författare)
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Applying World Dental Federation Theoretical Framework for Oral Health in a General Population
- 2021
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Ingår i: International Dental Journal. - : Elsevier. - 0020-6539 .- 1875-595X. ; 72:4, s. 536-544
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The World Dental Federation (FDI) has recently proposed a new definition and theoretical framework of oral health. The theoretical framework includes 4 main components and describes the relationships amongst them. In 2020, an international work group proposed the minimum Adult Oral Health Standard Set (AOHSS) of variables to measure oral health, which was mapped onto the FDI's theoretical framework. By using an empirical data set, the proposed variables in the AOHSS and the potential interactions amongst the components of the FDI's theoretical framework can be tested. The purpose of this research was to investigate structural relations of the components of the FDI's theoretical framework of oral health based on data from a general adult population. Methods: Data from a previously conducted Swedish cross-sectional study focusing on oral health were utilised (N = 630; women, 55.2%; mean age, 49.7 years [SD, 19.2]). Variable selection was guided by the AOHSS. Structural equation modeling was used to analyse relationships amongst the components of the FDI's theoretical model (core elements of oral health, driving determinants, moderating factors, and overall health and well-being). Results: The Oral Health Impact Profile (OHIP)-14, xerostomia, and aesthetic satisfaction had statistically significant direct effects on overall health and well-being (p < .05). Driving determinants and moderating factors had statistically significant direct effects on all core elements of oral health (p < .05) except aesthetic satisfaction (p = .616). The predictors explained 24.1% of the variance of the latent variable overall health and well-being. Based on several indices, the proposed model showed acceptable model fit. Conclusions: The FDI's theoretical framework can be used to describe different components of oral health and the relationship amongst them in an adult general population. Further research based on the FDI's theoretical framework in other populations and settings is needed to explore complex interactions and possible relationships that form oral health and to investigate other or additional important social determinants.
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| 2. |
- Ahonen, Hanna, et al.
(författare)
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Clinical and self-reported measurements to be included in the core elements of the World Dental Federation's theoretical framework of oral health
- 2021
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Ingår i: International Dental Journal. - : Elsevier. - 0020-6539 .- 1875-595X. ; 71:1, s. 53-62
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Oral health is part of general health, and oral diseases share risk factors with several non-communicable diseases. The World Dental Federation (FDI) has published a theoretical framework illustrating the complex interactions between the core elements of oral health (CEOHs): driving determinants, moderating factors, and general health and well-being. However, the framework does not specify which self-reported or clinical measurements to be included in the CEOHs. Objectives To explore oral health measurements relevant for a general adult population to be included in the CEOHs in the FDI's theoretical framework of oral health. Materials and methods A psychometric study was performed, using cross-sectional data from Sweden (N = 630, 54% women, mean age 49.7 years). The data set initially consisted of 186 self-reported and clinical measurements. To identify suitable measurements, the selection was discussed in different settings, including both experts and patients. Principal component analyses (PCAs) were performed to explore, reduce and evaluate measurements to be included in the three CEOHs. Internal consistency was estimated by Cronbach's Alpha. Results The validation process yielded 13 measurements (four clinical, nine self-reported) in concordance with the CEOHs. PCAs confirmed robust validity regarding the construction, predicting 60.85% of variance, representing psychosocial function (number of measurements = 5), disease and condition status (number of measurements = 4), and physiological function (number of measurements = 4). Cronbach's Alpha indicated good to sufficient internal consistency for each component in the constructs (alpha = 0.88, 0.68, 0.61, respectively). Conclusion In a Swedish general adult population, 13 self-reported and clinical measurements can be relevant to include to operationalise CEOHs in the FDI's theoretical framework.
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| 3. |
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| 4. |
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| 5. |
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| 6. |
- Ahonen, Hanna
(författare)
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The multifaceted concept of oral health : Studies on a Swedish general population and perspectives of persons with experience of long-term CPAP-treated obstructive sleep apnea
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Oral health is a multifaceted and changeable part of our overall health and well-being as it contributes to important everyday functions such as eating, talking, and conveying feelings. Our oral health can be affected by a range of determinants, one of which is obstructive sleep apnea [OSA] treated with continuous positive airway pressure [CPAP]. Even though xerostomia has been frequently reported upon, the possible relationship between oral health and CPAP-treated OSA is not clearly understood. The World Dental Federation [FDI] recently proposed a definition and theoretical framework of oral health, intended to be globally applicable and to move dentistry toward a more promotive approach. By using the FDI’s framework as a basis for exploration, studies in a general population can increase the understanding of different aspects of oral health and set the frame of reference for whether and how CPAP-treated OSA can be experienced to affect a person’s oral health.The overall aim of this thesis was to gain a deeper understanding of how the FDI’s theoretical framework of oral health can be applied in a general population and how oral health is experienced in a specific population of persons with increased risk for adverse oral health.The FDI’s framework was explored with empirical data from a general population (N=630) and a population of persons with experience of CPAP-treated OSA (N=18). In papers I and II, the FDI framework was tested and evaluated with quantitative methods (principal component analysis and structural equation modeling), using cross-sectional data from the Jönköping studies. In papers III and IV, qualitative methods (directed content analysis and critical incident technique) were used where personal views and experiences were explored using individual semi-structured interviews.The findings in paper I showed that factors such as dental caries, periodontal disease, experience of xerostomia, and aesthetic satisfaction can be included in the FDI’s component the core elements of oral health. In paper II, driving determinants and moderating factors were found to have direct effects on all core elements of oral health except aesthetic satisfaction. Three of the core elements of oral health (oral health-related quality of life, aesthetic satisfaction, and xerostomia) had direct effects on the latent variable overall health and well-being. Driving determinants and moderating factors had no direct effect on overall health and well-being, and no indirect effects were found. In paper III, the study participants’ views on oral health determinants were described and could be categorized into all the FDI framework dimensions. The component driving determinants could include a range of determinants affecting a person’s oral health such as CPAP treatment, age, the influence of family and social surroundings, interdental cleaning, willingness to change when needed, and relationship with oral healthcare professionals. In paper IV, the study participants described both negative and positive experiences occurring with or without their CPAP. The negative experiences included increased xerostomia, pain or discomfort, tooth wear, and negative feelings. The positive experiences included decreased xerostomia and improved oral health habits due to improved sleep. Many of the difficulties could be managed by easily accessible facilitators. The experiences the study participants described could be included in all the FDI framework components.In conclusion, the FDI’s framework can be applied in a general population to describe different components of oral health, and is also useful to describe a person’s views and experiences of oral health in a specific population. CPAP treatment could be considered an oral health determinant as it can affect a person’s oral health. Both positive and negative experiences can contribute to CPAP adherence as negative experiences often can be successfully managed.
