| 1. |
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| 2. |
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| 3. |
- Dragano, Nico, et al.
(author)
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Effort-Reward Imbalance at Work and Incident Coronary Heart Disease A Multicohort Study of 90,164 Individuals
- 2017
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In: Epidemiology. - : Lippincott Williams & Wilkins. - 1044-3983 .- 1531-5487. ; 28:4, s. 619-626
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Journal article (peer-reviewed)abstract
- Background: Epidemiologic evidence for work stress as a risk factor for coronary heart disease is mostly based on a single measure of stressful work known as job strain, a combination of high demands and low job control. We examined whether a complementary stress measure that assesses an imbalance between efforts spent at work and rewards received predicted coronary heart disease.Methods: This multicohort study (the "IPD-Work" consortium) was based on harmonized individual-level data from 11 European prospective cohort studies. Stressful work in 90,164 men and women without coronary heart disease at baseline was assessed by validated effort-reward imbalance and job strain questionnaires. We defined incident coronary heart disease as the first nonfatal myocardial infarction or coronary death. Study-specific estimates were pooled by random effects meta-analysis.Results: At baseline, 31.7% of study members reported effort-reward imbalance at work and 15.9% reported job strain. During a mean follow-up of 9.8 years, 1,078 coronary events were recorded. After adjustment for potential confounders, a hazard ratio of 1.16 (95% confidence interval, 1.00-1.35) was observed for effort-reward imbalance compared with no imbalance. The hazard ratio was 1.16 (1.01-1.34) for having either effort-reward imbalance or job strain and 1.41 (1.12-1.76) for having both these stressors compared to having neither effort-reward imbalance nor job strain.Conclusions: Individuals with effort-reward imbalance at work have an increased risk of coronary heart disease, and this appears to be independent of job strain experienced. These findings support expanding focus beyond just job strain in future research on work stress.
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| 4. |
- Ernsth Bravell, Marie, et al.
(author)
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Reciprocal patterns of support of very old people and their families
- 2016
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In: The Gerontologist. - : Oxford University Press (OUP). - 1758-5341.
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Conference paper (peer-reviewed)abstract
- Introduction: The aging population is often considered as a threat that will deplete family and societal resources. Yet older people may be a resource, giving support and care to their family. The aim of this study is to analyze patterns of giving and receiving support by the oldest old with their family. Method: Data were used from the OCTO2- study, a Swedish population-based sample of 171 women and 156 men, 75–90 years. Respondents completed the Intergenerational Support Index to examine patterns of receiving and giving care and support and factors associated with support exchanges. Results: Results showed that the oldest old gave as much support as they received within the family. Most of the older persons receiving formal help from the community (79%) continued giving support to family. The most common types of support given and received within the family were emotional (89% given, 90% received) and practical (44% given, 46% received). Older persons gave more financial support (26%) than they received (2%). Age, gender, functioning in daily life activities and satisfaction with life were associated with giving different types of family support. Conclusion: Old-old people in Sweden are not just consumers of care, but are involved in reciprocal patterns as receivers and providers of care and support. It is not a simple opposition between being a giver and receiver of informal support simultaneously, but more knowledge is needed about the complex interplay between various form of care and support.
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| 5. |
- Ferrie, Jane E., et al.
