| 1. |
- Kivimäki, M., et al.
(author)
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Job strain as a risk factor for coronary heart disease : A collaborative meta-analysis of individual participant data
- 2012
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In: The Lancet. - : Elsevier. - 0140-6736 .- 1474-547X. ; 380:9852, s. 1491-1497
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Journal article (peer-reviewed)abstract
- Background Published work assessing psychosocial stress (job strain) as a risk factor for coronary heart disease is inconsistent and subject to publication bias and reverse causation bias. We analysed the relation between job strain and coronary heart disease with a meta-analysis of published and unpublished studies. Methods We used individual records from 13 European cohort studies (1985-2006) of men and women without coronary heart disease who were employed at time of baseline assessment. We measured job strain with questions from validated job-content and demand-control questionnaires. We extracted data in two stages such that acquisition and harmonisation of job strain measure and covariables occurred before linkage to records for coronary heart disease. We defined incident coronary heart disease as the first non-fatal myocardial infarction or coronary death. Findings 30 214 (15%) of 197 473 participants reported job strain. In 1•49 million person-years at risk (mean follow-up 7•5 years [SD 1•7]), we recorded 2358 events of incident coronary heart disease. After adjustment for sex and age, the hazard ratio for job strain versus no job strain was 1•23 (95% CI 1•10-1•37). This effect estimate was higher in published (1•43, 1•15-1•77) than unpublished (1•16, 1•02-1•32) studies. Hazard ratios were likewise raised in analyses addressing reverse causality by exclusion of events of coronary heart disease that occurred in the first 3 years (1•31, 1•15-1•48) and 5 years (1•30, 1•13-1•50) of follow-up. We noted an association between job strain and coronary heart disease for sex, age groups, socioeconomic strata, and region, and after adjustments for socioeconomic status, and lifestyle and conventional risk factors. The population attributable risk for job strain was 3•4%. Interpretation Our findings suggest that prevention of workplace stress might decrease disease incidence; however, this strategy would have a much smaller effect than would tackling of standard risk factors, such as smoking. Funding Finnish Work Environment Fund, the Academy of Finland, the Swedish Research Council for Working Life and Social Research, the German Social Accident Insurance, the Danish National Research Centre for the Working Environment, the BUPA Foundation, the Ministry of Social Affairs and Employment, the Medical Research Council, the Wellcome Trust, and the US National Institutes of Health.
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| 2. |
- Sundström, Johan, Professor, 1971-, et al.
(author)
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Risk factors for subarachnoid haemorrhage : a nationwide cohort of 950 000 adults
- 2019
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In: International Journal of Epidemiology. - : Oxford University Press. - 0300-5771 .- 1464-3685. ; 48:6, s. 2018-2025
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Journal article (peer-reviewed)abstract
- BACKGROUND: Subarachnoid haemorrhage (SAH) is a devastating disease, with high mortality rate and substantial disability among survivors. Its causes are poorly understood. We aimed to investigate risk factors for SAH using a novel nationwide cohort consortium.METHODS: We obtained individual participant data of 949 683 persons (330 334 women) between 25 and 90 years old, with no history of SAH at baseline, from 21 population-based cohorts. Outcomes were obtained from the Swedish Patient and Causes of Death Registries.RESULTS: During 13 704 959 person-years of follow-up, 2659 cases of first-ever fatal or non-fatal SAH occurred, with an age-standardized incidence rate of 9.0 [95% confidence interval (CI) (7.4-10.6)/100 000 person-years] in men and 13.8 [(11.4-16.2)/100 000 person-years] in women. The incidence rate increased exponentially with higher age. In multivariable-adjusted Poisson models, marked sex interactions for current smoking and body mass index (BMI) were observed. Current smoking conferred a rate ratio (RR) of 2.24 (95% CI 1.95-2.57) in women and 1.62 (1.47-1.79) in men. One standard deviation higher BMI was associated with an RR of 0.86 (0.81-0.92) in women and 1.02 (0.96-1.08) in men. Higher blood pressure and lower education level were also associated with higher risk of SAH.CONCLUSIONS: The risk of SAH is 45% higher in women than in men, with substantial sex differences in risk factor strengths. In particular, a markedly stronger adverse effect of smoking in women may motivate targeted public health initiatives.
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| 3. |
- Theorell, Töres, et al.
(author)
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Job strain in relation to body mass index : pooled analysis of 160 000 adults from 13 cohort studies
- 2012
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In: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 272:1, s. 65-73
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Journal article (peer-reviewed)abstract
- Job strain in relation to body mass index: pooled analysis of 160 000 adults from 13 cohort studies. J Intern Med 2012; 272: 6573. Background. Evidence of an association between job strain and obesity is inconsistent, mostly limited to small-scale studies, and does not distinguish between categories of underweight or obesity subclasses. Objectives. To examine the association between job strain and body mass index (BMI) in a large adult population. Methods. We performed a pooled cross-sectional analysis based on individual-level data from 13 European studies resulting in a total of 161 746 participants (49% men, mean age, 43.7 years). Longitudinal analysis with a median follow-up of 4 years was possible for four cohort studies (n = 42 222). Results. A total of 86 429 participants were of normal weight (BMI 18.524.9 kg m-2), 2149 were underweight (BMI < 18.5 kg m-2), 56 572 overweight (BMI 25.029.9 kg m-2) and 13 523 class I (BMI 3034.9 kg m-2) and 3073 classes II/III (BMI = 35 kg m-2) obese. In addition, 27 010 (17%) participants reported job strain. In cross-sectional analyses, we found increased odds of job strain amongst underweight [odds ratio 1.12, 95% confidence interval (CI) 1.001.25], obese class I (odds ratio 1.07, 95% CI 1.021.12) and obese classes II/III participants (odds ratio 1.14, 95% CI 1.011.28) as compared with participants of normal weight. In longitudinal analysis, both weight gain and weight loss were related to the onset of job strain during follow-up. Conclusions. In an analysis of European data, we found both weight gain and weight loss to be associated with the onset of job strain, consistent with a U-shaped cross-sectional association between job strain and BMI. These associations were relatively modest; therefore, it is unlikely that intervention to reduce job strain would be effective in combating obesity at a population level.
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| 4. |
- Virtanen, Marianna, et al.
