| 1. |
- Björkenstam, Charlotte, et al.
(author)
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Sickness absence and disability pension before and after first childbirth and in nulliparous women : longitudinal analyses of three cohorts in Sweden
- 2019
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In: BMJ Open. - : BMJ. - 2044-6055. ; 9:9
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Journal article (peer-reviewed)abstract
- Objective Childbirth is suggested to be associated with elevated levels of sickness absence (SA) and disability pension (DP). However, detailed knowledge about SA/DP patterns around childbirth is lacking. We aimed to compare SA/DP across different time periods among women according to their childbirth status.Design Register-based longitudinal cohort study.Setting Sweden.Participants Three population-based cohorts of nulliparous women aged 18–39 years, living in Sweden 31 December 1994, 1999 or 2004 (nearly 500 000/cohort).Primary and secondary outcome measures Sum of SA >14 and DP net days/year.Methods We compared crude and standardised mean SA and DP days/year during the 3 years preceding and the 3 years after first childbirth date (Y−3 to Y+3), among women having (1) their first and only birth during the subsequent 3 years (B1), (2) their first birth and at least another delivery (B1+), and (3) no childbirths during follow-up (B0).Results Despite an increase in SA in the year preceding the first childbirth, women in the B1 group, and especially in B1+, tended to have fewer SA/DP days throughout the years than women in the B0 group. For cohort 2005, the mean SA/DP days/year (95% CIs) in the B0, B1 and B1+ groups were for Y−3: 25.3 (24.9–25.7), 14.5 (13.6–15.5) and 8.5 (7.9–9.2); Y−2: 27.5 (27.1–27.9), 16.6 (15.5–17.6) and 9.6 (8.9–10.4); Y−1: 29.2 (28.8–29.6), 31.4 (30.2–32.6) and 22.0 (21.2–22.9); Y+1: 30.2 (29.8–30.7), 11.2 (10.4–12.1) and 5.5 (5.0–6.1); Y+2: 31.7 (31.3–32.1), 15.3 (14.2–16.3) and 10.9 (10.3–11.6); Y+3: 32.3 (31.9–32.7), 18.1 (17.0–19.3) and 12.4 (11.7–13.0), respectively. These patterns were the same in all three cohorts.Conclusions Women with more than one childbirth had fewer SA/DP days/year compared with women with one childbirth or with no births. Women who did not give birth had markedly more DP days than those giving birth, suggesting a health selection into childbirth.
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| 2. |
- Orellana, Cecilia, et al.
(author)
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Precarious employment, business performance and occupational injuries : a study protocol of a register-based Swedish project
- 2019
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In: BMJ Open. - : BMJ. - 2044-6055. ; 9:2
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Journal article (peer-reviewed)abstract
- Introduction There is uncertainty regarding the trends in occupational injuries (OIs) in Sweden due to a significant and increasing problem with under-reporting to injury registers. Under-reporting, in general, is likely to be exacerbated by the rise in precarious employment (PE), a set of unfavourable employment characteristics that would benefit from formal definition and study. PE and global trends are believed also to affect companies and their commitment to health and safety. The present study attempts to bridge these knowledge gaps and presents a study protocol for planned studies, with three main objectives: first, to review the literature for definitions of PE emphasising those that are multidimensional and operationalise components in routinely collected register data; second, to estimate the under-reporting of OI in Swedish registers and third, using results from the first objective, to conduct large, register-based prospective studies, designed to measure effect sizes and interactions between PE, business performance and OI. Methods and analysis First, a scientific literature review will be conducted, including scientific databases and grey literature. Second, data from two major OI registers will be used to estimate the magnitude of under-reporting using capture-recapture methodology. Finally, all residents aged 18-65 in Sweden with any registered income during 2003-2015 will be included. Data sources encompass Swedish population and labour market registers with linkage to both the main OI register with national coverage and hospital records. Trends in PE and OI will be explored, together with risk of OI associated with PE and business performance. Ethics and dissemination The project has been approved by the Regional Ethics Committee, Stockholm (dnr: 2016/2325-31; 2017/2173-32). Dissemination of study results will include a series of peer-reviewed papers, at least one PhD thesis and one report in Swedish, engaging relevant stakeholders. Results will be presented in national and international conferences and through press releases to mass media.