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| 7. |
- Ahonen, Hanna, et al.
(författare)
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"The terrible dryness woke me up, I had some trouble breathing"-Critical situations related to oral health as described by CPAP-treated persons with obstructive sleep apnea
- 2022
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Ingår i: Journal of Sleep Research. - : John Wiley & Sons. - 0962-1105 .- 1365-2869. ; 31:6
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Tidskriftsartikel (refereegranskat)abstract
- Continuous positive airway pressure is a common and effective treatment for obstructive sleep apnea, but adherence remains an issue. Both obstructive sleep apnea and oral diseases are associated with cardiovascular diseases, and as oral dryness contributes to treatment abandonment, oral health is of importance for this patient group. The aim was therefore to explore how persons with continuous positive airway pressure-treated obstructive sleep apnea experience situations associated with their oral health, and which actions they take to manage these. An explorative and descriptive design was adopted using the critical incident technique. Based on a purposeful selection, 18 adults with long-term experience of continuous positive airway pressure-treatment were interviewed using a semi-structured interview guide. Both negative and positive situations were described. Negative situations consisted of challenges with breathing, including mouth-breathing, choking sensations, problems with night-time and daytime oral dryness, changes in the saliva composition, and deteriorating oral health. Positive situations included experiences of reduced mouth-breathing and oral dryness. The situations were often successfully managed by mimicking daytime movements, changing sleeping position, adjusting the CPAP-device and mask, increasing oral hygiene efforts, drinking water, using a humidifier or chinstrap, or contacting their oral healthcare clinic. Long-term experience of persons with continuous positive airway pressure-treated obstructive sleep apnea regard situations and actions from everyday life. Successful management can contribute to long-term adherence and decrease negative effects on oral health. More interdisciplinary collaborations could enable identification and adequate recommendations for persons who experience negative situations during their continuous positive airway pressure treatment.
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| 8. |
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| 9. |
- Ahonen, Hanna, et al.
(författare)
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Views on oral health determinants as described by persons with continuous positive airway pressure‑treated obstructive sleep apnoea : a qualitative study
- 2023
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Ingår i: BMC Oral Health. - : BioMed Central (BMC). - 1472-6831. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Oral diseases have been associated with cardiovascular diseases, and persons with continuous positiveairway pressure [CPAP]-treated obstructive sleep apnoea [OSA] have an increased risk for negative consequences forboth oral and general health. CPAP treatment is often life-long and adherence to treatment is essential. Xerostomiais a common side-effect which can lead to treatment abandonment. Oral health is a changeable part of our generalhealth and well-being and exploring the views of oral health determinants from persons with experience of CPAP-treatment is important to prevent adverse oral health outcomes. The purpose of this study was to explore whatpersons with experience of CPAP-treated OSA view as determinants for their oral health. Methods Eighteen persons with long-term experience of CPAP-treated OSA were purposively selected. Data werecollected by semi-structured individual interviews. A code book based on the World Dental Federation’s [FDI] theo-retical framework for oral health was developed and used to analyse the data using directed content analysis. Thedomains in the framework’s component driving determinants were used as pre-determined categories. Using thedescription of driving determinants as a guide, meaning units were extracted from the interview transcripts throughan inductive approach. Then, by employing a deductive approach the code book was used to categorise the meaningunits into the pre-determined categories. Findings The views on oral health determinants described by the informants were compatible with the five domainsin the component driving determinants in the FDI’s theoretical framework. Ageing, heredity, and salivation (biologicaland genetic factors), influences from family and the wider society (social environment), location and re-localisation(physical environment), oral hygiene habits, motivation, willingness to change, professional support (health behav-iours), and availability, control, finances, and trust (access to care) were viewed as important oral health determinantsby the informants. Conclusion The study points to a variety of individual oral health-related experiences that oral healthcare profession-als could consider when designing interventions to reduce xerostomia and prevent adverse oral health outcomes forpersons undergoing long-term CPAP-treatment.
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| 10. |
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| 11. |
- Alfredsson, Lars, et al.
(författare)
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Jobstrain och riskfaktorer för hjärtkärlsjukdom
- 2002
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Ingår i: Psykosocial belastning och riskfaktorer för hjärt-kärlsjukdom. - Stockholm : Arbetslivsinstitutet. - 9170456410 ; , s. 1-2
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)
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| 12. |
- Ander, Birgitta, 1958-, et al.
(författare)
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Onset of substance use among early adolescents in Sweden
- 2020
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Ingår i: Journal of Social Work Practice in The Addictions. - : Taylor & Francis. - 1533-256X. ; 20:2, s. 105-121
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Tidskriftsartikel (refereegranskat)abstract
- Problem: Early onset, prevalence, and predictors of substance use - tobacco, alcohol-drinking, alcohol-drunkenness, and drugs - were studied in 13 and 14-year-old boys and girls in Sweden.Methods: Self-reported data in four communities were used (n = 1,716). A large set of psychological and social factors were tried as predictors of early onset use (n = 1,459).Results: There were few gender differences and low prevalence. Primary predictor for early onset in tobacco use was availability; perceived parental approval for alcohol use, and delinquent behaviors for alcohol-drunkenness and drug use.Conclusions: Individual behavioral factors and parental norms seem to be most important in this age.