(author)
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Long working hours and change in body weight : analysis of individual-participant data from 19 cohort studies
- 2020
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In: International Journal of Obesity. - : Nature Publishing Group. - 0307-0565 .- 1476-5497. ; 44:6, s. 1368-1375
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Journal article (peer-reviewed)abstract
- Objective: To examine the relation between long working hours and change in body mass index (BMI). Methods: We performed random effects meta-analyses using individual-participant data from 19 cohort studies from Europe, US and Australia (n = 122,078), with a mean of 4.4-year follow-up. Working hours were measured at baseline and categorised as part time (<35 h/week), standard weekly hours (35–40 h, reference), 41–48 h, 49–54 h and ≥55 h/week (long working hours). There were four outcomes at follow-up: (1) overweight/obesity (BMI ≥ 25 kg/m2) or (2) overweight (BMI 25–29.9 kg/m2) among participants without overweight/obesity at baseline; (3) obesity (BMI ≥ 30 kg/m2) among participants with overweight at baseline, and (4) weight loss among participants with obesity at baseline. Results: Of the 61,143 participants without overweight/obesity at baseline, 20.2% had overweight/obesity at follow-up. Compared with standard weekly working hours, the age-, sex- and socioeconomic status-adjusted relative risk (RR) of overweight/obesity was 0.95 (95% CI 0.90–1.00) for part-time work, 1.07 (1.02–1.12) for 41–48 weekly working hours, 1.09 (1.03–1.16) for 49–54 h and 1.17 (1.08–1.27) for long working hours (P for trend <0.0001). The findings were similar after multivariable adjustment and in subgroup analyses. Long working hours were associated with an excess risk of shift from normal weight to overweight rather than from overweight to obesity. Long working hours were not associated with weight loss among participants with obesity. Conclusions: This analysis of large individual-participant data suggests a small excess risk of overweight among the healthy-weight people who work long hours.
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| 5. |
- Ahonen, Hanna, et al.
(author)
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Applying World Dental Federation Theoretical Framework for Oral Health in a General Population
- 2021
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In: International Dental Journal. - : Elsevier. - 0020-6539 .- 1875-595X. ; 72:4, s. 536-544
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Journal article (peer-reviewed)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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| 6. |
- Ahonen, Hanna, et al.
(author)
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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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In: International Dental Journal. - : Elsevier. - 0020-6539 .- 1875-595X. ; 71:1, s. 53-62
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Journal article (peer-reviewed)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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| 7. |
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| 8. |
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| 9. |
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| 10. |
- Ahonen, Hanna
(author)
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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
-
Doctoral thesis (other academic/artistic)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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| 11. |
- Ahonen, Hanna, et al.
(author)
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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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In: Journal of Sleep Research. - : John Wiley & Sons. - 0962-1105 .- 1365-2869. ; 31:6
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Journal article (peer-reviewed)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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| 12. |
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| 13. |
- Ahonen, Hanna, et al.
(author)
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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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In: BMC Oral Health. - : BioMed Central (BMC). - 1472-6831. ; 23:1
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Journal article (peer-reviewed)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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| 14. |
- Ander, Birgitta, 1958-, et al.
(author)
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Onset of substance use among early adolescents in Sweden
- 2020
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In: Journal of Social Work Practice in The Addictions. - : Taylor & Francis. - 1533-256X. ; 20:2, s. 105-121
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Journal article (peer-reviewed)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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| 15. |
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| 16. |
- Dahl, Anna, 1975-, et al.
(author)
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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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In: 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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Journal article (peer-reviewed)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. |
- Dahl, Anna K., et al.
(author)
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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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In: Age and Ageing. - : Oxford University Press. - 0002-0729 .- 1468-2834. ; 39:4, s. 445-451
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Journal article (peer-reviewed)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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| 18. |
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| 19. |
- Fristedt, Sofi, 1969-, et al.
(author)
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Physical functioning associated with life-space mobility in later life among men and women
- 2022
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In: BMC Geriatrics. - London, United Kingdom : BioMed Central. - 1471-2318. ; 22:1
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Journal article (peer-reviewed)abstract
- BackgroundLife-space mobility is defined as the ability to access different areas extending from the room where the person sleeps to places outside one’s hometown. Life-space mobility is vital to support performance of daily life activities and autonomous participation in social life. However, there is a dearth of research that investigates a wider range of physical functions and functioning in relation to life-space mobility rather than just single aspects. Thus, the purpose of the present study was to identify and describe several measures of physical functioning associated with life-space mobility among older men and women.MethodsData used in this study was derived from the OCTO 2 study, a population-based study of health, functioning and mobility among older persons (n = 312) in Sweden. Associations between Life-Space Assessment (LSA) total score and age, sex, Short Physical Performance Battery (SPPB), dizziness, lung function i.e. Peak Expiratory Flow (PEF), grip strength, self-rated vision and hearing were analysed through bivariate and multivariate regression models.ResultsThe bivariate models showed that life-space mobility was significantly associated with sex, but also age, SPPB, PEF and grip strength in the total group as well as among men and women. In addition, hearing was significantly associated with life-space mobility among women. Those factors that were statistically significant in the bivariate models were further analysed in multivariable models for the total group, and for men and women separately. In these models, sex, grip strength and SPPB remained significantly associated with life-space mobility in the total group, as well as SPPB among both men and women.ConclusionSex, physical function in terms of physical performance measured by SPPB (balance, gait speed and chair stand), and grip strength are associated with life-space mobility. Consequently, these factors need to be considered in assessments and interventions aiming to maintain mobility in old age.
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| 20. |
- Hallgren, Jenny, 1978-, et al.
(author)
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Trajectories of motor function and cognition in relation to hospitalization
- 2017
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Conference paper (peer-reviewed)abstract
- Background: Hospitalization among older people is common and associated with adverse outcomes. However, knowledge about long-term effects on motor functions and cognitive abilities in relation to hospitalization is scarce. In order to explore development of motor functions and cognition after hospitalization, a longitudinal study among middle-aged and older adults with up to 25 years of follow-up was conducted.Methods: Overall, 828 participants from the Swedish Adoption/Twin Study of Ageing (SATSA) were linked to the Swedish National Inpatient Register, which contains information on participants’ hospital admissions. Up to 8 assessments of cognitive performance and 7 assessments of motor functions i.e. fine motor, balance/upper strength, and flexibility, from 1986 to 2010 were available. Latent growth curve modelling was used to assess the association between hospitalization and subsequent motor function and cognitive performance.Results: A total of 735 (89 %) persons had at least one hospital admission during the follow-up. The mean age at first hospitalization was 70.2 (± 9.3) years. Persons who were hospitalized exhibited a lower mean level of cognitive performance in all domains and in motor functions compared with those who were not hospitalized. A significantly steeper decline was observed in motor function abilities as well as in processing speed, spatial/fluid, and general cognitive ability performance of hospitalized participants. These patterns remained even after comorbidities and dementia prevalence were controlled for.Discussion: We are the first to show that hospitalization is associated with steeper decline in both motor function and cognitive abilities across more than two decades of post-hospitalization follow-up.
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| 21. |
- Heikkila, Katriina, et al.