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| 3. |
- Orellana Pozo, Cecilia
(author)
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The association between hormonal/reproductive factors and the risk of developing rheumatoid arthritis
- 2015
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Doctoral thesis (other academic/artistic)abstract
- Rheumatoid arthritis (RA) is a chronic inflammatory disease which leads to joint damage and bone destruction, with a complex interplay of genetic and environmental factors involved in its etiology. RA is more common among women than men at all ages, but the gender difference seems to be highest before menopause. It has been hypothesized that changes in female hormonal levels might have a role in RA pathogenesis. The overall aim of this thesis was to study the association between hormonal/reproductive factors and the risk of RA and to determine whether these factors were differently associated with serological phenotypes of the disease (according to the presence/absence of anti-citrullinated peptides antibodies (ACPA) and rheumatoid factor (RF)). This thesis is based on information from two large studies. Three articles were based on the Swedish Epidemiological Investigation of Rheumatoid Arthritis (EIRA), a population-based case- control study comprising incident RA cases. The study population were people aged 18 and above, living in diverse geographical parts of Sweden from 1996. Controls were randomly selected from the population register and matched to the cases by age, sex and residential area. Cases and controls completed an extensive questionnaire, collecting information about life- style/environmental exposures. One article was based on the Nurses’ Health Study (NHS), which consists of two prospective cohorts of female nurses in the USA. Data collection started in 1976 (women aged 30-55 years) and 1989 (women aged 25-42 years). Both cohorts of the NHS were followed via biennial questionnaires about diseases, lifestyle and health practices. According to our results, parous women had an increased risk of ACPA-negative RA compared with nulliparous women, aged 18-44 years. The increased risk was attributable to an elevated risk during the postpartum period, and to a young age at first birth. Older age at first birth seemed to be associated with a decreased risk of ACPA-positive RA. Parous women who breastfed for more than a year had a decreased risk of ACPA-positive RA compared with parous women who breastfed for up to 6 months. This decreased risk was non-significant after adjustment for smoking. Ever oral contraceptive use was significantly associated with a decreased risk of ACPA- positive RA, while a longer duration of use was significantly associated with a decreased risk for both RA subsets. Postmenopausal women had an increased risk of seronegative RA, but they had no association with the onset of seropositive RA. Women with a long duration of postmenopausal hormone therapy (PMH) had an increased risk of seropositive RA in the NHS. Finally, in the EIRA study, postmenopausal women who were currently using PMH at onset of their disease had a decreased risk of ACPA-positive RA. This decreased risk was mainly observed among women aged 50-59 years, with a short duration of use (<7 years), and only among users of a combined therapy of estrogen and progestogens. Further research is required to explore the biological mechanisms behind our findings, but our results contribute to the knowledge of hormonal/reproductive factors, and their impact on the serological phenotypes of RA.
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| 4. |
- Pikwer, Mitra, et al.
(author)
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Parity influences the severity of ACPA-negative early rheumatoid arthritis : a cohort study based on the Swedish EIRA material
- 2015
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In: Arthritis Research & Therapy. - : Springer Science and Business Media LLC. - 1478-6362 .- 1478-6354. ; 17
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Journal article (peer-reviewed)abstract
- Background: In women with rheumatoid arthritis (RA) it has been observed that during pregnancy a majority of patients experience amelioration, but after delivery a relapse of the disease is common. However, there are few studies, with diverging results, addressing the effect of parity on the severity of RA over time. Our aim was to explore the impact of parity, with stratification for anti-citrullinated protein antibody (ACPA) status as well as for onset during reproductive age or not. Methods: Female RA cases aged 18-70 years were recruited for the Epidemiological Investigation of Rheumatoid Arthritis (EIRA). Information on disease severity (the health assessment questionnaire (HAQ) and the disease activity score 28 (DAS28)) was retrieved from the Swedish Rheumatology Quality Register at inclusion and 3, 6, 12 and 24 months after diagnosis. Mixed models were used to compare mean DAS28 and HAQ scores over time in parous and nulliparous women. Mean differences at individual follow-up visits were compared using analysis of covariance. The odds of having DAS28 or HAQ above the median in parous verus nulliparous women were estimated in logistic regression models. Results: A total of 1237 female cases (mean age 51 years, 65 % ACPA-positive) were included. ACPA-negative parous women, aged 18-44 years, had on average 1.17 units higher DAS28 (p < 0.001) and 0.43 units higher HAQ score (p < 0.001) compared to nulliparous women during the follow-up time, adjusted for age. In this subgroup, the average DAS28 and HAQ scores were significantly higher in parous women at all follow-up time points. Younger parous ACPA-negative women were significantly more likely to have DAS28 and HAQ values above the median compared to nulliparous women at all follow-up visits. No association between parity and severity of ACPA-positive disease was observed. Conclusions: Parity was a predictor of a more severe RA among ACPA-negative younger women, which might indicate that immunomodulatory changes during and after pregnancy affect RA severity, in particular for the ACPA-negative RA phenotype.
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