(author)
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Job insecurity and risk of diabetes : a meta-analysis of individual participant data
- 2016
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In: CMJA. Canadian Medical Association Journal. Onlineutg. Med tittel. - : Canadian Medical Association,Association Medicale Canadienne. - 0820-3946 .- 1488-2329. ; 188:17-18, s. E447-E455
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Journal article (peer-reviewed)abstract
- BACKGROUND: Job insecurity has been associated with certain health outcomes. We examined the role of job insecurity as a risk factor for incident diabetes.METHODS: We used individual participant data from 8 cohort studies identified in 2 open-access data archives and 11 cohort studies participating in the Individual-Participant-Data Meta-analysis in Working Populations Consortium. We calculated study-specific estimates of the association between job insecurity reported at baseline and incident diabetes over the follow-up period. We pooled the estimates in a meta-analysis to produce a summary risk estimate.RESULTS: The 19 studies involved 140 825 participants from Australia, Europe and the United States, with a mean follow-up of 9.4 years and 3954 incident cases of diabetes. In the preliminary analysis adjusted for age and sex, high job insecurity was associated with an increased risk of incident diabetes compared with low job insecurity (adjusted odds ratio [OR] 1.19, 95% confidence interval [CI] 1.09-1.30). In the multivariable-adjusted analysis restricted to 15 studies with baseline data for all covariates (age, sex, socioeconomic status, obesity, physical activity, alcohol and smoking), the association was slightly attenuated (adjusted OR 1.12, 95% CI 1.01-1.24). Heterogeneity between the studies was low to moderate (age- and sex-adjusted model: I(2) = 24%, p = 0.2; multivariable-adjusted model: I(2) = 27%, p = 0.2). In the multivariable-adjusted analysis restricted to high-quality studies, in which the diabetes diagnosis was ascertained from electronic medical records or clinical examination, the association was similar to that in the main analysis (adjusted OR 1.19, 95% CI 1.04-1.35).INTERPRETATION: Our findings suggest that self-reported job insecurity is associated with a modest increased risk of incident diabetes. Health care personnel should be aware of this association among workers reporting job insecurity.
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| 6. |
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| 7. |
- Fransson, Eleonor, 1971-, et al.
(author)
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Exposure to exhaust fumes, combustion products or soot and the risk of atrial fibrillation : Results from the Swedish WOLF study
- 2016
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In: Occupational and Environmental Medicine. - : BMJ Publishing Group Ltd. - 1351-0711 .- 1470-7926. ; 73:Suppl 1, s. 140-141
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Journal article (peer-reviewed)abstract
- Atrial fibrillation is a common heart rhythm disorder affecting 1-3% of the adult population. Despite being such a prevalent disorder, the knowledge about risk factors preceding the disease is very limited, especially regarding work related factors. The aim of the present study was to estimate the association between the 310 exposure to exhaust fumes, combustion products or soot in the work environment and the risk of atrial fibrillation.MethodData from the Swedish Work, Lipids and Fibrinogen (WOLF) study was used. The study includes working men and women in the counties of Stockholm, Västernorrland and Jämtland (n=10416). The baseline data collection was carried out 1992-1998. Atrial fibrillation cases were identified by the Swedish national hospital discharge register.ResultsDuring a median follow-up time of 13.6 years, 252 incident cases with atrial fibrillation were identified. In total, 1249 (12.5%) people reported exposure to exhaust fumes, combustion products or soot at baseline. The age and sex adjusted hazard ratio (HR) for atrial fibrillation was 1.01 (95% CI 0.70-1.46) for the exposed group compared with the unexposed group. Further adjustment for socio-economic status, lifestyle factors, job strain, waist circumference and hypertension did not alter the estimated HR in any substantial way (HR 0.99, 95% CI 0.66-1.48). However, when combining the exposure with smoking status, an increased risk for atrial fibrillation was observed among those exposed both to smoking and exhaust fumes, combustion products or soot compared to non-smokers who were not exposed (HR 1.83, 95% CI 1.07-3.12).Exposure-Smoking status HR* 95% CINon exposed-Non-smoker 1 -Non exposed-Smoker 1.09 0.78-1.52Exposed-Non-smoker 0.69 0.40-1.19Exposed-Smoker 1.83 1.07-3.12*Adjusted for SES, life-style, job strain, waist circumference and hypertensionConclusionPreliminary results indicate that exposure to exhaust fumes, combustion products or soot in combination with smoking is associated with an increased risk of atrial fibrillation.
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| 8. |
- Fransson, Eleonor I, et al.