(author)
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Job Strain and Tobacco Smoking : An Individual-Participant Data Meta-Analysis of 166 130 Adults in 15 European Studies
- 2012
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 7:7
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Journal article (peer-reviewed)abstract
- Background: Tobacco smoking is a major contributor to the public health burden and healthcare costs worldwide, but the determinants of smoking behaviours are poorly understood. We conducted a large individual-participant meta-analysis to examine the extent to which work-related stress, operationalised as job strain, is associated with tobacco smoking in working adults. Methodology and Principal Findings: We analysed cross-sectional data from 15 European studies comprising 166 130 participants. Longitudinal data from six studies were used. Job strain and smoking were self-reported. Smoking was harmonised into three categories never, ex- and current. We modelled the cross-sectional associations using logistic regression and the results pooled in random effects meta-analyses. Mixed effects logistic regression was used to examine longitudinal associations. Of the 166 130 participants, 17% reported job strain, 42% were never smokers, 33% ex-smokers and 25% current smokers. In the analyses of the cross-sectional data, current smokers had higher odds of job strain than never-smokers (age, sex and socioeconomic position-adjusted odds ratio: 1.11, 95% confidence interval: 1.03, 1.18). Current smokers with job strain smoked, on average, three cigarettes per week more than current smokers without job strain. In the analyses of longitudinal data (1 to 9 years of follow-up), there was no clear evidence for longitudinal associations between job strain and taking up or quitting smoking. Conclusions: Our findings show that smokers are slightly more likely than non-smokers to report work-related stress. In addition, smokers who reported work stress smoked, on average, slightly more cigarettes than stress-free smokers.
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| 22. |
- Jarling, Aleksandra, et al.
(author)
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Relationships first : Formal and informal home care of older adults in Sweden
- 2022
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In: Health & Social Care in the Community. - : Hindawi Limited. - 0966-0410 .- 1365-2524.
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Journal article (peer-reviewed)abstract
- To a great extent, older people in Sweden, often with extensive care needs, are cared for in their own home. Support is often needed from both family and professional caregivers. This study aimed to describe and analyse different aspects of health, functioning and social networks, and how they relate to formal and informal care in the home among older adults. Analyses were performed utilising data from the OCTO-2 study, with a sample of 317 people living in Jonkoping County, aged 75, 80, 85 or 90 years, living in their own homes. Data were collected with in-person-testing. Based on receipt of care, the participants were divided into three groups: no care, informal care only, and formal care with or without informal care. Descriptive statistics and multinomial regression analysis were performed to explore the associations between received care and different aspects of health (such as multimorbidity, polypharmacy), social networks (such as loneliness, number of confidants) and functioning (such as managing daily life). The findings demonstrate that the majority of the participants received no care at home (61%). Multimorbidity and polypharmacy were more common among those receiving some kind of care in comparison to those who received no care; moreover, those receiving some kind of care also had difficulties managing daily life and less satisfaction with their social networks. The multinomial logistic regression analyses demonstrated that age, functioning in daily life, perceived general health and satisfaction with the number of confidants were related to receipt of care, but the associations among these factors differed depending on the type of care that was received. The results show the importance of a holistic perspective that includes the older person's experiences when planning home care. The results also highlight the importance of considering social perspectives and relationships in home care rather than focusing only on health factors.
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| 23. |
- Johansson, Anette, et al.
(author)
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Factors associated to functioning and health in relation to home rehabilitation in Sweden : a non-randomized pre-post intervention study
- 2021
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In: BMC Geriatrics. - : BioMed Central. - 1471-2318. ; 21:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: Home rehabilitation is a growing rehabilitation service in many countries, but scientific knowledge of its components and outcomes is still limited. The aim of this study was to investigate; 1) which changes in functioning and self-rated health could be identified in relation to a home rehabilitation program in a population of community-dwelling citizens, and 2) how socio-demographic factors, health conditions and home rehabilitation interventions were associated to change in functioning and self-rated health after the home rehabilitation program.METHOD: The sample consisted of participants in a municipal home rehabilitation project in Sweden and consisted of 165 community-dwelling citizens. General Linear Models (ANOVA repeated measures) was used for identifying changes in rehabilitation outcomes. Logistic regressions analysis was used to investigate associations between rehabilitation outcomes and potential factors associated to outcome.RESULT: Overall improvements in functioning and self-rated health were found after the home rehabilitation program. Higher frequencies of training sessions with occupational therapists, length of home rehabilitation, and orthopaedic conditions of upper extremities and spine as the main health condition, were associated with rehabilitation outcomes.CONCLUSION: The result indicates that the duration of home rehabilitation interventions and intensity of occupational therapy, as well as the main medical condition may have an impact on the outcomes of home rehabilitation and needs to be considered when planning such programs. However, more research is needed to guide practice and policymaking.
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| 24. |
- Johansson, Lisbeth, et al.
(author)
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Agreement between questions about physical activity and sitting time, and device-based measures, used in Swedish targeted health dialogues in the context of primary health care
- 2023
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In: BMC Sports Science, Medicine and Rehabilitation. - : BioMed Central (BMC). - 2052-1847. ; 15:1
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Journal article (peer-reviewed)abstract
- Background: It is important that easy-to-use measures like subjective questions about physical activity (PA) and sedentary behaviour are valid and reliable providing accurate measures, when they are used in health promotion work aiming to support people to improve their lifestyle habits such as PA. The aim of this study was to evaluate the concurrent validity of a structured interview form estimating self-reported PA and a question about sitting time used in Swedish targeted health dialogues in the context of primary health care. Method: The study was conducted in the southern part of Sweden. To evaluate concurrent validity of the interview form, time spent in moderate-to-vigorous physical activities (MVPA) and energy expenditure related to MVPA estimated by an interview form was compared with the same measures assessed by an ActiGraph GT3X-BT accelerometer. To evaluate a question about sitting time, the Swedish School of Sport and Health Sciences’ single-item question about sitting time (SED-GIH) was compared with measures from an activPAL inclinometer. Statistical analyses included deriving Bland‒Altman plots and calculating Spearman’s rank correlation coefficients. Result: Bland‒Altman plots indicated lower absolute variation in the difference between self-reported and device-based PA measures for lower PA levels, both for energy expenditure and time spent in MVPA. No systematic over- or underestimation was observed. The Spearman’s correlation coefficient between self-reported and device-based PA measures was 0.27 (p = 0.014) for time spent in MVPA and 0.26 (p = 0.022) for energy expenditure. The correlation coefficient between the single item question and device-based sitting time measures was 0.31 (p = 0.002). Sitting time was underestimated by 74% of the participants. Conclusion: The PA interview form and the SED-GIH question on sitting time may be of value in targeted health dialogues in primary health care with the intention to support sedentary and insufficiently physically active persons in increasing their physical activity and limiting their sitting time. The questionnaires are easy to use and are more cost effective than device-based measures, especially regarding population-based interventions conducted in primary health care for thousands of participants such as targeted health dialogues. Clinical trial registration: Not applicable.
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| 25. |
- Johansson, Lisbeth, et al.
(author)
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Can physical activity compensate for low socioeconomic status with regard to poor self-rated health and low quality-of-life?
