| 1. |
- Bennet, Anna M, et al.
(författare)
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The risk of myocardial infarction is enhanced by a synergistic interaction between serum insulin and smoking.
- 2002
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Ingår i: European Journal of Endocrinology. - : Oxford University Press (OUP). - 0804-4643 .- 1479-683X. ; 147:5, s. 641-7
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To evaluate the relationship between levels of serum insulin, the homeostasis model assessment (HOMA) and IGF-binding protein-1 (IGFBP-1) as factors related to myocardial infarction (MI) risk, and their interaction with lifestyle-related risk factors. DESIGN: The Stockholm epidemiology programme (SHEEP), a case-control study, consisting of 749 first-time MI cases (510 men, 239 women) and 1101 healthy controls (705 men, 396 women) was used. METHODS: The risk of developing MI was assessed by calculating odds ratios (OR) and synergistic interactions (SI) between serum insulin, IGFBP-1, HOMA and other variables related to MI risk (including smoking) in men and women. RESULTS: Subjects with elevated levels of insulin and HOMA (>75th percentile) had increased MI risks when compared with individuals with low levels. ORs for elevated insulin and HOMA (adjusted for age and residential area) for men: insulin 1.6 (95% confidence interval (CI) 1.3-2.1) and HOMA 1.5 (95% CI 1.1-1.9) and for women: insulin 2.1 (95% CI 1.5-2.9) and HOMA 1.9 (95% CI 1.3-2.8). Women with low levels of IGFBP-1 (<10th percentile) showed a tendency towards elevated MI risk even if this was not statistically significant (OR 1.5 (95% CI 0.9-2.6)). Smokers with high levels of serum insulin had greatly increased MI risk (OR for men: 4.7 (95% CI 3.0-7.2) and OR for women: 8.1 (95% CI 4.5-14.8)). SI scores based upon these interactions were statistically significant. CONCLUSIONS: These results might have preventive cardiovascular implications as they clearly suggest that subjects with insulin resistance are particularly susceptible to the hazards of smoking.
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| 2. |
- Bigert, Carolina, et al.
(författare)
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Myocardial infarction among professional drivers.
- 2003
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Ingår i: Epidemiology. - 1044-3983 .- 1531-5487. ; 14:3, s. 333-9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Professional drivers are at an increased risk of myocardial infarction but the underlying causes for this increased risk are uncertain. METHODS: We identified all first events of myocardial infarction among men age 45-70 years in Stockholm County for 1992 and 1993. We selected controls randomly from the population. Response rates of 72% and 71% resulted in 1067 cases and 1482 controls, respectively. We obtained exposure information from questionnaires. We calculated odds ratios (ORs), with and without adjustment for socioeconomic status, tobacco smoking, alcohol drinking, physical inactivity at leisure time, overweight status, diabetes and hypertension. RESULTS: The crude OR among bus drivers was 2.14 (95% confidence interval = 1.34-3.41), among taxi drivers 1.88 (1.19-2.98) and among truck drivers 1.66 (1.22-2.26). Adjustment for potential confounders gave lower ORs: 1.49 (0.90-2.45), 1.34 (0.82-2.19) and 1.10 (0.79-1.53), respectively. Additional adjustment for job strain lowered the ORs only slightly. An exposure-response pattern (by duration of work) was found for bus and taxi drivers. CONCLUSIONS: The high risk among bus and taxi drivers was partly explained by unfavorable life-style factors and social factors. The work environment may contribute to their increased risk. Among truck drivers, individual risk factors seemed to explain most of the elevated risk.
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| 3. |
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| 4. |
- Burström, Lage, et al.