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| 13. |
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| 14. |
- Bouillon, Kim, et al.
(författare)
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Measures of frailty in population-based studies: An overview
- 2013
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Ingår i: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 13:64
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Tidskriftsartikel (refereegranskat)abstract
- Background: Although research productivity in the field of frailty has risen exponentially in recent years, there remains a lack of consensus regarding the measurement of this syndrome. This overview offers three services: first, we provide a comprehensive catalogue of current frailty measures; second, we evaluate their reliability and validity; third, we report on their popularity of use.Methods: In order to identify relevant publications, we searched MEDLINE (from its inception in 1948 to May 2011); scrutinized the reference sections of the retrieved articles; and consulted our own files. An indicator of the frequency of use of each frailty instrument was based on the number of times it had been utilized by investigators other than the originators.Results: Of the initially retrieved 2,166 papers, 27 original articles described separate frailty scales. The number (range: 1 to 38) and type of items (range of domains: physical functioning, disability, disease, sensory impairment, cognition, nutrition, mood, and social support) included in the frailty instruments varied widely. Reliability and validity had been examined in only 26% (7/27) of the instruments. The predictive validity of these scales for mortality varied: for instance, hazard ratios/odds ratios (95% confidence interval) for mortality risk for frail relative to non-frail people ranged from 1.21 (0.78; 1.87) to 6.03 (3.00; 12.08) for the Phenotype of Frailty and 1.57 (1.41; 1.74) to 10.53 (7.06; 15.70) for the Frailty Index. Among the 150 papers which we found to have used at least one of the 27 frailty instruments, 69% (n = 104) reported on the Phenotype of Frailty, 12% (n = 18) on the Frailty Index, and 19% (n = 28) on one of the remaining 25 instruments.Conclusions: Although there are numerous frailty scales currently in use, reliability and validity have rarely been examined. The most evaluated and frequently used measure is the Phenotype of Frailty.
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| 15. |
- Dahl, Anna, et al.
(författare)
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Being overweight in midlife is associated with lower cognitive ability and steeper cognitive decline in late life.
- 2010
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Ingår i: The journals of gerontology. Series A, Biological sciences and medical sciences. - : Oxford University Press (OUP). - 1758-535X .- 1079-5006. ; 65:1, s. 57-62
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Although an increasing body of evidence links being overweight in midlife with an increased risk for dementia in late life, no studies have examined the association between being overweight in midlife and cognitive ability in late life. Our aim was to examine the association between being overweight in midlife as measured by body mass index (BMI) and cognitive ability assessed over time. METHODS: Participants in the Swedish Adoption/Twin Study Aging were derived from a population-based sample. The participants completed baseline surveys in 1963 or 1973 (mean age 41.6 years, range 25-63 years). The surveys included questions about height, weight, diseases, and lifestyle factors. Beginning in 1986, the same individuals were assessed on neuropsychological tests every 3 years (except in 1995) until 2002. During the study period, 781 individuals who were 50 years and older (60% women) had at least one complete neuropsychological assessment. A composite score of general cognitive ability was derived from the cognitive test battery for each measurement occasion. RESULTS: Latent growth curve models adjusted for twinness showed that persons with higher midlife BMI scores had significantly lower general cognitive ability and significantly steeper longitudinal decline than their thinner counterparts. The association did not change substantially when persons who developed dementia during the study period were excluded from the analysis. CONCLUSIONS: Higher midlife BMI scores precede lower general cognitive ability and steeper cognitive decline in both men and women. The association does not seem to be mediated by an increased risk for dementia.
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| 16. |
- Dahl, Anna, 1975-, et al.
(författare)
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Being overweight in midlife is associated with lower cognitive ability and steeper cognitive decline in late life
- 2010
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Ingår i: The journals of gerontology. Series A, Biological sciences and medical sciences. - : Oxford University Press. - 1079-5006 .- 1758-535X. ; 65A:1, s. 57-62
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Although an increasing body of evidence links being overweight in midlife with an increased risk for dementia in late life, no studies have examined the association between being overweight in midlife and cognitive ability in late life. Our aim was to examine the association between being overweight in midlife as measured by body mass index (BMI) and cognitive ability assessed over time. METHODS: Participants in the Swedish Adoption/Twin Study Aging were derived from a population-based sample. The participants completed baseline surveys in 1963 or 1973 (mean age 41.6 years, range 25-63 years). The surveys included questions about height, weight, diseases, and lifestyle factors. Beginning in 1986, the same individuals were assessed on neuropsychological tests every 3 years (except in 1995) until 2002. During the study period, 781 individuals who were 50 years and older (60% women) had at least one complete neuropsychological assessment. A composite score of general cognitive ability was derived from the cognitive test battery for each measurement occasion. RESULTS: Latent growth curve models adjusted for twinness showed that persons with higher midlife BMI scores had significantly lower general cognitive ability and significantly steeper longitudinal decline than their thinner counterparts. The association did not change substantially when persons who developed dementia during the study period were excluded from the analysis. CONCLUSIONS: Higher midlife BMI scores precede lower general cognitive ability and steeper cognitive decline in both men and women. The association does not seem to be mediated by an increased risk for dementia
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| 17. |
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| 18. |
- Dahl, Anna, et al.
