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  • 1. Agahi, Neda
    et al.
    Shaw, Ben
    Kåreholt, Ingemar
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Lennartsson, Carin
    Trajectories of social activities and mobility problems from middle to old age2012In: The 21st Nordic Congress of Gerontology, Dilemmas in Ageing Societies, Abstracts and Program, Copenhagen, Denmark, June 10th - 13th, 2012, 2012, p. 207-Conference paper (Refereed)
    Abstract [en]

    Objectives: To investigate how trajectories of social activities, suchas spending time with family and friends, observed during a34-year period (from middle age to old age) were associated withtrajectories of mobility problems during the same time periodamong men and women.Methods: Nationally representative data from the Swedish Levelof Living Survey (LNU) and the Swedish Panel Study of the OldestOld (SWEOLD) were used. LNU data from 1968, 1981, 1991 and2000 were merged with SWEOLD data from 1992 and 2002 tocreate a longitudinal dataset with four observation periodscovering the period 1968-2002. The sample consisted of thoseaged 40-60 years at baseline who survived through the period,and participated in at least three observation periods (n=698).Trajectories of social activity were identified through clusteranalysis, and then used as predictors of mobility trajectories inmultilevel regression models.Results: Most people had a socially active life as they moved frommiddle age into old age. Five trajectories of social activity wereidentified: continuously very active, continuously active,increasing social activity, decreasing social activity, and continuouslyinactive. Upholding a very active social life was morecommon among women than men.Mobility problems increased significantly over time for bothwomen and men. Among men, decreasing activity levels overtime were associated with a faster increase in mobility problems.Among women, those who were continuously inactive or whodecreased their activity levels had higher levels of mobilityproblems, but the increase in mobility problems with age wassimilar across trajectories of social activity.Conclusions: Most men and women had high levels of socialactivity in midlife, and continued their high activity levels into latelife. Decreasing social activity was related to worse mobility inboth men and women. The nature and direction of theseassociations need to be explored further.

  • 2. Ahacic, Kozma
    et al.
    Kennison, Robert F.
    Kåreholt, Ingemar
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Changes in sobriety in the Swedish population over three decades: age, period or cohort effects?2012In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 107, no 4, p. 748-755Article in journal (Refereed)
    Abstract [en]

    Aims: This study aimed to examine age, cohort and period trends in alcohol abstinence.

    Design: Two surveys, the Level of Living Survey collected in 1968, 1974, 1981, 1990 and 2000, and the Swedish Panel Study of the Oldest Old (SWEOLD) collected in 1992 and 2002, were studied with graphical depictions of cross-sectional and longitudinal data presented over time and over age. Cross-sectional 10-year age group differences, time-lag differences between waves and within-cohort differences between waves for 10-year birth cohorts were examined. Logistic regression models were applied to confirm the observed patterns.

    Setting: The samples were representative of the Swedish population.

    Participants: Participants ranged in age from 18 to 75 (n = 5000 per wave), and 77+ at later waves (n = 500).

    Measurements: Alcohol abstinence was determined by asking 'Do you ever drink wine, beer, or spirits?', where a 'no' response indicated abstinence.

    Findings: Decreases in abstinence rates were observed from 1968 to 2000/02. While cross-sectional analysis indicated increased abstinence with advancing age, the longitudinal analysis suggested otherwise. Inspection of cohort differences revealed little change within cohorts and large differences between cohorts; abstinence rates declined in later-born cohorts up to the 1940s birth cohorts; stability was observed in cohorts born since the 1940s. Logistic regression models indicated that neither age nor period were significant (P > 0.05) predictors of abstinence when cohort (P < 0.001) was included.

    Conclusion: Decreasing proportions of total alcohol abstainers in Sweden from 1968 to 2000 appear to be attributable primarily to decreases in successive cohorts rather than drinkers becoming abstainers.

  • 3. Ahacic, Kozma
    et al.
    Trygged, Sven
    Kåreholt, Ingemar
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Income and education as predictors of stroke mortality after the survival of a first stroke2012In: Stroke Research and Treatment, ISSN 2090-8105, E-ISSN 2042-0056Article in journal (Refereed)
    Abstract [en]

    Background: It is well known that socioeconomic indicators, such as income and education, predict both stroke incidence and stroke mortality. This means that persons in lower socioeconomic positions are less likely to survive their stroke, and there will be a selective survival in the group discharged from hospital after their first stroke.

    Question: Does socioeconomic position continue to predict mortality, stroke specific, or from other causes, among patients surviving their first stroke in spite of this selective survival?