- 2019
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In: Health and Quality of Life Outcomes. - : BioMed Central. - 1477-7525. ; 17:1, s. 1-10
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Journal article (peer-reviewed)abstract
- BACKGROUND: Both high socioeconomic status (SES) and high physical activity (PA) are associated with better self-rated health (SRH) and higher quality-of-life (QoL).AIM: To investigate whether high levels of PA may compensate for the association between low SES and subjective health outcomes in terms of poorer SRH and lower QoL.METHOD: Data from a cross-sectional, population-based study (n = 5326) was utilized. Multiple logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for the associations between indicators of SES (economic situation and educational level), SRH and QoL, as well as between the combination of SES and PA in relation to SRH and QoL.RESULT: Participants with high PA and economic problems had approximately the same OR for good SRH as those with low PA and without economic problems (OR 1.75 [95% CI 1.20-2.54] and 1.81 [1.25-2.63] respectively). Participants with high PA and low education had higher odds for good SRH (OR 3.34 [2.96-5.34] compared to those with low PA and high education (OR 1.46 [0.89-2.39]).Those with high PA and economic problems had an OR of 2.09 [1.42-3.08], for high QoL, while the corresponding OR for those with low PA and without economic problems was 4.38 [2.89-6.63].CONCLUSION: Physically active people with low SES, had the same or even better odds to report good SRH compared to those with low PA and high SES. For QoL the result was not as consistent. The findings highlight the potential for promotion of PA to reduce SES-based inequalities in SRH.
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| 26. |
- Johansson, Lisbeth, et al.
(author)
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Exploring how people achieve the recommended levels of physical activity despite self-reported economic difficulties : a sense of coherence perspective
- 2024
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In: BMC Primary Care. - : BioMed Central (BMC). - 2731-4553. ; 25:1
-
Journal article (peer-reviewed)abstract
- BackgroundThe salutogenic theory forms the basis for health promotion and describes health as a continuum from a dis-ease pole of health to an ease pole. The core concept for the salutogenic theory is sense of coherence (SOC). For a strong SOC, general resistance resources, such as solid economic situation, are essential. The aim was to explore how people – despite self-reported economic difficulties – comprehend, manage and find it meaningful to achieve the level of physical activity recommended by World Health Organisation (WHO).MethodThe study is based on interviews with people achieving the recommended physical activity (PA) level despite economic difficulties. The interviews were conducted at primary health care centres and family centres after a targeted health dialogue. We used a qualitative deductive content analysis based on sense of coherence as the main category, with the three generic categories of comprehensibility, manageability and meaningfulness.ResultThe findings elucidate a pattern of a process. In this process, the participants comprehend their knowledge of the health benefits of PA and have a plan for performing their PA. They utilise their resources in order to manage to apply their knowledge and plan for PA in their lives despite their challenges. When PA becomes meaningful to them, they have an intrinsic motivation to perform it and experience its benefits.ConclusionThis study suggests a possible process that might help in achieving the recommended PA level among people with economic difficulties and other challenges. The findings might be used in health promotion work, such as targeted health dialogues in primary health care, to reduce health inequalities when supporting people who are not achieving the recommended levels of PA.Trial registrationNot applicable.
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| 27. |
- Johansson, Lisbeth, et al.
(author)
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Physical activity related to mastery and vitality in a Swedish adult population with economic difficulties
- 2021
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In: BMC Public Health. - : BioMed Central. - 1471-2458. ; 21:1
-
Journal article (peer-reviewed)abstract
- BACKGROUND: People with low socio-economic status report lower levels of physical activity (PA). There is insufficient knowledge about the availability of psychological resources for those who are physically active despite having a low socio-economic status. The aim of this study is to investigate the association between PA level and mastery and vitality, respectively, within an adult population with self-reported economic difficulties.METHOD: Data from a cross-sectional, population-based study (n = 817) were used. Linear regression was used to estimate the unstandardised regression coefficient (β) with 95% confidence intervals (95% CI), describing associations between PA levels (independent variable) and scale scores of psychological resources in terms of mastery and vitality (outcome variables). Three models were constructed: Model I unadjusted; Model II adjusted for sex and age; and Model III adjusted for sex, age, smoking and food quality.RESULT: After adjusting for sex, age, smoking and food quality and using low-level PA as the reference, high-level PA, but not intermediate-level PA, was related to higher scale scores of mastery (β = 0.72 [95% CI 0.08 to 1.37]). For vitality, both high-level PA and intermediate-level PA were related to higher scale scores (β = 9.30 [95% CI 5.20 to 13.40] and β = 6.70 [95% CI 1.40 to 12.00] respectively).CONCLUSION: In an adult population with self-reported economic difficulties, higher levels of physical activity were related to higher mastery and vitality. Our results support that the association between physical activity and psychological resources in terms of mastery and vitality should be considered in the context of targeted health dialogues.
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| 28. |
- Johansson, Lisbeth
(author)
-
To do or not to do? Physical activity in relation to socioeconomic status and health – a salutogenic perspective in the context of targeted health dialogues
- 2024
-
Doctoral thesis (other academic/artistic)abstract
- It is well known that physical activity (PA) has a major positive impact on health and that the performance of PA is lower in low socioeconomic groups. However, more knowledge about the relationship between PA and health is needed especially between and within socioeconomic groups.This thesis aimed, from a salutogenic perspective, to increase the understanding of the relationship between physical activity and health in the adult population, with a particular focus on people with economic difficulties. A further aim was to validate questions about physical activity and to explore the people’s experiences of PA from a sense of coherence perspective, all in the context of targeted health dialogues.The first study in this thesis is a validation study. It validates a PA interview form and questions about sedentary time used in the targeted health dialogues. Studies II and III comprise quantitative analyses of PA, health and psychological factors in the population, especially in groups with low socioeconomic status (SES). Study IV is a qualitative deductive study based on interviews with participants with low SES in the targeted health dialogues. The deductive analysis contains the participants’ experiences of PA from a sense of coherence perspective.The findings in study I showed that the interview form and the single-item question about sedentary time could be considered as acceptable to use in Swedish targeted health dialogues. In study II, physically active people with low SES were shown to have the same odds of reporting good self-rated health compared to those with low PA and high SES. The findings in study III showed that within the group of people with self-reported economic difficulties, higher levels of PA were related to better mastery and more vitality. Study IV showed that it is essential for the participants to have an awareness of the health benefits of PA and their challenges in performing PA. The participants also constructed a plan to follow while utilising their resources, and their intrinsic motivation to achieve the PA recommendations and the PA benefits.This thesis brings a deeper knowledge and understanding of the healthperspective of PA. This knowledge can be used to further develop thetargeted health dialogues in a salutogenic way. It will give people,especially those with lower SES, the opportunity to use their resourcesto increase PA and thereby improve their future health.
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| 29. |
- Johnsen, Anna, et al.