(författare)
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Daily text messages used as a method for assessing low back pain among workers
- 2016
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Ingår i: Journal of Clinical Epidemiology. - : Elsevier BV. - 0895-4356 .- 1878-5921. ; :70, s. 45-51
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To evaluate a method for collecting data concerning low back pain (LBP) using daily text messages and to characterize the reported LBP in terms of intensity, variability, and episodes.STUDY DESIGN AND SETTING: We conducted a cohort study of LBP among workers used by a mining company. The participants were asked to answer the question "How much pain have you had in your lower back in the last 24 hours on a scale from 0 to 10, where 0 = no pain and 10 = the worst pain imaginable" once a day for 5 weeks, with this process being repeated 6 months later.RESULTS: A total of 121 workers participated in the first period of data collection, and 108 participated in the second period. The daily response rate was 93% for both periods, and cluster analysis was shown to be a feasible statistical method for clustering LBP into subgroups of low, medium, and high pain. The daily text messages method also worked well for assessing the episodic nature of LBP.CONCLUSION: We have demonstrated a method for repeatedly measuring of LBP using daily text messages. The data permitted clustering into subgroups and could be used to define episodes of LBP.
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| 5. |
- de Flon, Pierre, et al.
(författare)
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Empirical evidence of underutilization of referrals for epilepsy surgery evaluation
- 2010
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Ingår i: European Journal of Neurology. - : Wiley. - 1351-5101 .- 1468-1331. ; 17:4, s. 619-625
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Tidskriftsartikel (refereegranskat)abstract
- Background: Epilepsy surgery is a treatment that can cure patients with intractable epilepsy. This study investigates whether referrals for epilepsy surgery evaluation are underutilized. Methods: Patients with epilepsy aged 18–60 years were identified in a computerized registry held by public health care providers in a Swedish county using ICD codes. Clinical data and data on referral status for epilepsy surgery were obtained from the patients' medical records. Potential candidates for epilepsy surgery evaluation were identified using pre-specified criteria. Obstacles for referral were analysed by comparing clinical data in patients who were considered for referral and those who were not. Appropriateness of non-referral was evaluated against recommendations from the Swedish Council on Technology in Health Care (SBU). Results: Of 378 patients with epilepsy in the registry, 251 agreed to participate. Of 251, 40 were already referred patients and 48 patients were identified as potential candidates for epilepsy surgery evaluation by study criteria. Referral had been considered but not performed in 15 of the potential candidates. Potential candidates not considered for referral were less likely to have seen a neurologist, to have had an EEG, CT and MRI, and more likely to have cognitive disturbances. Following the recommendations by the SBU, 28 of 48 potential candidates were identified as inappropriately not referred patients. Conclusion: The number of missed referrals for epilepsy surgery evaluation was estimated to be 60 per 100 000 inhabitants. Several important obstacles were found for not referring patients for epilepsy surgery evaluation.
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| 9. |
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| 10. |
- Hermansson, Jonas, et al.
(författare)
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Case fatality of myocardial infarction among shift workers
- 2015
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Ingår i: International Archives of Occupational and Environmental Health. - Berlin Heidelberg : Springer Berlin/Heidelberg. - 0340-0131 .- 1432-1246. ; 88:5, s. 599-605
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Shift work has been associated with an excess risk of cardiovascular disease (CVD) and more specifically myocardial infarction (MI). The majority of the studies that found a positive association between shift work and CVD have been based on incidence data. The results from studies on cardiovascular-related mortality among shift workers have shown little or no elevated mortality associated with shift work. None of the previous studies have analysed short-term mortality (case fatality) after MI. Therefore, we investigated whether shift work is associated with increased case fatality after MI compared with day workers.METHODS: Data on incident cases with first MI were obtained from case-control study conducted in two geographical sites in Sweden (Stockholm Heart Epidemiology Program and Västernorrland Heart Epidemiology Program), including 1,542 cases (1,147 men and 395 women) of MI with complete working time information and 65 years or younger. Case fatality was defined as death within 28 days of onset of MI. Risk estimates were calculated using logistic regression.RESULTS: The crude odds ratios for case fatality among male shift workers were 1.63 [95 % confidence interval (CI) 1.12, 2.38] and 0.56 (95 % CI 0.26, 1.18) for female shift workers compared with day workers. Adjustments for established cardiovascular risk factors such as diabetes type II and socio-economic status did not alter the results.CONCLUSION: Shift work was associated with increased risk of case fatality among male shift workers after the first MI.