(author)
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Job strain and the risk of stroke : an individual-participant data meta-analysis
- 2015
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In: Stroke. - 0039-2499 .- 1524-4628. ; 46:2, s. 557-559
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Journal article (peer-reviewed)abstract
- BACKGROUND AND PURPOSE: Psychosocial stress at work has been proposed to be a risk factor for cardiovascular disease. However, its role as a risk factor for stroke is uncertain.METHODS: We conducted an individual-participant-data meta-analysis of 196 380 males and females from 14 European cohort studies to investigate the association between job strain, a measure of work-related stress, and incident stroke.RESULTS: In 1.8 million person-years at risk (mean follow-up 9.2 years), 2023 first-time stroke events were recorded. The age- and sex-adjusted hazard ratio for job strain relative to no job strain was 1.24 (95% confidence interval, 1.05;1.47) for ischemic stroke, 1.01 (95% confidence interval, 0.75;1.36) for hemorrhagic stroke, and 1.09 (95% confidence interval, 0.94;1.26) for overall stroke. The association with ischemic stroke was robust to further adjustment for socioeconomic status.CONCLUSION: Job strain may be associated with an increased risk of ischemic stroke, but further research is needed to determine whether interventions targeting job strain would reduce stroke risk beyond existing preventive strategies.
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| 9. |
- Fransson, Eleonor I., et al.
(author)
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The Association between Job Strain and Atrial Fibrillation : Results from the Swedish WOLF Study
- 2015
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In: BioMed Research International. - : Hindawi Publishing Corporation. - 2314-6133 .- 2314-6141.
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Journal article (peer-reviewed)abstract
- Introduction: Atrial fibrillation (AF) is a common heart rhythmdisorder. Several life-style factors have been identified as risk factors for AF, but less is known about the impact of work-related stress. This study aims to evaluate the association between work-related stress, defined as job strain, and risk of AF. Methods: Data from the Swedish WOLF study was used, comprising 10,121 working men and women. Job strain was measured by the demand-control model. Information on incident AF was derived from national registers. Cox proportional hazard regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between job strain and AF risk. Results: In total, 253 incident AF cases were identified during a total follow-up time of 132,387 person-years. Job strain was associated with AF risk in a time-dependent manner, with stronger association after 10.7 years of follow-up (HR 1.93, 95% CI 1.10-3.36 after 10.7 years, versus HR 1.11, 95% CI 0.67-1.83 before 10.7 years). The results pointed towards a dose-response relationship when taking accumulated exposure to job strain over time into account. Conclusion: This study provides support to the hypothesis that work-related stress defined as job strain is linked to an increased risk of AF.
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| 10. |
- Fransson, Eleonor, et al.
(author)
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Job strain and atrial fibrillation : results from the Swedish Longitudinal Occupational Survey of Health and meta-analysis of three studies
- 2018
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In: European Journal of Preventive Cardiology. - : Sage Publications. - 2047-4873 .- 2047-4881. ; 25:11, s. 1142-1149
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Journal article (peer-reviewed)abstract
- Background: Knowledge about the impact of occupational exposures, such as work stress, on the risk of atrial fibrillation is limited. The present study aims to investigate the association between job strain, a measure of work stress, and atrial fibrillation.Design: Prospective cohort study design and fixed-effect meta-analysis.Methods: Data from the Swedish Longitudinal Occupational Survey of Health (SLOSH) was utilised for the main analysis, combining self-reported data on work stress at baseline with follow-up data on atrial fibrillation from nationwide registers. Cox proportional hazard regression analyses were used to estimate hazard ratios and 95% confidence intervals (CIs). A fixed-effect meta-analysis was conducted to pool the results from the present study with results from two similar previously published studies.Results: Based on SLOSH data, job strain was associated with an almost 50% increased risk of atrial fibrillation (hazard ratio 1.48, 95% CI 1.00-2.18) after adjustment for age, sex and education. Further adjustment for smoking, physical activity, body mass index and hypertension did not alter the estimated risk. The meta-analysis of the present and two previously published studies showed a consistent pattern, with job strain being associated with increased risk of atrial fibrillation in all three studies. The estimated pooled hazard ratio was 1.37 (95% CI 1.13-1.67).Conclusion: The results highlight that occupational exposures, such as work stress, may be important risk factors for incident atrial fibrillation.
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| 11. |
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| 12. |
- Fransson, Eleonor, et al.