(author)
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Work-, lifestyle-, and health-related factors among women and men working in the emergency medical services
- 2024
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In: International Journal of Occupational Safety and Ergonomics. - : Taylor & Francis. - 1080-3548 .- 2376-9130. ; 30:2, s. 651-661
-
Journal article (peer-reviewed)abstract
- Objectives. This study aimed to describe work-, lifestyle-, and health-related factors among ambulance personnel, and to analyse differences between women and men.Methods. The cross-sectional study (N = 106) included self-reported and objective measures of work, lifestyle, and health in 10 Swedish ambulance stations. The data collection comprised clinical health examination, blood samples, tests of physical capacity, and questionnaires.Results. A high proportion of the ambulance personnel reported heavy lifting, risk of accidents, threats and violence at work. A low level of smoking and alcohol use, and a high level of leisure-time physical activity were reported. The ambulance personnel had, on average, good self-rated health, high work ability and high physical capacity. However, the results also showed high proportions with risk factors for cardiovascular disease (CVD), e.g., high blood pressure, and high levels of blood lipids. More women than men reported high work demands. Furthermore, women performed better in tests of physical capacity and had a lower level of CVD risk factors.Conclusions. Exposure to work-related factors that might affect health was common among ambulance personnel. Lifestyle- and health-related factors were somewhat contradictory, with a low proportion reporting lifestyle-related risk factors, but a high proportion having risk factors for CVD.
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| 30. |
- Johnsen, Anna, et al.
(author)
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Work-related factors and hair cortisol concentrations among men and women in emergency medical services in Sweden
- 2023
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In: Scientific Reports. - : Springer. - 2045-2322. ; 13:1
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Journal article (peer-reviewed)abstract
- Ambulance personnel in emergency medical services are exposed to physical demands and stress during work, and an increased prevalence of ill health has been observed in this group. The aim was to compare hair cortisol concentration (HCC) among Swedish ambulance personnel with HCC in a population-based reference sample, to analyse differences between women and men, and differences due to work-related factors. Samples of hair 1 cm closest to the skin (5-10 mg) were collected and analysed for cortisol by radioimmunoassay. Moreover, the participants responded to a questionnaire regarding their work environment. The HCC among the ambulance personnel did not differ from the HCC in the population-based reference sample (median 19.2 vs. 22.2 pg/mg, p = 0.319), nor were there statistically significant differences between women and men. Furthermore, no associations were found between HCC and physical and psychosocial work demands, work stress, or rest and recovery from work. However, occupational balance was positively correlated with HCC (rp = 0.240; p = 0.044). The association remained statistically significant after adjustment for sex, age, hair bleaching, and corticosteroid treatment in a linear regression model. This study adds knowledge regarding HCC among ambulance personnel, and thus contributes to the overall picture of work environment and health for this group.
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| 31. |
- Jood, Katarina, et al.
(author)
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Faktorer i arbetslivet och återgång till arbete efter stroke eller risk för ny stroke : en kunskapsöversikt
- 2021
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Reports (peer-reviewed)abstract
- Syftet med kunskapsöversikten var att sammanfatta och värdera kunskapsläget vad gäller arbetsrelaterade faktorer som påverkar återgång i arbete efter stroke och om det finns faktorer i arbetslivet som kan påverka risken för att återinsjukna i stroke. En litteratursökning genomfördes i tre databaser och omfattade studier publicerade till och med januari 2019. För att en studie skulle tas med i kunskapssammanställningen krävdes att: – det var en originalartikel – studiepopulationen utgjordes av personer som drabbats av stroke – återgång i arbete eller återinsjuknande i stroke fanns med som utfallsmått – minst en arbetsrelaterad exponeringsfaktor hade studerats Totalt identifierades 2 864 publikationer i databaserna och efter genomgång kvarstod 33 publikationer som inkluderades i kunskapssammanställningen. Kvantitativa metoder hade använts i 27 studier och kvalitativa metoder hade använts i sex studier. De inkluderade studierna var utförda i 16 olika länder. Uppföljningstid och definition av återgång i arbete varierade betydligt mellan studierna. Ett fåtal, ofta breda, arbetsrelaterade faktorer hade undersökts i relation till återgång i arbete efter stroke. De två vanligaste jämförelserna var tjänstemän jämfört med arbetare och icke-manuellt jämfört med manuellt arbete. Andra jämförelser var anställningsform, offentlig/privat sektor, storlek på företag samt organisatoriska och psykosociala faktorer. Resultaten tyder på att personer med tjänstemannayrken respektive personer med icke-manuella arbeten återgår till arbete efter stroke i högre utsträckning än arbetare och personer med manuella arbeten men resultaten är inte entydiga. För de övriga arbetslivsfaktorerna är kunskapsunderlaget alltför osäkert för att kunna dra slutsatser om deras betydelse för återgång i arbete. I de kvalitativa studierna framkom det att stöd från arbetsgivare och kollegor, samt flexibilitet på arbetsplatsen rapporterades som viktiga främjande faktorer för återgång i arbete. Bristande stöd, arbetsrelaterad stress och bristande kunskap om stroke hos arbetsgivaren angavs som faktorer som kan hindra eller försvåra återgång till arbete efter stroke. Inga studier där arbetslivsfaktorer analyserades i relation till risk för återinsjuknande i stroke identifierades i litteratursökningen.
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| 32. |
- Kivimäki, Mika, et al.
(author)
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Long working hours as a risk factor for atrial fibrillation : a multi-cohort study
- 2017
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In: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 38:34, s. 2621-2628
-
Journal article (peer-reviewed)abstract
- Aims Studies suggest that people who work long hours are at increased risk of stroke, but the association of long working hours with atrial fibrillation, the most common cardiac arrhythmia and a risk factor for stroke, is unknown. We examined the risk of atrial fibrillation in individuals working long hours (>= 55 per week) and those working standard 35-40 h/week. Methods and results In this prospective multi-cohort study from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium, the study population was 85 494 working men and women (mean age 43.4 years) with no recorded atrial fibrillation. Working hours were assessed at study baseline (1991-2004). Mean follow-up for incident atrial fibrillation was 10 years and cases were defined using data on electrocardiograms, hospital records, drug reimbursement registers, and death certificates. We identified 1061 new cases of atrial fibrillation (10-year cumulative incidence 12.4 per 1000). After adjustment for age, sex and socioeconomic status, individuals working long hours had a 1.4-fold increased risk of atrial fibrillation compared with those working standard hours (hazard ratio = 1.42, 95% CI= 1.13-1.80, P= 0.003). There was no significant heterogeneity between the cohort-specific effect estimates (I-2= 0%, P = 0.66) and the finding remained after excluding participants with coronary heart disease or stroke at baseline or during the follow-up (N= 2006, hazard ratio= 1.36, 95% CI= 1.05-1.76, P = 0.0180). Adjustment for potential confounding factors, such as obesity, risky alcohol use and high blood pressure, had little impact on this association. Conclusion Individuals who worked long hours were more likely to develop atrial fibrillation than those working standard hours.
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| 33. |
- Kivimäki, Mika, et al.