(författare)
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Body mass index across midlife and cognitive change in late life
- 2013
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Ingår i: International Journal of Obesity. - : Springer Science and Business Media LLC. - 0307-0565 .- 1476-5497. ; 37, s. 296-302
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: High midlife body mass index (BMI) has been linked to a greater risk of dementia in late life, but few have studied the effect of BMI across midlife on cognitive abilities and cognitive change in a dementia-free sample. METHODS: We investigated the association between BMI, measured twice across midlife (mean age 40 and 61 years, respectively), and cognitive change in four domains across two decades in the Swedish Adoption/Twin Study of Aging. RESULTS: Latent growth curve models fitted to data from 657 non-demented participants showed that persons who were overweight/obese in early midlife had significantly lower cognitive performance across domains in late life and significantly steeper decline in perceptual speed, adjusting for cardio-metabolic factors. Both underweight and overweight/obesity in late midlife were associated with lower cognitive abilities in late life. However, the association between underweight and low cognitive abilities did not remain significant when weight decline between early and late midlife was controlled for. CONCLUSION: There is a negative effect on cognitive abilities later in life related to being overweight/obese across midlife. Moreover, weight decline across midlife rather than low weight in late midlife per se was associated with low cognitive abilities. Weight patterns across midlife may be prodromal markers of late life cognitive health.
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| 19. |
- Dahl, Anna, 1975-
(författare)
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Body mass index, cognitive ability, and dementia : prospective associations and methodological issues in late life
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aims of the present study were to investigate the association between overweight and cognitive ability and dementia, and to evaluate the usefulness of self-reported body mass index (BMI) in late life and various data sources commonly used in epidemiological studies to identify persons with dementia. Data were drawn from three population-based studies: the Swedish Adoption/Twin Study of Aging (SATSA), Aging in Women and Men: A Longitudinal Study of Gender Differences in Health Behaviour and Health among Elderly (the Gender Study), and the Finnish Lieto Study. In Study I, the agreement between self-reported and measured BMI over time was evaluated among 774 men and women, ages 40 to 88 years at baseline (mean age 63.9) participating in both the questionnaire phase and in-person testing of SATSA. Latent growth curve (LGC) modeling showed a small but significant increase between self-reported and measured BMI (0.02 kg/m2/y) over time, which would probably not affect the results if self-reported BMI were used as a continuous variable in longitudinal research. In Study II, the agreement between dementia diagnoses from various sources and dementia diagnoses set at a consensus conference was evaluated. Among the 498 elderly people ages 70 to 81 at baseline (mean age 74.5) enrolled in the Gender Study, 87 were diagnosed with dementia during an eight-year period. Review of medical records and nurse evaluations yielded the highest sensitivity (0.83 and 0.80, respectively) and a high specificity (0.98 and 0.96), indicating that these sources might be good proxies of dementia, while data extraction from the Swedish Inpatient Discharge Registry underestimated the prevalence of dementia (sensitivity 0.26). In Study III, the association between being overweight in midlife and cognitive ability in late life was examined in SATSA. The 781 participants ages 25 to 63 at baseline (mean age 41.6) in 1963 or 1973 self-reported their height and weight. From 1986 until 2002, they were assessed five times using a cognitive test battery. LGC models showed that people with higher midlife BMI scores had significantly lower cognitive ability and a significantly steeper decline than their thinner counterparts, an association that persisted when those who developed dementia during the study period were excluded from the analysis. This finding indicates that being overweight might affect cognitive ability independently of dementia. In Study IV, the association between BMI and dementia risk in older persons was described among 605 persons without dementia and ages 65 to 92 at baseline (mean age 70.8) in the Lieto Study. Among these, 86 persons were diagnosed with dementia during eight years of follow-up. Cox regression analyses indicated that for each unit increase in BMI score, the risk of dementia decreased 8% (hazard ratio = 0.92, 95% confidence interval = 0.87–0.97) and the association remained significant when individuals who developed dementia during the first four years of follow-up were excluded from the analyses. This result suggests that low BMI scores are present almost a decade before clinical dementia onset.
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| 20. |
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| 21. |
- Dahl, Anna K., et al.
(författare)
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Agreement between self-reported and measured height, weight and body mass index in old age : a longitudinal study with 20 years of follow-up
- 2010
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Ingår i: Age and Ageing. - : Oxford University Press. - 0002-0729 .- 1468-2834. ; 39:4, s. 445-451
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Tidskriftsartikel (refereegranskat)abstract
- Background: self-reported body mass index (BMI) based on self-reported height and weight is a widely used measure of adiposity in epidemiological research. Knowledge about the accuracy of these measures in late life is scarce.Objective: the study aimed to evaluate the accuracy and changes in accuracy of self-reported height, weight and BMI calculated from self-reported height and weight in late life.Design: a longitudinal population-based study with five times of follow-up was conducted.Participants: seven hundred seventy-four community-living men and women, aged 40–88 at baseline (mean age 63.9), included in The Swedish Adoption/Twin Study of Aging.Methods: participants self-reported their height and weight in a questionnaire, and height and weight were measured by experienced research nurses at an in-person testing five times during a 20-year period. BMI was calculated as weight (kilogramme)/height (metre)2.Results: latent growth curve modelling showed an increase in the mean difference between self-reported and measured values over time for height (0.038 cm/year) and BMI (0.016 kg/m2/year), but not for weight.Conclusions: there is a very small increase in the mean difference between self-reported and measured BMI with ageing, which probably would not affect the results when self-reported BMI is used as a continuous variable in longitudinal studies.
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| 22. |
- Dahl, Anna K, et al.
(författare)
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Is Self-reported Body Mass Index Less Reliable in Late Life?
- 2010
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Konferensbidrag (refereegranskat)abstract
- Objectives: Self-reported Body Mass Index (BMI) based on self-reported height and weight is a widely used measure of adiposity in epidemiological research. Knowledge about the accuracy of these measures in late life is scarce, and especially if there is intra-individual changes over time. Methods: Seven hundred seventy-four men and women, aged 40 to 88 at baseline (mean age 63.9), in The Swedish Adoption/Twin Study of Aging self-reported and had their height and weight measured by experienced research nurses five times during a twenty year period. BMI was calculated as weight (kilos)/height (meter)2. Results: There was significant correlation between self-reported and measured height (0.97-0.98), weight (0.97-0.98), and BMI (0.93-0.95) at each measurement occasion, and substantial agreement for BMI as a categorical variable (Kappa coefficient 0.72-0.81). Latent growth curve modeling showed an increase in the mean difference between self-reported and measured values over time for height (0.04 cm/year) and BMI (0.02 kg/m2/year), but not for weight. Conclusions: There is a very small significant increase in the mean difference between self-reported and measured BMI with aging, mainly due to unawareness of changes in height, which probably would not affect the results when self-reported BMI is used as a continuous variable in longitudinal studies.