(author)
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Psychosocial work environment and risk of stroke : Findings from the IPD-Work Consortium
- 2017
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In: European Journal of Preventive Cardiology. - : Sage Publications. - 2047-4873 .- 2047-4881. ; , s. 10-10
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Conference paper (peer-reviewed)abstract
- Aim: To quantify the associations of two aspects of the psychosocial work environment, job strain and long working hours, with the risk of incident stroke.Methods: We conducted large-scale meta-analyses of working men and women from prospective cohort studies to evaluate job strain and long working hours at baseline as risk factors for incident stroke during a mean follow-up of 7–9 years. Job strain, which is one of several indicators of work stress, was defined according to the demand–control model, where those exposed to high psychological job demands in combination with low control (i.e. job strain) were compared with all others. Study-specific hazard ratios with 95% confidence intervals (CI) were estimated from 14 studies participating in the IPD-Work Consortium and were pooled in a random-effects meta-analysis (total N ¼ 196,380). The definition of long working hours varied from 45 hours or more to 55 hours or more per week, depending on study. Study-specific hazard ratios or odds ratios were pooled into a common estimate of relative risk from 17 studies, including cohorts from the IPD-Work Consortium and published studies identified via a systematic literature review (total N ¼ 528,908).Results: During a mean follow-up time of 9.2 years, 2023 first-time stroke events were recorded in the job strain analysis. After adjusting for age and sex, no association was found between being exposed to job strain and the risk of overall stroke (hazard ratio 1.09, 95% CI 0.94–1.26) or haemorrhagic stroke (hazard ratio 1.01, 95% CI 0.75–1.36). However, an increased risk of ischaemic stroke was observed among those with job strain (hazard ratio 1.24, 95% CI 1.05–1.47). After further adjustment for socioeconomic status the hazard ratio was 1.18 (95% CI 1.00–1.39). In the analysis of long working hours, 1722 stroke cases were identified during a mean follow-up time of 7.2 years. After adjustment for age, sex and socioeconomic status, long working hours were associated with an increased risk of incident stroke (relative risk 1.33, 95% CI 1.11–1.61). Furthermore, a dose–response association between weekly working hours and risk of stroke was observed.Conclusion: We observed an approximately 20% increase in the risk of ischaemic stroke for individuals exposed to job strain and a 30% increase in the risk of overall stroke among those working long hours. These results support the hypothesis that psychosocial factors in the work environment are important in the development of ill-health in terms of stroke. The potential mechanisms linking these workplace factors to increased stroke risk are unclear, but might involve both direct effects on the cardiovascular system through activation of the neuroendocrine stress response and dysregulation of the hypothalamopituitary axis, and indirect effects from changes in health-related behaviours, such as physical activity, diet and alcohol consumption.
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| 13. |
- Fristedt, Sofi, et al.
(author)
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Concurrent validity of the Swedish version of the life-space assessment questionnaire
- 2016
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In: BMC Geriatrics. - : BioMed Central. - 1471-2318. ; 16
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Journal article (peer-reviewed)abstract
- BACKGROUND: The Life-Space Assessment (LSA), developed in the USA, is an instrument focusing on mobility with respect to reaching different areas defined as life-spaces, extending from the room where the person sleeps to mobility outside one's hometown. A newly translated Swedish version of the LSA (LSA-S) has been tested for test-retest reliability, but the validity remains to be tested. The purpose of the present study was to examine the concurrent validity of the LSA-S, by comparing and correlating the LSA scores to other measures of mobility.METHOD: The LSA was included in a population-based study of health, functioning and mobility among older persons in Sweden, and the present analysis comprised 312 community-dwelling participants. To test the concurrent validity, the LSA scores were compared to a number of other mobility-related variables, including the Short Physical Performance Battery (SPPB) as well as "stair climbing", "transfers", "transportation", "food shopping", "travel for pleasure" and "community activities". The LSA total mean scores for different levels of the other mobility-related variables, and measures of correlation were calculated.RESULTS: Higher LSA total mean scores were observed with higher levels of all the other mobility related variables. Most of the correlations between the LSA and the other mobility variables were large (r = 0.5-1.0) and significant at the 0.01 level. The LSA total score, as well as independent life-space and assistive life-space correlated with transportation (0.63, 0.66, 0.64) and food shopping (0.55, 0.58, 0.55). Assistive life-space also correlated with SPPB (0.47). With respect to maximal life-space, the correlations with the mobility-related variables were generally lower (below 0.5), probably since this aspect of life-space mobility is highly influenced by social support and is not so dependent on the individual's own physical function.CONCLUSION: LSA was shown to be a valid measure of mobility when using the LSA total, independent LS or assistive LSA.