(author)
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Overweight, obesity, and risk of cardiometabolic multimorbidity : pooled analysis of individual-level data for 120 813 adults from 16 cohort studies from the USA and Europe
- 2017
-
In: The Lancet Public Health. - : The Lancet Publishing Group. - 2468-2667. ; 2:6, s. e277-e285
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Although overweight and obesity have been studied in relation to individual cardiometabolic diseases, their association with risk of cardiometabolic multimorbidity is poorly understood. Here we aimed to establish the risk of incident cardiometabolic multimorbidity (ie, at least two from: type 2 diabetes, coronary heart disease, and stroke) in adults who are overweight and obese compared with those who are a healthy weight.METHODS: ) to achieve sufficient case numbers for analysis. The main outcome was cardiometabolic multimorbidity (ie, developing at least two from: type 2 diabetes, coronary heart disease, and stroke). Incident cardiometabolic multimorbidity was ascertained via resurvey or linkage to electronic medical records (including hospital admissions and death). We analysed data from each cohort separately using logistic regression and then pooled cohort-specific estimates using random-effects meta-analysis.FINDINGS: Participants were 120 813 adults (mean age 51·4 years, range 35-103; 71 445 women) who did not have diabetes, coronary heart disease, or stroke at study baseline (1973-2012). During a mean follow-up of 10·7 years (1995-2014), we identified 1627 cases of multimorbidity. After adjustment for sociodemographic and lifestyle factors, compared with individuals with a healthy weight, the risk of developing cardiometabolic multimorbidity in overweight individuals was twice as high (odds ratio [OR] 2·0, 95% CI 1·7-2·4; p<0·0001), almost five times higher for individuals with class I obesity (4·5, 3·5-5·8; p<0·0001), and almost 15 times higher for individuals with classes II and III obesity combined (14·5, 10·1-21·0; p<0·0001). This association was noted in men and women, young and old, and white and non-white participants, and was not dependent on the method of exposure assessment or outcome ascertainment. In analyses of different combinations of cardiometabolic conditions, odds ratios associated with classes II and III obesity were 2·2 (95% CI 1·9-2·6) for vascular disease only (coronary heart disease or stroke), 12·0 (8·1-17·9) for vascular disease followed by diabetes, 18·6 (16·6-20·9) for diabetes only, and 29·8 (21·7-40·8) for diabetes followed by vascular disease.INTERPRETATION: The risk of cardiometabolic multimorbidity increases as BMI increases; from double in overweight people to more than ten times in severely obese people compared with individuals with a healthy BMI. Our findings highlight the need for clinicians to actively screen for diabetes in overweight and obese patients with vascular disease, and pay increased attention to prevention of vascular disease in obese individuals with diabetes.FUNDING: NordForsk, Medical Research Council, Cancer Research UK, Finnish Work Environment Fund, and Academy of Finland.
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| 34. |
- Kivimäki, Mika, et al.
(author)
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Work stress and risk of death in men and women with and without cardiometabolic disease : a multicohort study
- 2018
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In: The Lancet Diabetes and Endocrinology. - : Elsevier. - 2213-8587 .- 2213-8595. ; 6:9, s. 705-713
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Although some cardiovascular disease prevention guidelines suggest a need to manage work stress in patients with established cardiometabolic disease, the evidence base for this recommendation is weak. We sought to clarify the status of stress as a risk factor in cardiometabolic disease by investigating the associations between work stress and mortality in men and women with and without pre-existing cardiometabolic disease.METHODS: In this multicohort study, we used data from seven cohort studies in the IPD-Work consortium, initiated between 1985 and 2002 in Finland, France, Sweden, and the UK, to examine the association between work stress and mortality. Work stress was denoted as job strain or effort-reward imbalance at work. We extracted individual-level data on prevalent cardiometabolic diseases (coronary heart disease, stroke, or diabetes [without differentiation by diabetes type]) at baseline. Work stressors, socioeconomic status, and conventional and lifestyle risk factors (systolic and diastolic blood pressure, total cholesterol, smoking status, BMI, physical activity, and alcohol consumption) were also assessed at baseline. Mortality data, including date and cause of death, were obtained from national death registries. We used Cox proportional hazards regression to study the associations of work stressors with mortality in men and women with and without cardiometabolic disease.RESULTS: We identified 102 633 individuals with 1 423 753 person-years at risk (mean follow-up 13·9 years [SD 3·9]), of whom 3441 had prevalent cardiometabolic disease at baseline and 3841 died during follow-up. In men with cardiometabolic disease, age-standardised mortality rates were substantially higher in people with job strain (149·8 per 10 000 person-years) than in those without (97·7 per 10 000 person-years; mortality difference 52·1 per 10 000 person-years; multivariable-adjusted hazard ratio [HR] 1·68, 95% CI 1·19-2·35). This mortality difference for job strain was almost as great as that for current smoking versus former smoking (78·1 per 10 000 person-years) and greater than those due to hypertension, high total cholesterol concentration, obesity, physical inactivity, and high alcohol consumption relative to the corresponding lower risk groups (mortality difference 5·9-44·0 per 10 000 person-years). Excess mortality associated with job strain was also noted in men with cardiometabolic disease who had achieved treatment targets, including groups with a healthy lifestyle (HR 2·01, 95% CI 1·18-3·43) and those with normal blood pressure and no dyslipidaemia (6·17, 1·74-21·9). In all women and in men without cardiometabolic disease, relative risk estimates for the work stress-mortality association were not significant, apart from effort-reward imbalance in men without cardiometabolic disease (mortality difference 6·6 per 10 000 person-years; multivariable-adjusted HR 1·22, 1·06-1·41).INTERPRETATION: In men with cardiometabolic disease, the contribution of job strain to risk of death was clinically significant and independent of conventional risk factors and their treatment, and measured lifestyle factors. Standard care targeting conventional risk factors is therefore unlikely to mitigate the mortality risk associated with job strain in this population.FUNDING: NordForsk, UK Medical Research Council, and Academy of Finland.
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| 35. |
- Larsen, Louise B., et al.
(author)
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Psychosocial job demand and control : multi-site musculoskeletal pain in Swedish police
- 2019
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In: Scandinavian Journal of Public Health. - : Sage Publications. - 1403-4948 .- 1651-1905. ; 47:3, s. 318-325
-
Journal article (peer-reviewed)abstract
- AimsPolice have a high prevalence of musculoskeletal disorders. While physical factors contributing to this have been explored, little is known regarding the contribution of the psychosocial work environment. This study explores the association between elements of the JDC model, social support and multi-site musculoskeletal pain among Swedish police.MethodsIn this cross-sectional study, response from 4185 police were collected using a self-administered online survey. The survey included questions on psychosocial work environment and musculoskeletal pain, as well as several potential confounding factors. Binominal regression analyses were performed to explore the degree of association between 1) the indices for job demands, job control, social support and multi-site musculoskeletal pain and 2) the four categories of the JDC model, social support and multi-site musculoskeletal pain.Results The overall psychosocial work environment of Swedish police was characterised by low control and high social support. Police who reported active and high strain jobs were found to have an increase in the odds ratio for multi-site musculoskeletal pain (OR 1.45 (95% CI 1.08-1.94), and 1.84 (1.51-2.24) respectively). High demands, which is a component in the categories for active and high strain jobs, was also found to be associated with an increase in the odds ratio for multi-site musculoskeletal pain (OR 1.66 (1.45-1.91)). High social support was associated with a decrease in the odds ratio formulti-site musculoskeletal pain (OR 0.72 (0.57-0.86)).Conclusions Psychosocial work environment should be considered when investigating factors related to the health and wellbeing of police.