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| 23. |
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| 24. |
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| 25. |
- Dragano, Nico, et al.
(författare)
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Effort-Reward Imbalance at Work and Incident Coronary Heart Disease A Multicohort Study of 90,164 Individuals
- 2017
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Ingår i: Epidemiology. - : Lippincott Williams & Wilkins. - 1044-3983 .- 1531-5487. ; 28:4, s. 619-626
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Tidskriftsartikel (refereegranskat)abstract
- Background: Epidemiologic evidence for work stress as a risk factor for coronary heart disease is mostly based on a single measure of stressful work known as job strain, a combination of high demands and low job control. We examined whether a complementary stress measure that assesses an imbalance between efforts spent at work and rewards received predicted coronary heart disease.Methods: This multicohort study (the "IPD-Work" consortium) was based on harmonized individual-level data from 11 European prospective cohort studies. Stressful work in 90,164 men and women without coronary heart disease at baseline was assessed by validated effort-reward imbalance and job strain questionnaires. We defined incident coronary heart disease as the first nonfatal myocardial infarction or coronary death. Study-specific estimates were pooled by random effects meta-analysis.Results: At baseline, 31.7% of study members reported effort-reward imbalance at work and 15.9% reported job strain. During a mean follow-up of 9.8 years, 1,078 coronary events were recorded. After adjustment for potential confounders, a hazard ratio of 1.16 (95% confidence interval, 1.00-1.35) was observed for effort-reward imbalance compared with no imbalance. The hazard ratio was 1.16 (1.01-1.34) for having either effort-reward imbalance or job strain and 1.41 (1.12-1.76) for having both these stressors compared to having neither effort-reward imbalance nor job strain.Conclusions: Individuals with effort-reward imbalance at work have an increased risk of coronary heart disease, and this appears to be independent of job strain experienced. These findings support expanding focus beyond just job strain in future research on work stress.
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| 26. |
- Ernsth Bravell, Marie, et al.
(författare)
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Reciprocal patterns of support of very old people and their families
- 2016
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Ingår i: The Gerontologist. - : Oxford University Press (OUP). - 1758-5341.
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Konferensbidrag (refereegranskat)abstract
- Introduction: The aging population is often considered as a threat that will deplete family and societal resources. Yet older people may be a resource, giving support and care to their family. The aim of this study is to analyze patterns of giving and receiving support by the oldest old with their family. Method: Data were used from the OCTO2- study, a Swedish population-based sample of 171 women and 156 men, 75–90 years. Respondents completed the Intergenerational Support Index to examine patterns of receiving and giving care and support and factors associated with support exchanges. Results: Results showed that the oldest old gave as much support as they received within the family. Most of the older persons receiving formal help from the community (79%) continued giving support to family. The most common types of support given and received within the family were emotional (89% given, 90% received) and practical (44% given, 46% received). Older persons gave more financial support (26%) than they received (2%). Age, gender, functioning in daily life activities and satisfaction with life were associated with giving different types of family support. Conclusion: Old-old people in Sweden are not just consumers of care, but are involved in reciprocal patterns as receivers and providers of care and support. It is not a simple opposition between being a giver and receiver of informal support simultaneously, but more knowledge is needed about the complex interplay between various form of care and support.
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| 27. |
- Falkenberg, Helena, et al.
(författare)
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Short- and long-term effects of major organisational change on minor psychiatric disorder and self-rated health : Results from the Whitehall II study
- 2013
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Ingår i: Occupational and Environmental Medicine. - : BMJ. - 1351-0711 .- 1470-7926. ; 70:10, s. 688-696
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Tidskriftsartikel (refereegranskat)abstract
- Objective To investigate short- and long-term effects of major organisational change on minor psychiatric disorder and self-rated health for women and men in different employment grades.Methods Minor psychiatric disorder and self-rated health among 6710 British civil servants (1993 women and 4717 men) in three employment grades from the Whitehall II study were examined from 1985 to 1988 under stable employment conditions. The short-term effects of organisational change were investigated in 1991–1993 after a time of major restructuring aiming at increasing the influence of market forces in the civil service and the long-term effects were investigated in 1997–1999.Results Those who had experienced organisational change and those who anticipated organisational change reported more negative short-term health effects (minor psychiatric disorder and poor self-rated health) compared with those who reported no change. No major differences were found depending on employment grade or gender. The negative health effects had diminished during 1997–1999 for those who reported that a major change had happened before 1991–1993. Those who anticipated an organisational change in 1991–1993 still reported more ill-health in 1997–1999 (both minor psychiatric disorder and self-reported health) than those in the comparison group.Conclusions The results indicate that organisational change affects employees’ health negatively in the short term but also that it is possible to recover from such negative effects. As it was not possible to discern any definite difference between the gender and grades, the results point at the importance of working proactively to implement organisational change for women and men at all levels.
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| 28. |
- Ferrie, Jane E., et al.