    Methods: All persons in Sweden aged 40–59 years who were discharged after a first hospitalization for stroke in 1996–2000 were included (n = 10,487), then followed up until the end of the fourth calendar year after discharge. Data were analysed with Cox regressions controlling for age, sex, and stroke type.

    Results: Persons with high socioeconomic position, measured by education and income, have lower mortality than those of low position. Education was not significant when adjusted for income, however. The risk of dying was similar for stroke-specific mortality and all-cause mortality, for those with cerebral infarction as well as for all patients.

    Conclusions: Socioeconomic position predicted stroke-specific mortality also in the selective group of persons who survived their first stroke.

  • 4.
    Ahlström, Gerd
    Jönköping University, School of Health Science.
    Research Outcomes about Coping in Swedish populations: the Ways of Coping Questionnaire (WCQ)2009In: / [ed] Mehdi Ghazinour, Department of social work, Umeå University, Umeå University, 2009, p. 1-Conference paper (Refereed)
    Abstract [en]

    The lecture will present an overview of the development and results from the Swedish version of the WCQ. The process of translation of the original questionnaire into Swedish is described as well as the results of the first Swedish study about coping with illness-related problems in persons with chronic diseases compared with a group healthy subjects. The first findings indicated the importance of further testing of the psychometric properties of the WCQ. Further psychometric evaluation of the WCQ included 510 subjects (patients, their next of kin and students). The result indicated modest support for the 8-factor model and deviation from equality of factor structures among the sub-samples. The 8-factor model was more adequate in describing clinical than non-clinical samples. A modification of the WCQ with a version of 45 items was made based on the results, which is now current in several studies.

  • 5. Andel, Ross
    et al.
    Silverstein, Merril
    Kåreholt, Ingemar
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Occupational and Leisure Time Engagement at Midlife and Cognitive Functioning in Advanced Old Age2012In: The 21st Nordic Congress of Gerontology, Dilemmas in Ageing Societies, Abstracts and Program, Copenhagen, Denmark, June 10th - 13th, 2012, 2012Conference paper (Refereed)
  • 6. Arvidsson, H
    et al.
    Hultsjö, S
    Needs and care of migrants considered as severely mentally ill--cross-sectional and longitudinal studies of a Swedish sample.2009In: European psychiatry : the journal of the Association of European Psychiatrists, ISSN 1778-3585, Vol. 24, no 8, p. 533-9Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Higher incidence of mental illnesses and less access to care is previously reported concerning migrants but few studies focus on the needs and care of migrant groups in psychiatry. The aim of this study was to compare differences in needs and care between migrant and nonmigrant groups of severely and persistently mentally ill (SMI) after the 1995 Swedish mental health care reform.

    METHODS: In a Swedish area, inventories were made in 2001 and 2006 of persons considered as SMI. These persons were interviewed and their needs were assessed. In a cross-sectional study in 2006, needs and care were compared between migrants and nonmigrants. In a longitudinal study, migrants and nonmigrants interviewed in both 2001 and 2006 were compared concerning the development of needs and care.

    RESULTS: The needs of the migrant group were less taken care of. In 2006, there were more unmet needs in this group concerning accommodation, physical health, psychological distress, basic education and economy.

    CONCLUSION: The improvement of groups considered as SMI concerning functional disability and efforts of care found in the actual area did not seem to include the migrant group, at least not to the same degree.

  • 7.
    Augustine, Lilly
    et al.
    Statens folkhälsoinstitut.
    Ljungdahl, Sofia
    Statens folkhälsoinstitut.
    Bremberg, Sven
    Statens folkhälsoinstitut.
    Är depression en klassfråga? En systematisk litteraturöversikt över kopplingen mellan social klass och depression2008Report (Other academic)
  • 8.
    Augustine, Lilly
    et al.
    Jönköping University, School of Education and Communication, HLK, CHILD. Kristianstad University, Sweden.
    Lygnegård, Frida
    Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Granlund, Mats
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Social Work. Jönköping University, School of Education and Communication, HLK, CHILD. Jönköping University, School of Health and Welfare, HHJ. CHILD. Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue).
    Adolfsson, Margareta
    Jönköping University, School of Education and Communication, HLK, CHILD.
    Linking youths’ mental, psychosocial, and emotional functioning to ICF-CY: Lessons learned2018In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 40, no 19, p. 2293-2299Article in journal (Refereed)
    Abstract [en]

    Purpose: Linking ready-made questionnaires to codes within the International Classification of Functioning, Disability and Health, Children and Youth Version with the intention of using the information statistically for studying mental health problems can pose several challenges. Many of the constructs measured are latent, and therefore, difficult to describe in single codes. The aim of this study was to describe and discuss challenges encountered in this coding process.