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| 11. |
- Hermansson, Jonas, et al.
(författare)
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Interaction between Shift Work and Established Coronary Risk Factors
- 2019
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Ingår i: International Journal of Occupational and Environmental Medicine. - : IJOEM. - 2008-6520 .- 2008-6814. ; 10:2, s. 57-65
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Shift work is associated with increased risk of cardiovascular disease, but the causes have not yet been fully established. It has been proposed that the coronary risk factors are more hazardous for shift workers, resulting in a potential interaction effect with shift work.OBJECTIVE: To analyse interaction effects of work schedule and established risk factors for coronary artery disease on the risk of myocardial infarction.METHODS: This analysis was conducted in SHEEP/VHEEP, a case-control study conducted in two counties in Sweden, comprising all first-time cases of myocardial infarction among men and women 45-70 years of age with controls stratified by sex, age, and hospital catchment area, totalling to 4648 participants. Synergy index (SI) was used as the main outcome analysis method for interaction analysis.RESULTS: There was an interaction effect between shift work and physical inactivity on the risk of myocardial infarction with SI of 2.05 (95% CI 1.07 to 3.92) for male shift workers. For female shift workers, interaction effects were found with high waist-hip ratio (SI 4.0, 95% CI 1.12 to 14.28) and elevated triglycerides (SI 5.69, 95% CI 1.67 to 19.38).CONCLUSION: Shift work and some established coronary risk factors have significant interactions.
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| 12. |
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| 14. |
- Järvholm, Bengt, 1947-, et al.
(författare)
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Mortality attributable to occupational exposure in Sweden
- 2013
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Ingår i: Scandinavian Journal of Work, Environment and Health. - : Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 39:1, s. 106-111
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The objective of this study was to estimate the mortality from cancer, cardiovascular, and respiratory diseases attributable to occupational exposure in Sweden. METHODS: Estimates were calculated for men and women separately, and we considered only deaths between 25-74 years of age. We considered cancer exposures/sites classified as I or 2a according to the International Agency for Research on Cancer (IARC). Acute myocardial infarction was the only included cardiovascular disease. Respiratory diseases comprised chronic obstructive pulmonary disease (COPD) asthma, pneumoconiosis and alveolitis. All deaths of pneumoconiosis and alveolitis were considered work-related. Estimates were based on the Swedish mortality in 2007. RESULTS: In total, we estimate that there are about 800 work-related deaths per year in the studied causes. The majority are due to acute myocardial infarction, with 126 deaths among women and 337 deaths among men attributable to job strain, shift work, exhaust gases, combustion products, or environmental tobacco smoke (ETS). There are 99 respiratory disease-related deaths, the vast majority from COPD (N=92). In total, 270 cancer deaths are estimated to be work-related. For men, half of the cases are attributed to asbestos exposure. CONCLUSIONS: Our results indicate that preventive measures to decrease occupational mortality should consider factors associated with myocardial infarction such as job strain, shift work and exhaust gases from vehicles and combustion products. Exposures to factors associated with COPD, such as dust, also seem important to prevent.
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| 15. |
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| 16. |
- Ludvigsson, Jonas F, et al.
(författare)
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External review and validation of the Swedish national inpatient register.
- 2011
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Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 11, s. 450-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The Swedish National Inpatient Register (IPR), also called the Hospital Discharge Register, is a principal source of data for numerous research projects. The IPR is part of the National Patient Register. The Swedish IPR was launched in 1964 (psychiatric diagnoses from 1973) but complete coverage did not begin until 1987. Currently, more than 99% of all somatic (including surgery) and psychiatric hospital discharges are registered in the IPR. A previous validation of the IPR by the National Board of Health and Welfare showed that 85-95% of all diagnoses in the IPR are valid. The current paper describes the history, structure, coverage and quality of the Swedish IPR. METHODS AND RESULTS: In January 2010, we searched the medical databases, Medline and HighWire, using the search algorithm "validat* (inpatient or hospital discharge) Sweden". We also contacted 218 members of the Swedish Society of Epidemiology and an additional 201 medical researchers to identify papers that had validated the IPR. In total, 132 papers were reviewed. The positive predictive value (PPV) was found to differ between diagnoses in the IPR, but is generally 85-95%. CONCLUSIONS: In conclusion, the validity of the Swedish IPR is high for many but not all diagnoses. The long follow-up makes the register particularly suitable for large-scale population-based research, but for certain research areas the use of other health registers, such as the Swedish Cancer Register, may be more suitable.