(författare)
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Job insecurity and risk of diabetes : a meta-analysis of individual participant data
- 2016
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Ingår i: CMJA. Canadian Medical Association Journal. Onlineutg. Med tittel. - : Canadian Medical Association,Association Medicale Canadienne. - 0820-3946 .- 1488-2329. ; 188:17-18, s. E447-E455
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Job insecurity has been associated with certain health outcomes. We examined the role of job insecurity as a risk factor for incident diabetes.METHODS: We used individual participant data from 8 cohort studies identified in 2 open-access data archives and 11 cohort studies participating in the Individual-Participant-Data Meta-analysis in Working Populations Consortium. We calculated study-specific estimates of the association between job insecurity reported at baseline and incident diabetes over the follow-up period. We pooled the estimates in a meta-analysis to produce a summary risk estimate.RESULTS: The 19 studies involved 140 825 participants from Australia, Europe and the United States, with a mean follow-up of 9.4 years and 3954 incident cases of diabetes. In the preliminary analysis adjusted for age and sex, high job insecurity was associated with an increased risk of incident diabetes compared with low job insecurity (adjusted odds ratio [OR] 1.19, 95% confidence interval [CI] 1.09-1.30). In the multivariable-adjusted analysis restricted to 15 studies with baseline data for all covariates (age, sex, socioeconomic status, obesity, physical activity, alcohol and smoking), the association was slightly attenuated (adjusted OR 1.12, 95% CI 1.01-1.24). Heterogeneity between the studies was low to moderate (age- and sex-adjusted model: I(2) = 24%, p = 0.2; multivariable-adjusted model: I(2) = 27%, p = 0.2). In the multivariable-adjusted analysis restricted to high-quality studies, in which the diabetes diagnosis was ascertained from electronic medical records or clinical examination, the association was similar to that in the main analysis (adjusted OR 1.19, 95% CI 1.04-1.35).INTERPRETATION: Our findings suggest that self-reported job insecurity is associated with a modest increased risk of incident diabetes. Health care personnel should be aware of this association among workers reporting job insecurity.
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| 29. |
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| 30. |
- Fransson, Eleonor, et al.
(författare)
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Association between change in body composition and change in inflammatory markers : An 11-year follow-up in the Whitehall II study
- 2010
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Ingår i: Journal of Clinical Endocrinology and Metabolism. - : Oxford University Press. - 0021-972X .- 1945-7197. ; 95:12, s. 5370-5374
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Tidskriftsartikel (refereegranskat)abstract
- Context: Obesity is associated with low-grade inflammation, but the long-term effects of weight change on inflammation are unknown.Objective: The aim was to examine the association of change in weight, body mass index (BMI), and waist circumference with change in C-reactive protein (CRP) and IL-6 and to assess whether this association is modified by baseline obesity status.Design and Setting: The design was a prospective cohort study among civil servants (the Whitehall II Study, UK). We used data from two clinical screenings carried out in 1991–1993 and 2002–2004 (mean follow-up, 11.3 yr).Participants: We studied 2496 men and 1026 women [mean age, 49.4 (SD = 6.0) yr at baseline] with measurements on inflammatory markers and anthropometry at both baseline and follow-up.Main Outcome Measures: We measured change in serum CRP and IL-6 during follow-up.Results: The mean increases in CRP and IL-6 were 0.08 [95% confidence interval (CI), 0.07–0.09] mg/liter and 0.04 (95% CI, 0.03–0.05) pg/ml per 1-kg increase in body weight during follow-up. Study members with a BMI less than 25 kg/m2 at baseline had an average increase in CRP of 0.06 (95% CI, 0.05–0.08) mg/liter per 1-kg increase in body weight, whereas the increase in those who were overweight (25 BMI < 30 kg/m2) and obese (BMI 30 kg/m2) was greater: 0.08 (95% CI, 0.06–0.09) mg/liter and 0.11 (95% CI, 0.07–0.14) mg/liter, respectively (P value for interaction = 0.002). Similar patterns were observed for changes in BMI and waist circumference.Conclusions: Those who were overweight or obese at baseline had a greater absolute increase in CRP per unit increase in weight, BMI, and waist circumference than people who were normal weight.
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| 31. |
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| 32. |
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| 33. |
- Fransson, Eleonor, 1971-, et al.
(författare)
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Comparison of alternative versions of the job demand-control scales in 17 European cohort studies : the IPD-Work consortium
- 2012
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 12, s. 62-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Job strain (i.e., high job demands combined with low job control) is a frequently used indicator of harmful work stress, but studies have often used partial versions of the complete multi-item job demands and control scales. Understanding whether the different instruments assess the same underlying concepts has crucial implications for the interpretation of findings across studies, harmonisation of multi-cohort data for pooled analyses, and design of future studies. As part of the 'IPD-Work' (Individual-participant-data meta-analysis in working populations) consortium, we compared different versions of the demands and control scales available in 17 European cohort studies. Methods: Six of the 17 studies had information on the complete scales and 11 on partial scales. Here, we analyse individual level data from 70 751 participants of the studies which had complete scales (5 demand items, 6 job control items). Results: We found high Pearson correlation coefficients between complete scales of job demands and control relative to scales with at least three items (r > 0.90) and for partial scales with two items only (r = 0.76-0.88). In comparison with scores from the complete scales, the agreement between job strain definitions was very good when only one item was missing in either the demands or the control scale (kappa > 0.80); good for job strain assessed with three demand items and all six control items (kappa > 0.68) and moderate to good when items were missing from both scales (kappa = 0.54-0.76). The sensitivity was > 0.80 when only one item was missing from either scale, decreasing when several items were missing in one or both job strain subscales. Conclusions: Partial job demand and job control scales with at least half of the items of the complete scales, and job strain indices based on one complete and one partial scale, seemed to assess the same underlying concepts as the complete survey instruments.
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| 34. |
- Fransson, Eleonor, 1971-, et al.