    Materials and methods: A questionnaire from a Swedish research programme was linked to the International Classification of Functioning, Disability and Health, Children and Youth Version and the agreement was assessed.

    Results: Including the original aim of the questionnaire into the coding process was found to be very important for managing the coding of the latent constructs of the items. Items from the International Classification of Functioning, Disability and Health, Children and Youth Version chapters with narrow definitions for example mental functions, were more easily translated to meaningful concepts to code, while broadly defined chapters, such as interactions and relationships, were more difficult.

    Conclusion: This study stresses the importance of a clear, predefined coding scheme as well as the importance of not relying too heavily on common linking rules, especially in cases when it is not possible to use multiple codes for a single item.

    • Implications for rehabilitation
    • The International Classification of Functioning, Disability and Health, Children and Youth Version, is a useful tool for merging assessment data from several sources when documenting adolescents’ mental functioning in different life domains.

    • Measures of mental health are often based on latent constructs, often revealed in the description of the rationale/aim of a measure. The latent construct should be the primary focus in linking information.

    • By mapping latent constructs to the International Classification of Functioning, Disability and Health, Children and Youth Version, users of the classification can capture a broad range of areas relevant to everyday functioning in adolescents with mental health problems.

    • The subjective experience of participation, i.e., the level of subjective involvement, is not possible to code into the International Classification of Functioning, Disability and Health, Children and Youth Version. However, when linking mental health constructs to the International Classification of Functioning, Disability and Health, Children and Youth Version codes, the two dimensions of participation (the being there, and the level of involvement) need to be separated in the linking process. This can be performed by assigning codes focusing on being there as separate from items focusing on the subjective experience of involvement while being there.

  • 9.
    Berg Lissel, Elin
    et al.
    Jönköping University, School of Health Science, HHJ. Prosthetics and Orthotics. Jönköping University, School of Health Science, HHJ, Dep. of Rehabilitation.
    Fredriksson, Erika
    Jönköping University, School of Health Science, HHJ. Prosthetics and Orthotics. Jönköping University, School of Health Science, HHJ, Dep. of Rehabilitation.
    Magnusson, Lina
    Jönköping University, School of Health Science, HHJ. Prosthetics and Orthotics. Jönköping University, School of Health Science, HHJ, Dep. of Rehabilitation.
    Living With A Physical Disability In Malawi: A Prosthetic And Orthotic Patient Perspective2013Conference paper (Refereed)
    Abstract [en]

    Introduction:Malawi is located in south-east Africa, 53% of the population live below the poverty line. Few studies have specifically investigated the situation for people with physical disabilities in Malawi. The aim of this study was to explore the opinions and feelings of how it is to live with a physical disability in Malawi from a prosthetic and orthotic patient perspective.

    Methods:A qualitative study using individual semi-structure interviews for data collection was performed with 16 patients, men and women with physical disabilities receiving services from the prosthetic and orthotic centre in Lilongwe, Malawi. Data were analysed using content analysis.

    Results:Six categories emerged from the data. People with physical disabilities felt independent and wanted to take care of themselves. They experienced mainly positive attitudes and encouragement from others. They had a positive view of life, but the disability affected their life situation. Contact with other people with physical disabilities was requested for support and experience-sharing. The major concern was work and the financial situation. Ability to work was important to meet basic needs and for the feeling of independence. Negative attitudes were a result of poor knowledge.

    DiscussionThe study showed a clear need of creating work opportunities specifically for people with physical disabilities, since having a job was found important for many reasons. Support programs profiled to help and strengthen people with physical disabilities in Malawi would be beneficial for them to access the labour market. Spreading knowledge and information about physical disabilities and orthopedic devices is a key issue to create a better understanding and to change people ́s attitudes.

    Conclusions:Work was important for the feeling of freedom, independence and for the self-image. Negative attitudes were uncommon, but when seen they were a result of poor knowledge about causes of disability and the situation for these people.