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| 36. |
- Lindmark, Ulrika, 1965-, et al.
(author)
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The use of the concept of transition in different disciplines within health and social welfare: An integrative literature review
- 2019
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In: Nursing Open. - : John Wiley & Sons. - 2054-1058. ; 6:3, s. 664-675
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Journal article (peer-reviewed)abstract
- Aims: To continuing the quest of the concept of transition in nursing research and toexplore how the concept of transition is used in occupational therapy, oral health andsocial work as well as in interdisciplinary studies in health and welfare, between2003–2013.Design: An integrative literature review.Methods: PubMed, CINAHL, PsycINFO, DOSS, SocIndex, Social Science Citation Indexand AMED databases from 2003–2013 were used. Identification of 350 articles includingthe concept of transition in relation to disciplines included. Assessment of articlesare in accordance to Meleis’ typologies of transition by experts in each discipline.Chosen key factors were entered into Statistical Package for the Social Sciences (SPSS).Results: Meleis’ four typologies were found in all studied disciplines, except developmentin oral health. The health‐illness type was the most commonly explored,whereas in social work and in occupation therapy, situational transitions dominated.
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| 37. |
- Stadin, Magdalena, 1987-, et al.
(author)
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Healthcare managers’ experiences of technostress and the actions they take to handle it : a critical incident analysis
- 2020
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In: BMC Medical Informatics and Decision Making. - : BioMed Central. - 1472-6947. ; 20
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Journal article (peer-reviewed)abstract
- BackgroundHealthcare managers, in comparison with other healthcare professionals, have an increased likelihood of experiencing technostress at work. Since knowledge about the causes and severity of technostress and about the strategies healthcare managers use to handle it is limited, the aim of this study was to describe their experience of technostress and the actions they employ to address it.MethodsAn explorative design based on the critical incident technique was used. In total, 20 healthcare managers (10 women, 10 men) from four hospitals in two county councils in Sweden were purposively selected according to professional background, hierarchical management position, control span, time in the management position, and sex. Semi-structured interviews with regard to critical incidents and actions taken to handle technostress were conducted.ResultsHealthcare managers’ experiences of technostress (n = 279) were categorised related to three main areas. These involved ‘negative aspects of digital communication’ (e.g. high workload, invasion of private life, and negative feelings related to digital communication), ‘poor user experience of ICT systems (such as illogicality of the ICT system, time-consuming ICT system, or malfunctioning ICT system) and ‘needs to improve organisational resources’ (e.g. needs associated with digital literacy, user influence and distribution of work and ICT systems). Actions taken to handle technostress (n=196) were described relating to three main areas involving ‘culture, norms and social support’ (such as good email culture, and co-worker support), ‘individual resources’ (e.g. individual strategies and competence) and ‘organisational resources’ (such as IT-related assistance and support).ConclusionsHealthcare managers described negative aspects of digital communication, poor user experience of ICT systems, and lack of organisational resources as potential technostress creators. These problems were handled by taking action related to culture, norms and social support, and individual as well as organisational resources. All these features, along with consideration of healthcare managers’ job demands and resources in general, should be incorporated into actions monitored by healthcare organisations to improve or maintain a sustainable digitalised environment for healthcare managers.
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| 38. |
- Stadin, Magdalena, 1987-, et al.
(author)
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Repeated exposure to high ICT demands at work, and development of suboptimal self-rated health : findings from a 4-year follow-up of the SLOSH study
- 2019
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In: International Archives of Occupational and Environmental Health. - : Springer Science and Business Media LLC. - 0340-0131 .- 1432-1246. ; 92:5, s. 717-728
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Journal article (peer-reviewed)abstract
- The knowledge about the association between Information and Communication Technology (ICT) demands at work and self-rated health (SRH) is insufficient. The aim of this study was to examine the association between repeated exposure to high ICT demands at work, and risk of suboptimal SRH, and to determine modifications by sex or socioeconomic position (SEP). A prospective design was used, including repeated measurement of ICT demands at work, measured 2 years apart. SRH was measured at baseline and at follow-up after 4 years. The data were derived from the Swedish Longitudinal Occupational Survey of Health (SLOSH), including 4468 gainfully employees (1941 men, 2527 women) with good SRH at baseline. In the total study sample, repeated exposure to high ICT demands at work was associated with suboptimal SRH at follow-up (OR 1.34 [CI 1.06-1.70]), adjusted for age, sex, SEP, health behaviours, BMI, job strain and social support. An interaction between ICT demands and sex was observed (p = 0.010). The risk was only present in men (OR 1.53 [CI 1.09-2.16]), and not in women (OR 1.17 [CI 0.85-1.62]). The risk of suboptimal SRH after consistently high ICT demands at work was most elevated in participants with high SEP (OR 1.68 [CI 1.02-2.79]), adjusted for age, sex, health behaviours, BMI and job strain. However, no significant interaction between ICT demands and SEP regarding SRH was observed. Repeated exposure to high ICT demands at work was associated with suboptimal SRH at follow-up, and the association was modified by sex.
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| 39. |
- Stadin, Magdalena, 1987-, et al.
(author)
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Technostress operationalised as information and communication technology (ICT) demands among managers and other occupational groups : Results from the Swedish Longitudinal Occupational Survey of Health (SLOSH)
- 2021
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In: Computers in human behavior. - : Elsevier BV. - 0747-5632 .- 1873-7692. ; 114
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Journal article (peer-reviewed)abstract
- Exposure to technostress operationalised as ICT demands is more prevalent in higher socioeconomic groups, but little is known about the exposure in different occupational groups considering industry and position. The aim of the present study was to explore the exposure to ICT demands in managers and other occupational groups. Cross-sectional self-reported data from the Swedish Longitudinal Occupational Survey of Health (SLOSH), collected in 2016 was used, including 13 572 respondents (1 241 'managers', 12 331 'non-managers'). ICT demands based on a six-item Likert scale were analysed as the main measure. 'Managers' (varying industries and positions) in comparison with 'non-managers', including nine occupational groups separated by industry and education level, showed the highest prevalence (74.7%) of ICT demands. 'Managers in health care, other community services and education' showed the highest odds ratio (OR) with 95% Confidence Intervals (CI) of ICT demands, in comparison with 'non-managers' (OR 4.64 [CI 3.26-6.61], and with 'all other managers' (OR 1.55 [CI 1.01-2.38]), after adjustment for sex, age, job strain, and social support. In conclusion, managers have increased odds of exposure to ICT demands, especially managers in health care, other community services and education. Targeted actions to improve the digitalised work environment among managers are warranted.