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| 17. |
- Norlund, Sofia, et al.
(författare)
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Burnout, working conditions and gender : results from the northern Sweden MONICA Study
- 2010
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 10:326
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Sick-leave because of mental and behavioural disorders has increased considerably in Sweden since the late nineties, and especially in women. The aim of this study was to assess the level of burnout in the general working population in northern Sweden and analyse it's relation to working conditions and gender.METHODS: In this cross-sectional study the survey from the MONICA-study (Monitoring of Trends and Determinants in Cardiovascular Disease) in northern Sweden 2004 was used. A burnout instrument, the Shirom Melamed Burnout Questionnaire (SMBQ), was incorporated in the original survey which was sent to a random sample of 2500 individuals with a response rate of 76%. After including only actively working people, aged 25-64 years, our study population consisted of 1000 participants (497 women and 503 men). ANOVA and multiple linear regression models were used.RESULTS: The prevalence of a high level of burnout (SMBQ >4.0) was 13%. Women had a higher level of burnout than men with the most pronounced difference in the age group 35-44 years. In both sexes the level of burnout decreased with age. Demand and control at work, and job insecurity were related to burnout. In women the level of education, socioeconomic position, work object, and working varying hours were of importance. Interaction effects were found between sex and work object, and sex and working hours. In a multiple regression analysis almost half of the gender difference could be explained by work related and life situational factors.CONCLUSIONS: Working life conditions contributed to the level of burnout in this actively working sample from the general population in northern Sweden. Especially in women, socioeconomic position was associated with burnout. The high level of burnout in women compared to men was partly explained by more unfavourable working conditions and life situational factors. Efforts to level out gender differences in burnout should probably focus on improving both working and socioeconomic conditions for women.
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| 18. |
- Norlund, Sofia, et al.
(författare)
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Work related factors and sick leave after rehabilitation in burnout patients : experiences from the REST-project
- 2011
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Ingår i: Journal of occupational rehabilitation. - : Springer Science and Business Media LLC. - 1053-0487 .- 1573-3688. ; 21:1, s. 23-30
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Tidskriftsartikel (refereegranskat)abstract
- Introduction The aim of this study was to investigate the impact of psychosocial working conditions and coping strategies at work on change in sick leave level for patients on long-term sick leave due to burnout.Methods A cohort sample of patients (n = 117) on long-term sick leave due to burnout was analyzed. The patients answered a questionnaire at baseline and sick leave information was collected from the Swedish Social Insurance Agency at baseline and at follow-up 2 years later. Two groups were formed depending on whether the patients had "improved" and reduced their sick leave level (56%) or if the sick leave level was "unchanged" (44%) at follow-up. The association between change in sick leave and predictors measuring psychosocial working conditions and coping strategies at work were analyzed using logistic regression.Results The predictor, low control at work, was associated with unchanged sick leave at follow-up. When background characteristics were taken into account, usage of covert coping towards supervisors and covert coping towards workmates, respectively, also predicted unchanged sick leave level. High overcommitment was of borderline significance and associated with a reduced sick leave level at follow-up.Conclusions Patients with burnout who have experienced low control at work and used covert coping towards supervisors and/or workmates have a higher risk of not reducing their sick leave after rehabilitation. The workplace may contribute to a reduction of sick leave lengths with a more flexible work environment and improvement in communication strategies for employees and supervisors.
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| 19. |
- Norlund, Sofia, et al.