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| 14. |
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| 15. |
- Fristedt, Sofi, et al.
(author)
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Life-space mobility and participation in daily activities and social life among older men and women
- 2015
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Conference paper (peer-reviewed)abstract
- BackgroundLife-space mobility, i.e., the frequency and independence of transferring to different life-spaces (extending from a person’s bedroom to places beyond hometown), is evident to decrease in later life with potential risk of restricted participation in daily activities and social life. Modes of transport support participation through life-space mobility differently, and older men and women tend to choose different modes. The aim was to identify differences in participation in daily activities and social life related to life-space mobility and gender.MethodsData included the Life-Space Assessment (LSA), transportation, activities of daily living, and community activities. Participants living in their own housing in Sweden (n=312; 147 men, 165 women), aged 75+ (mean age 80), were randomly selected from a population register.ResultLSA total score differed significantly (p<0.001) between men (mean=72) and women (mean=58), and between different modes of transport (p<0.001) with bike users (mean=79) and car drivers (mean=77) reaching the highest LSA total scores. Gender differences were evident related to mode of transport (p<0.001), with men predominantly (74%) driving their own car, while women were driving (32%), going by car as a passenger (32%) or used public transportation (21%). Participation in community activities did not differ significantly between genders, but between LSA total scores (p<0.001). For example, LSA total score was lower for persons taking part in no (mean=55) compared to five (mean=84) community activities at least once a month.ConclusionLife-space mobility is vital to consider when aiming to support continuing participation in daily activities and social life.
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| 16. |
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| 17. |
- Fristedt, Sofi, 1969-, et al.
(author)
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Validitet och reliabilitet för Life-Space Assessment (LSA) - ett instrument för bedömning av äldre personers mobilitet
- 2015
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Conference paper (peer-reviewed)abstract
- Bakgrund: Förmågan och möjligheter att förflytta (mobilitet) begränsas ofta i senare delen av livet, med negativa konsekvenser fördelaktighet i dagliga och sociala aktiviteter. Såväl i praktisk verksamhet som för forskning behövs instrument som kanbedöma mobilitet. The Life Space Assessment (LSA), utvecklat i USA, är bedömer en individs mobilitet genom attfokusera på förmågan att ta sig till olika “life-spaces”, från rummet där personen sover till platser bortom hemorten undersenaste månaden. LSA beaktar dessutom hur ofta detta sker, och om det sker med hjälpmedel eller hjälp av annanperson.Syfte: Syftet var att undersöka samtidig validitet och testa reliabilitet av LSAs svenska version.Metod: LSA översattes till svenska och inkluderades tillsammans med andra hälsorelaterade mått i en populationsbaserad studiemed slumpmässigt utvalda personer mellan 75 och 90 år (medelålder 81 år) i enskilt boende. LSA summerades till fyrapoängsummor, dvs total, oberoende, assisterad och maximal life-space poäng. 298 individer ingick i reliabilitetstudienoch besvarade LSA vid två tillfällen med 14 dagars mellanrum. 312 individer ingick i validitetsstudien där LSA jämfördesmed andra mobilitetsrelaterade mått.Resultat/preliminärt resultat: Det fanns inga signifikanta skillnader mellan skattningarna över tid för LSA fyra poängsummor. Medelvärdet för total life-space poäng var t ex 65 (22) och 65 (23) (max 120). Korrelationsvärden (ICC) mellan 0.84-0.94 visar på god till utmärktreliabilitet för total, oberoende och assisterad LSA. Vad gäller validitet påvisas signifikanta (p<0.01) och måttligt till godakorrelationer (0.50- 0.75) mellan LSAs fyra poängsummor och förmåga till förflyttning (överflyttning, balans, uppresningoch gångförmåga), transport (vardagliga resor och nöjesresor), och aktivitet i samhället (inköp och fritid)Slutsats: Den svenska versionen av LSA har god validitet samt god till utmärkt reliabilitet och kan med förtroende användas för attbedöma mobilitet hos äldre i enskilt boende.