(författare)
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Exposure to exhaust fumes, combustion products or soot and the risk of atrial fibrillation : Results from the Swedish WOLF study
- 2016
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Ingår i: Occupational and Environmental Medicine. - : BMJ Publishing Group Ltd. - 1351-0711 .- 1470-7926. ; 73:Suppl 1, s. 140-141
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Tidskriftsartikel (refereegranskat)abstract
- Atrial fibrillation is a common heart rhythm disorder affecting 1-3% of the adult population. Despite being such a prevalent disorder, the knowledge about risk factors preceding the disease is very limited, especially regarding work related factors. The aim of the present study was to estimate the association between the 310 exposure to exhaust fumes, combustion products or soot in the work environment and the risk of atrial fibrillation.MethodData from the Swedish Work, Lipids and Fibrinogen (WOLF) study was used. The study includes working men and women in the counties of Stockholm, Västernorrland and Jämtland (n=10416). The baseline data collection was carried out 1992-1998. Atrial fibrillation cases were identified by the Swedish national hospital discharge register.ResultsDuring a median follow-up time of 13.6 years, 252 incident cases with atrial fibrillation were identified. In total, 1249 (12.5%) people reported exposure to exhaust fumes, combustion products or soot at baseline. The age and sex adjusted hazard ratio (HR) for atrial fibrillation was 1.01 (95% CI 0.70-1.46) for the exposed group compared with the unexposed group. Further adjustment for socio-economic status, lifestyle factors, job strain, waist circumference and hypertension did not alter the estimated HR in any substantial way (HR 0.99, 95% CI 0.66-1.48). However, when combining the exposure with smoking status, an increased risk for atrial fibrillation was observed among those exposed both to smoking and exhaust fumes, combustion products or soot compared to non-smokers who were not exposed (HR 1.83, 95% CI 1.07-3.12).Exposure-Smoking status HR* 95% CINon exposed-Non-smoker 1 -Non exposed-Smoker 1.09 0.78-1.52Exposed-Non-smoker 0.69 0.40-1.19Exposed-Smoker 1.83 1.07-3.12*Adjusted for SES, life-style, job strain, waist circumference and hypertensionConclusionPreliminary results indicate that exposure to exhaust fumes, combustion products or soot in combination with smoking is associated with an increased risk of atrial fibrillation.
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| 35. |
- Fransson, Eleonor
(författare)
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Fysisk aktivitet och riskfaktorer för hjärt-kärlsjukdom
- 2002
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Ingår i: Psykosocial belastning och riskfaktorer för hjärt-kärlsjukdom. - Stockholm : Arbetslivsinstitutet. - 9170456410 ; , s. 11-14
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)
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| 36. |
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| 37. |
- Fransson, Eleonor I, et al.
(författare)
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Job strain and the risk of stroke : an individual-participant data meta-analysis
- 2015
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Ingår i: Stroke. - 0039-2499 .- 1524-4628. ; 46:2, s. 557-559
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Psychosocial stress at work has been proposed to be a risk factor for cardiovascular disease. However, its role as a risk factor for stroke is uncertain.METHODS: We conducted an individual-participant-data meta-analysis of 196 380 males and females from 14 European cohort studies to investigate the association between job strain, a measure of work-related stress, and incident stroke.RESULTS: In 1.8 million person-years at risk (mean follow-up 9.2 years), 2023 first-time stroke events were recorded. The age- and sex-adjusted hazard ratio for job strain relative to no job strain was 1.24 (95% confidence interval, 1.05;1.47) for ischemic stroke, 1.01 (95% confidence interval, 0.75;1.36) for hemorrhagic stroke, and 1.09 (95% confidence interval, 0.94;1.26) for overall stroke. The association with ischemic stroke was robust to further adjustment for socioeconomic status.CONCLUSION: Job strain may be associated with an increased risk of ischemic stroke, but further research is needed to determine whether interventions targeting job strain would reduce stroke risk beyond existing preventive strategies.
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| 38. |
- Fransson, Eleonor I., et al.
(författare)
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The Association between Job Strain and Atrial Fibrillation : Results from the Swedish WOLF Study
- 2015
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Ingår i: BioMed Research International. - : Hindawi Publishing Corporation. - 2314-6133 .- 2314-6141.
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Atrial fibrillation (AF) is a common heart rhythmdisorder. Several life-style factors have been identified as risk factors for AF, but less is known about the impact of work-related stress. This study aims to evaluate the association between work-related stress, defined as job strain, and risk of AF. Methods: Data from the Swedish WOLF study was used, comprising 10,121 working men and women. Job strain was measured by the demand-control model. Information on incident AF was derived from national registers. Cox proportional hazard regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between job strain and AF risk. Results: In total, 253 incident AF cases were identified during a total follow-up time of 132,387 person-years. Job strain was associated with AF risk in a time-dependent manner, with stronger association after 10.7 years of follow-up (HR 1.93, 95% CI 1.10-3.36 after 10.7 years, versus HR 1.11, 95% CI 0.67-1.83 before 10.7 years). The results pointed towards a dose-response relationship when taking accumulated exposure to job strain over time into account. Conclusion: This study provides support to the hypothesis that work-related stress defined as job strain is linked to an increased risk of AF.
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| 39. |
- Fransson, Eleonor, et al.
(författare)
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Indications of recall bias found in a retrospective study of physical activity and myocardial infarction
- 2008
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Ingår i: Journal of Clinical Epidemiology. - : Elsevier BV. - 0895-4356 .- 1878-5921. ; 61:8, s. 840-847
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate the presence of recall bias in retrospective studies of physical activity and myocardial infarction. Study Design and Setting: In 2005, seventy-eight cases who had suffered from a myocardial infarction and 243 control subjects, who had previously participated in the Swedish WOLF (Work, Lipids, and Fibrinogen) study, were asked about their physical activity level during 1990-2005. The answers about recalled past leisure time, occupational, and household physical activity level were compared with physical activity level as reported at the baseline examination of the WOLF study in 1992-1998. Results: The proportion who recalled the same activity level as originally reported ranged from 69% to 96% (cases) and 69% to 89% (controls), and the kappa values ranged from 0.30 to 0.91 (cases) and 0.46 to 0.59 (controls), with the exception of perceived physical workload in household work, which showed low agreement between the originally stated and later recalled activity levels. Some differences were found between cases and controls regarding recall of past occupational activity, indicating the presence of recall bias in this domain of physical activity. Conclusion: We cannot preclude the existence of recall bias when using retrospectively recalled information about occupational physical activity in studies of physical activity and myocardial infarction.
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| 40. |
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| 41. |
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| 42. |
- Fransson, Eleonor, et al.