(författare)
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Work situation and self-perceived economic situation as predictors of change in burnout - a prospective general population-based cohort study
- 2015
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Background: Sick leave rates due to mental and behavioural disorders have increased in Sweden during the last decades. The aim of this prospective study was to investigate changes in the level of burnout in a working subset of the general population and to identify how such changes relate to changes in work situation and self-perceived economic situation. Methods: A cohort of 1000 persons from a subset of the 2004 northern Sweden MONICA (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease) general population survey was followed over a five-year period (2004-2009). In total, 623 persons (323 women and 300 men) were included in the analysis. Burnout levels were measured at baseline and follow-up using the Shirom Melamed Burnout Questionnaire. Risk factors were assessed at both measuring points. Results: In the whole study cohort, a small (-0.15) but statistically significant reduction in burnout level was found. No differences in change of burnout were found between men and women. Constant strain at work, an increased risk of unemployment, and a perceived worsening of economic situation during the study time period were related to an increased burnout level. An accumulation of these risk factors was associated with increased burnout level. Conclusions: Risk factors in work situation and self-perceived economy are related to changes in burnout level, and special attention should be directed towards persons exposed to multiple risk factors.
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| 20. |
- Reuterwall, Christina, 1945-
(författare)
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Genetic variation in a large game species, the moose (Alces alces) : patterns of differentiation and some management implications
- 1980
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Management of wildlife populations frequently involves selective harvesting, resulting in different death rates for different sexes and age groups. Such selectivity always has specific effects on the population breeding structure and can thereby affect the rate and magnitude of genetic changes with consequences on the genetic composition of the population. The Swedish moose population was chosen as a model to examine the effects of selective harvesting policies on the genetic structure of a wildlife population. In this study the genetic composition of moose from different areas was analyzed by electrophoresis. Effective population size and generation interval (i.e. the parameters determining the rate of inbreeding and genetic drift) as affected by various hunting regimes were evaluated using stochastic computer simulations.Assuming the number of allelic substitutions to be proportional to time electrophoretically detectable differentiation between Scandinavian moose (Alces alces alces) and North American moose (A. a. americana) corresponds to an effective divergence time of approximately 300,000 years. The population structure within Scandinavian moose appears quite complex; the relative amount of genetic differentiation between population subunits is of the same magnitude as that between the three major races of man. The existence of genetically distinct subunits over short geographical distances suggests that natural moose units might be quite restricted in absolute size. The results of the computer simulations indicate that the effective population number may be much smaller than the actual number and that both relative effective size and generation interval can vary widely depending on the harvesting regime applied.The Scandinavian moose is at present almost completely controlled by man and the current results emphasize the need to adequately consider the genetic consequences when designing and implementing management programs.
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| 21. |
- Widerström, Micael, et al.
(författare)
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Large outbreak of cryptosporidium hominis infection transmitted through the public water supply, Sweden
- 2014
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Ingår i: Emerging Infectious Diseases. - : Centers for Disease Control and Prevention (CDC). - 1080-6040 .- 1080-6059. ; 20:4, s. 581-589
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Tidskriftsartikel (refereegranskat)abstract
- In November 2010, approximate to 27,000 (approximate to 45%) inhabitants of Östersund, Sweden, were affected by a waterborne outbreak of cryptosporidiosis. The outbreak was characterized by a rapid onset and high attack rate, especially among young and middle-aged persons. Young age, number of infected family members, amount of water consumed daily, and gluten intolerance were identified as risk factors for acquiring cryptosporidiosis. Also, chronic intestinal disease and young age were significantly associated with prolonged diarrhea. Identification of Ctyptosporidium hominis subtype lbA10G2 in human and environmental samples and consistently low numbers of oocysts in drinking water confirmed insufficient reduction of parasites by the municipal water treatment plant. The current outbreak shows that use of inadequate microbial barriers at water treatment plants can have serious consequences for public health. This risk can be minimized by optimizing control of raw water quality and employing multiple barriers that remove or inactivate all groups of pathogens.
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