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| 18. |
- Hallgren, Jenny, et al.
(author)
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Factors associated with hospitalization among older people in Sweden : Results from the Satsa Study
- 2015
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In: The Gerontologist. - : Oxford University Press. - 0016-9013 .- 1758-5341. ; 55, s. 678-679
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Journal article (peer-reviewed)abstract
- Background: Hospitalization among older people is common and associated with risk of adverse outcomes such as iatrogenic disorders and physical impairments. Knowledge about personal characteristics and social factors related to hospitalization is scarce. In order to understand which factors that are related to hospitalization risk, a prospective study with a multifactorial approach was conducted.Methods: In 2003, 794 Swedish persons (mean age 70.1 years, 60.7% females) answered a postal questionnaire as a part of the population-based longitudinal Swedish Adoption/Twin Study of Aging (SATSA). Participants were asked about physiological and psychological health, personality and socio economic factors. During seven years of follow-up, information on hospitalizations and the associated diagnoses were obtained from the Swedish National Inpatient Register.Results: Preliminary results show that 484 persons (61.0%) had at least one hospital admission during the follow-up period. The most common causes of admission were cardiovascular diseases and tumors. Cox proportional hazard regression model controlling for age, sex and dependency within twin pairs, showed that higher locus of control (HR=0.89, 95% CI=0.83-0.96), marital status (widow/widower (HR=0.64, 95 % CI=0.50-0.81) and unmarried (HR=0.67, 95% CI=0.50-0.90)), and support from friends (HR=0.93, 95% CI=0.87-0.99) were associated with lower risk of hospitalization, while greater numbers of diseases (HR=1.11, 95% CI=1.03-1.20) and negative life events (HR=1.16, 95% CI=1.00-1.34) were associated with increased risk of hospitalization.Discussion: Our results show that both personal and social factors were important for the risk of hospitalization. This might be used in future interventions for understanding health care utilization.
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| 19. |
- Hallgren, Jenny, 1978-, et al.
(author)
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Factors associated with hospitalization risk among community living middle aged and older persons : Results from the Swedish Adoption/Twin Study of Aging (SATSA)
- 2016
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In: Archives of gerontology and geriatrics (Print). - : Elsevier. - 0167-4943 .- 1872-6976. ; 66, s. 102-108
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Journal article (peer-reviewed)abstract
- The aims of the present study were to: (1) describe and compare individual characteristics of hospitalized and not hospitalized community living persons, and (2) to determine factors that are associated with hospitalization risk over time. We conducted a prospective study with a multifactorial approach based on the population-based longitudinal Swedish Adoption/Twin Study of Aging (SATSA). A total of 772 Swedes (mean age at baseline 69.7 years, range 46–103, 59.8% females) answered a postal questionnaire about physical and psychological health, personality and socioeconomic factors. During nine years of follow-up, information on hospitalizations and associated diagnoses were obtained from national registers. Results show that 484 persons (63%) had at least one hospital admission during the follow-up period. The most common causes of admission were cardiovascular diseases (25%) and tumors (22%). Cox proportional hazard regression models controlling for age, sex and dependency within twin pairs, showed that higher age (HR = 1.02, p < 0.001) and more support from relatives (HR = 1.09, p = 0.028) were associated with increased risk of hospitalization, while marital status (unmarried (HR = 0.75, p = 0.033) and widow/widower (HR = 0.69, p < 0.001)) and support from friends (HR = 0.93, p = 0.029) were associated with lower risk of hospitalization. Social factors were important for hospitalization risk even when medical factors were controlled for in the analyses. Number of diseases was not a risk in the final regression model. Hospitalization risk was also different for women and men and within different age groups. We believe that these results might be used in future interventions targeting health care utilization.