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| 40. |
- Stadin, Magdalena, 1987-
(author)
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The digitalised work environment : Health, experiences and actions
- 2020
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Doctoral thesis (other academic/artistic)abstract
- Background: The aim of this thesis was to examine the association between technostress, operationalised as information and communication technology (ICT) demands, and indicators of work-related stress, as well as its association with self-rated health. Additional aims were to identify occupational groups at risk with regard to ICT demands, and to describe experiences of technostress and how it was handled by healthcare managers.Methods: The thesis includes four individual papers. Papers I–III have a quantitative (cross-sectional or prospective) study design and are based on data derived from the Swedish Longitudinal Occupational Survey of Health (SLOSH) and collected between 2006 and 2016. Data was analysed by statistical methods, such as linear and logistic regression analysis. Paper IV has a qualitative study design and is based on data from 20 semi-structured interviews with healthcare managers. The data was analysed using the critical incident technique.Results: ICT demands were correlated with job strain and effort-reward imbalance, especially the demands and effort dimensions of these measures. High ICT demands were associated with suboptimal self-rated health in cross-sectional analyses and in prospective analyses including repeated measurement. Managers, and particularly ‘managers in healthcare and other community services’, followed by ‘managers in education’, had the highest odds ratio of ICT demands, in comparison with both ‘non-managers’ and ‘all other managers’. Healthcare managers’ experiences of technostress could be categorised into the main areas ‘negative aspects of digital communication’, ‘poor user experience of ICTs’ and ‘needs to improve organisational resources’. The actions they took to cope with technostress were categorised into the main areas ‘culture, norms and social support’, ‘individual resources’ and ‘organisational resources’.Conclusions: Technostress operationalised as ICT demands is associated with suboptimal self-rated health. Occupational groups differ in their exposure to ICT demands by industry and position. Organisational efforts to ensure a sustainable and healthy digital work environment are warranted. ICT demands should be assessed against ICT resources for a comprehensive understanding of their association with health.
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| 41. |
- Stadin, Magdalena, 1987-, et al.
(author)
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The ICT demands index included in the Swedish Longitudinal Occupational Survey of Health (SLOSH)
- 2021
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In: Das Gesundheitswesen. - : Georg Thieme Verlag KG. - 1439-4421 .- 0941-3790. ; 83:8/9, s. 674-675
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Journal article (peer-reviewed)abstract
- Purpose: Technostress operationalised as ICT demands is measured by the ICT demands index in the Swedish Longitudinal Occupational Survey of Health (SLOSH). This index is mainly based on findings in a qualitative Swedish study, published in 2003.Methods: The index consists of six items, accompanied by five response options rated on a Likert scale. The index is introduced by: ‘New technology and flexible working conditions have changed the working life of many people. Technology can be a great help but can also lead to new kinds of stress. Estimate the extent to which you are stressed by…’. Then follows the items, such as ‘…too many calls and emails’, ‘…demands to give immediate answers to emails and telephone calls that require a lot of work’ and ‘…computers and other digital device that fails to work properly’.Results: ICT demands have been observed to be correlated with the demands- and effort dimension in the demand control- and the effort-reward imbalance models, respectively. ICT demands have also been associated with cognitive complaints and suboptimal self-rated health, in cross-sectional- and prospective analyses. However, the ICT demands index in SLOSH have also some limitations. The index does not have a resource dimesion (such as ‘technostress inhibitors’ or ‘ICT resources’) and can thus not be considered a complete measure of technostress. Additionally, the ICT demands index only reflect a smaller part of technostress and does not reflect aspects such as insecurity and uncertainty related to ICT, lack of digital literacy, and ineffective communication. The items might also be somewhat outdated since new ICT demands might have occurred since 2003, such as ICT demands related to new types of digital communication and use of RPA and AI.Conclusions: It is warranted to use updated measures of technostress that reflects both ICT demands and resources
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| 42. |
- Theorell, Töres, et al.
(author)
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Obesity and loss of disease-free years owing to major non-communicable diseases : a multicohort study
- 2018
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In: The Lancet Public Health. - : Elsevier Ltd. - 2468-2667. ; 3:10, s. e490-e497
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Journal article (peer-reviewed)abstract
- Background: Obesity increases the risk of several chronic diseases, but the extent to which the obesity-related loss of disease-free years varies by lifestyle category and across socioeconomic groups is unclear. We estimated the number of years free from major non-communicable diseases in adults who are overweight and obese, compared with those who are normal weight. Methods: We pooled individual-level data on body-mass index (BMI) and non-communicable diseases from men and women with no initial evidence of these diseases in European cohort studies from the Individual-Participant-Data Meta-Analysis in Working Populations consortium. BMI was assessed at baseline (1991–2008) and non-communicable diseases (incident type 2 diabetes, coronary heart disease, stroke, cancer, asthma, and chronic obstructive pulmonary disease) were ascertained via linkage to records from national health registries, repeated medical examinations, or self-report. Disease-free years from age 40 years to 75 years associated with underweight (BMI <18·5 kg/m2), overweight (≥25 kg/m2 to <30 kg/m2), and obesity (class I [mild] ≥30 kg/m2 to <35 kg/m2; class II–III [severe] ≥35 kg/m2) compared with normal weight (≥18·5 kg/m2 to <25 kg/m2) were estimated. Findings: Of 137 503 participants from ten studies, we excluded 6973 owing to missing data and 10 349 with prevalent disease at baseline, resulting in an analytic sample of 120 181 participants. Of 47 127 men, 211 (0·4%) were underweight, 21 468 (45·6%) normal weight, 20 738 (44·0%) overweight, 3982 (8·4%) class I obese, and 728 (1·5%) class II–III obese. The corresponding numbers among the 73 054 women were 1493 (2·0%), 44 760 (61·3%), 19 553 (26·8%), 5670 (7·8%), and 1578 (2·2%), respectively. During 1 328 873 person-years at risk (mean follow-up 11·5 years [range 6·3–18·6]), 8159 men and 8100 women developed at least one non-communicable disease. Between 40 years and 75 years, the estimated number of disease-free years was 29·3 (95% CI 28·8–29·8) in normal-weight men and 29·4 (28·7–30·0) in normal-weight women. Compared with normal weight, the loss of disease-free years in men was 1·8 (95% CI −1·3 to 4·9) for underweight, 1·1 (0·7 to 1·5) for overweight, 3·9 (2·9 to 4·9) for class I obese, and 8·5 (7·1 to 9·8) for class II–III obese. The corresponding estimates for women were 0·0 (−1·4 to 1·4) for underweight, 1·1 (0·6 to 1·5) for overweight, 2·7 (1·5 to 3·9) for class I obese, and 7·3 (6·1 to 8·6) for class II–III obese. The loss of disease-free years associated with class II–III obesity varied between 7·1 and 10·0 years in subgroups of participants of different socioeconomic level, physical activity level, and smoking habit. Interpretation: Mild obesity was associated with the loss of one in ten, and severe obesity the loss of one in four potential disease-free years during middle and later adulthood. This increasing loss of disease-free years as obesity becomes more severe occurred in both sexes, among smokers and non-smokers, the physically active and inactive, and across the socioeconomic hierarchy. Funding: NordForsk, UK Medical Research Council, US National Institute on Aging, Academy of Finland, Helsinki Institute of Life Science, and Cancer Research UK.
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| 43. |
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