(författare)
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Job strain and atrial fibrillation : results from the Swedish Longitudinal Occupational Survey of Health and meta-analysis of three studies
- 2018
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Ingår i: European Journal of Preventive Cardiology. - : Sage Publications. - 2047-4873 .- 2047-4881. ; 25:11, s. 1142-1149
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Tidskriftsartikel (refereegranskat)abstract
- Background: Knowledge about the impact of occupational exposures, such as work stress, on the risk of atrial fibrillation is limited. The present study aims to investigate the association between job strain, a measure of work stress, and atrial fibrillation.Design: Prospective cohort study design and fixed-effect meta-analysis.Methods: Data from the Swedish Longitudinal Occupational Survey of Health (SLOSH) was utilised for the main analysis, combining self-reported data on work stress at baseline with follow-up data on atrial fibrillation from nationwide registers. Cox proportional hazard regression analyses were used to estimate hazard ratios and 95% confidence intervals (CIs). A fixed-effect meta-analysis was conducted to pool the results from the present study with results from two similar previously published studies.Results: Based on SLOSH data, job strain was associated with an almost 50% increased risk of atrial fibrillation (hazard ratio 1.48, 95% CI 1.00-2.18) after adjustment for age, sex and education. Further adjustment for smoking, physical activity, body mass index and hypertension did not alter the estimated risk. The meta-analysis of the present and two previously published studies showed a consistent pattern, with job strain being associated with increased risk of atrial fibrillation in all three studies. The estimated pooled hazard ratio was 1.37 (95% CI 1.13-1.67).Conclusion: The results highlight that occupational exposures, such as work stress, may be important risk factors for incident atrial fibrillation.
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| 43. |
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| 44. |
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| 45. |
- Fransson, Eleonor, 1971-, et al.
(författare)
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Job strain as a risk factor for leisure-time physical inactivity : an individual-participant meta-analysis of up to 170,000 men and women
- 2012
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Ingår i: American Journal of Epidemiology. - Cary : Oxford University Press. - 0002-9262 .- 1476-6256. ; 176:12, s. 1078-1089
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Forskningsöversikt (refereegranskat)abstract
- Unfavorable work characteristics, such as low job control and too high or too low job demands, have been suggested to increase the likelihood of physical inactivity during leisure time, but this has not been verified in large-scale studies. The authors combined individual-level data from 14 European cohort studies (baseline years from 19851988 to 20062008) to examine the association between unfavorable work characteristics and leisure-time physical inactivity in a total of 170,162 employees (50 women; mean age, 43.5 years). Of these employees, 56,735 were reexamined after 29 years. In cross-sectional analyses, the odds for physical inactivity were 26 higher (odds ratio 1.26, 95 confidence interval: 1.15, 1.38) for employees with high-strain jobs (low control/high demands) and 21 higher (odds ratio 1.21, 95 confidence interval: 1.11, 1.31) for those with passive jobs (low control/low demands) compared with employees in low-strain jobs (high control/low demands). In prospective analyses restricted to physically active participants, the odds of becoming physically inactive during follow-up were 21 and 20 higher for those with high-strain (odds ratio 1.21, 95 confidence interval: 1.11, 1.32) and passive (odds ratio 1.20, 95 confidence interval: 1.11, 1.30) jobs at baseline. These data suggest that unfavorable work characteristics may have a spillover effect on leisure-time physical activity.
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| 46. |
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| 47. |
- Fransson, Eleonor
(författare)
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Motion och risken för hjärtinfarkt
- 2006
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Ingår i: Svensk idrottsmedicin. - Södertälje : Svensk idrottsmedicinsk förening. - 1103-7652. ; 25:4, s. 10-11
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Tidskriftsartikel (populärvet., debatt m.m.)
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| 48. |
- Fransson, Eleonor, 1971-
(författare)
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Normalt åldrande
- 2008
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Ingår i: Den äldre parkinsonpatienten. - Stockholm : Svensk Geriatrisk Förening. - 9789163336928 ; , s. 7-9
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Bokkapitel (populärvet., debatt m.m.)
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| 49. |
- Fransson, Eleonor, et al.
(författare)
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Perceptions of intimate relationships in partners before and after a patient's myocardial infarction
- 2014
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Ingår i: Journal of Clinical Nursing. - : Wiley-Blackwell. - 0962-1067 .- 1365-2702. ; 23:15-16, s. 2196-2204
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Tidskriftsartikel (refereegranskat)abstract
- AIMS AND OBJECTIVES:To describe and explore how partners rate their intimate relationship before and after the patients' first myocardial infarction. A further aim was to investigate the association between partners' rating of their intimate relationship and self-rated health.BACKGROUND:To date, information on how partners experience the intimate relationship before and after a patient's myocardial infarction is sparse.DESIGN:A descriptive and exploratory design with longitudinal data collection.METHODS:The study comprised 127 partners, aged 34-87 years. Data collection included self-reported information on socio-demographic data, intimate relationship and self-rated health one year before and one year after patients' first myocardial infarction. Intimate relationship was assessed by the Swedish version of the Relationship Assessment Scale. Self-rated health was evaluated by the EuroQoL visual analogue scale.RESULTS:In general, partners reported high satisfaction with their intimate relationship both before and after the patients' myocardial infarction. Women reported somewhat lower ratings in their intimate relationship than men before the myocardial infarction. Women increased their ratings after one year, while men on average decreased their ratings. Partners with higher education reported lower ratings for intimate relationship after one year. Those with children living at home rated intimate relationship lower than those without children living at home after one year. Partners' self-rated health status was stable over time. No significant association between intimate relationship and self-rated health was found.CONCLUSIONS:This study provides important insights regarding couples' relationships from the perspective of the partner. Socio-demographic factors such as sex, educational level, having children living at home and employment status may influence how the relationship, from the partners' perspective, is affected by a myocardial infarction event.RELEVANCE TO CLINICAL PRACTICE:This study provides insight into how partners rate their intimate relationship and self-rated health over time before and after patients' myocardial infarction.
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