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| 20. |
- Hallgren, Jenny
(author)
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Should I stay or should I go – Factors associated with hospitalization risk among older persons in Sweden
- 2016
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Doctoral thesis (other academic/artistic)abstract
- An increasingly older population will most likely lead to greater demands on the health care system, as older age is associated with an increased risk of having acute and chronic conditions. The number of diseases or disabilities is not the only marker of the amount of health care utilized, as persons may seek hospitalization without a disease and/or illness that requires hospital healthcare. Hospitalization may pose a severe risk to older persons, as exposure to the hospital environment may lead to increased risks of iatrogenic disorders, confusion, falls and nosocomial infections, i.e., disorders that may involve unnecessary suffering and lead to serious consequences.Aims: The overall aim of this thesis was to describe and explore individual trajectories of cognitive development in relation to hospitalization and risk factors for hospitalization among older persons living in different accommodations in Sweden and to explore older persons' reasons for being transferred to a hospital.Methods: The study designs were longitudinal, prospective and descriptive, and both quantitative and qualitative methods were used. Specifically, latent growth curve modelling was used to assess the association of cognitive development with hospitalization. The Cox proportional hazards regression model was used to analyse factors associated with hospitalization risk overtime. In addition, an explorative descriptive design was used to explore how home health care patients experienced and perceived their decision to seek hospital care.Results: The most common reasons for hospitalization were cardiovascular diseases, which caused more than one-quarter of first hospitalizations among the persons living in ordinary housing and nursing home residents (NHRs). The persons who had been hospitalized had a lower mean level of cognitive performance in general cognition, verbal, spatial/fluid, memory and processing speed abilities compared to those who had not been hospitalized. Significantly steeper declines in general cognition, spatial/fluid and processing speed abilities were observed among the persons who had been hospitalized. Cox proportional hazards regression analysis showed that the number of diseases, number of drugs used, having experienced a fall and being assessed as malnourished according to the Mini Nutritional Assessment scale were related to an increased hospitalization risk among the NHRs. Among the older persons living in ordinary housing, the risk factors for hospitalization were related to marital status, i.e., unmarried persons and widows/widowers had a decreased hospitalization risk. In addition, among social factors, receipt of support from relatives was related to an increased hospitalization risk, while receipt of support from friends was related to a decreased risk. The number of illnesses was not associated with the hospitalization risk for older persons in any age group or for those of either sex, when controlling for other variables. The older persons who received home health care described different reasons for their decisions to seek hospital care. The underlying theme of the home health care patients’ perceptions of their transfer to a hospital involved trust in hospitals. This trust was shared by the home health care patients, their relatives and the home health care staff, according to the patients.Conclusions: This thesis revealed that middle-aged and older persons who had been hospitalized exhibited a steeper decline in cognition. Specifically, spatial/fluid, processing speed, and general cognitive abilities were affected. The steeper decline in cognition among those who had been hospitalized remained even after controlling for comorbidities. The most common causes of hospitalization among the older persons living in ordinary housing and in nursing homes were cardiovascular diseases, tumours and falls. Not only health-related factors, such as the number of diseases, number of drugs used, and being assessed as malnourished, but also social factors and marital status were related to the hospitalization risk among the older persons living in ordinary housing and in nursing homes. Some risk factors associated with hospitalization differed not only between the men and women but also among the different age groups. The information provided in this thesis could be applied in care settings by professionals who interact with older persons before they decide to seek hospital care. To meet the needs of an older population, health care systems need to offer the proper health care at the most appropriate level, and they need to increase integration and coordination among health care delivered by different care services.
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| 21. |
- 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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| 22. |
- Heikkila, Katriina, et al.
(author)
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Long working hours and cancer risk : a multi-cohort study
- 2016
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In: British Journal of Cancer. - : Springer Science and Business Media LLC. - 0007-0920 .- 1532-1827. ; 114, s. 813-818
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Journal article (peer-reviewed)abstract
- BACKGROUND: Working longer than the maximum recommended hours is associated with an increased risk of cardiovascular disease, but the relationship of excess working hours with incident cancer is unclear.METHODS: This multi-cohort study examined the association between working hours and cancer risk in 116 462 men and women who were free of cancer at baseline. Incident cancers were ascertained from national cancer, hospitalisation and death registers; weekly working hours were self-reported.RESULTS: During median follow-up of 10.8 years, 4371 participants developed cancer (n colorectal cancer: 393; n lung cancer: 247; n breast cancer: 833; and n prostate cancer: 534). We found no clear evidence for an association between working hours and the overall cancer risk. Working hours were also unrelated the risk of incident colorectal, lung or prostate cancers. Working ⩾55 h per week was associated with 1.60-fold (95% confidence interval 1.12-2.29) increase in female breast cancer risk independently of age, socioeconomic position, shift- and night-time work and lifestyle factors, but this observation may have been influenced by residual confounding from parity.CONCLUSIONS: Our findings suggest that working long hours is unrelated to the overall cancer risk or the risk of lung, colorectal or prostate cancers. The observed association with breast cancer would warrant further research.
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| 23. |
- 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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| 24. |
- Johnsen, Anna M., et al.
(author)
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Association between occupational physical activity and myocardial infarction : A prospective cohort study
- 2016
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In: BMJ Open. - : BMJ. - 2044-6055. ; 6:10
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Journal article (peer-reviewed)abstract
- Objective Recommendations regarding physical activity typically include both leisure time and occupational physical activity. However, the results from previous studies on occupational physical activity and the association with myocardial infarction have been inconsistent. The aim of this study was to investigate if occupational physical activity is associated with the risk of myocardial infarction. Design Prospective cohort study. Participants Data from the Swedish Work, Lipids and Fibrinogen (WOLF) study was used, comprising 9961 employees (6849 men, 3112 women, mean age 42.7 years) having no history of myocardial infarction. The participants were categorised into 3 groups according to their level of occupational physical activity. Outcome Data regarding incident myocardial infarction were obtained from the Swedish National Patient Register and the Cause of Death Register. Cox proportional hazard regression was used for estimation of HRs for different levels of occupational physical activity in relation to the risk of myocardial infarction. Results During a mean follow-up of 13.1 years, 249 cases of incident myocardial infarction were identified. In analyses adjusted for age, sex and socioeconomic status, participants standing and walking more than 50% of their working day had an HR of 1.13 (95% CI 0.83 to 1.54), compared with participants seated more than 50% of their working day. The corresponding HR for participants whose work included lifting or carrying was 0.86 (95% CI 0.59 to 1.24). Further adjustment did not alter the results. Stratified analyses resulted in a significantly decreased risk for young people whose work included lifting or carrying, HR 0.37 (95% CI 0.17 to 0.84), compared with younger persons who sat most of their working day. Conclusions No significant association between occupational physical activity and the risk of myocardial infarction was observed in the total group of employees in this study. Based on the results from this study, occupational physical activity in general does not seem to be enough for reducing the risk of myocardial infarction.
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| 25. |
- Johnsen, Anna, et al.
(author)
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Weak associations between occupational physical activity and myocardial infarction
- 2016
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In: Occupational and Environmental Medicine. - : BMJ Publishing Group Ltd. ; , s. A198-
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Conference paper (peer-reviewed)abstract
- IntroductionRecommendations regarding physical activity typically include both leisure time and occupational physical activity. However, the results of research on occupational physical activity and the association to myocardial infarction are inconsistent. The aim of this study was to investigate if occupational physical activity affects the risk of myocardial infarction.Method In this prospective cohort study, data from the WOLF study are analysed. In total, 9,961 employees having no history of myocardial infarction were followed from inclusion to their first incidence of myocardial infarction. Hazard ratios (HR) were estimated using Cox proportional hazard regression, for different levels of occupational physical activity in relation to the risk of myocardial infarction.Results A follow-up with a mean of 13.1 years found 249 cases of myocardial infarction. In analyses adjusted for age, sex and socio-economic status, participants standing and walking more than 50% of their working day had HR of 1.13 (95% CI: 0.83– 1.54), compared to participants seated more than 50% of their working day. The corresponding HR for participants whose work included lifting or carrying was 0.86 (95% CI: 0.59–1.24). Stratified analyses resulted in a significantly decreased risk for young people whose work included lifting or carrying, HR 0.37 (95% CI: 0.17–0.84), compared with younger persons who sat most of their working day.ConclusionOnly weak associations between occupational physical activity and the risk of myocardial infarction were observed in this study. A significant reduced risk were seen for young participants with work including lifting and carrying, but this result must be interpreted with caution due to few participants in the stratified analyses. Based on the results from this study, occupational physical activity does not seem to be enough for reducing the risk of myocardial infarction, which is an important message to people with high levels of occupational physical activity.
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