  • 10.
    Björck-Åkesson, Eva
    et al.
    Jönköping University, School of Education and Communication, HLK, CHILD.
    Wilder, Jenny
    Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Granlund, Mats
    Jönköping University, School of Health and Welfare, HHJ. CHILD. Jönköping University, School of Education and Communication, HLK, CHILD.
    Pless, Mia
    Simeonsson, Rune
    Jönköping University, School of Education and Communication, HLK, CHILD.
    Adolfsson, Margareta
    Jönköping University, School of Education and Communication, HLK, CHILD.
    Almqvist, Lena
    Jönköping University, School of Education and Communication, HLK, CHILD.
    Augustine, Lilly
    Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Klang, Nina
    Lillvist, Anne
    The international classification of functioning, disability and health and the version for children and youth as a tool in child habilitation/early childhood intervention: feasibility and usefulness as a common language and frame of reference for practice2010In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 32, no S1, p. 125-138Article in journal (Refereed)
    Abstract [en]

    Early childhood intervention and habilitation services for children with disabilities operate on an interdisciplinary basis. It requires a common language between professionals, and a shared framework for intervention goals and intervention implementation. The International Classification of Functioning, Disability and Health (ICF) and the version for children and youth (ICF-CY) may serve as this common framework and language. This overview of studies implemented by our research group is based on three research questions: Do the ICF-CY conceptual model have a valid content and is it logically coherent when investigated empirically? Is the ICF-CY classification useful for documenting child characteristics in services? What difficulties and benefits are related to using ICF-CY model as a basis for intervention when it is implemented in services? A series of studies, undertaken by the CHILD researchers are analysed. The analysis is based on data sets from published studies or master theses. Results and conclusion show that the ICF-CY has a useful content and is logically coherent on model level. Professionals find it useful for documenting children's body functions and activities. Guidelines for separating activity and participation are needed. ICF-CY is a complex classification, implementing it in services is a long-term project.

  • 11.
    Björklund, Margereth
    Högskolan Kristianstad, Sektionen för hälsa och samhälle.
    Living with head and neck cancer: a health promotion perspective - a qualitative study2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background and aim: In society there is a growing awareness that a vital factor for patientswith chronic diseases, such as head and neck cancer (HNC), is how well they are able to function in their every day lives – a common, but often overlooked, public health issue. The overall aim of this thesis is to reach a deeper understanding of living with HNC and to identify the experiences that patients felt promoted their health and well-being. It also explores the patients' experiences of contact and care from health professionals and whether these encounters could increase their feelings of health and well-being; salutogenic approach.

    Methods: This thesis engages a qualitative data design. On three occasions, 35 purposivelyselected patients were interviewed (31 from Sweden and one from Denmark, Finland, Island, and Norway). The first study was conducted in the Nordic counties (I), and the remainingstudies were conducted in Sweden (II, III, IV). Interviews were performed on a single basis(I, II, III) and then repeated (IV). The individual, semi-structured qualitative interviews usedopen-ended questions (n=53). Three different forms of analyses were used: critical incident technique (I), thematic content analysis (II), latent content analysis (III), and interpretativedescriptive analysis (paper IV).

    Findings: Living with head and neck cancer was expressed as living in captivity, in the sensethat patients' sometimes life-threatening symptoms were constant reminders of the disease. The patients experienced a threat against identity and existence. Patients struggled to find power and control over everyday life, and if successful this appeared to offer them better health and well-being along with spiritual growth. The general understanding was that these patients had strong beliefs in the future despite living on a virtual rollercoaster. The patients went through a process of interplay of internal and external enabling that helped them acquire strength and feelings of better health and well-being. Consequently, they found power and control from inner strength and other health resources, e.g. social networks, nature, hobbies, activity, and health professionals. However, the findings also revealed the opposite; that some patients were more vulnerable and felt powerless and faced everyday life with emotional and existential loneliness. They were dependent on next of kin and health professionals. Having good interpersonal relationships and emotional support 24 hours a day from next of kin were crucial, as were health promoting contacts and care from health professionals. This health promoting contact and care built on working relationships with competent health professionals that were available, engaged, respectful, validating, and, above all experienced in the treatment phase. But many patients experienced not health promoting contact and care – and a sense of not being respected, or even believed. Added were the patients' experiences of inadequate coordination between phases of their lengthy illness trajectory. They felt lost and abandoned by health services, especially before and after treatment.

    Conclusions: Inner strength, good relationships with next of kin, nature, hobbies, andactivities could create strength and a sense of better health and well-being. Patients experienced a mutual working relationship during dialoguing and sensed co-operation and equality in encounters with competent health professionals. This could lead to enhanced power and control i.e. empowerment in a patient's everyday life. The findings highlight psychosocial rehabilitation in a patient-centred organisation when health professionals supportpatients' inner strength and health resources , and also offer long-term support to next of kin.Finally, this research suggests that if health professionals could gain a deeper understanding of the psychosocial, existential, social, and economic questions on patients' minds, they could better sense how patients feel and would be better equipped not only to offer greater support, but to raise their voices to improve health policy and health care for these patients. 

  • 12.
    Bokenberger, Kathleen
    et al.
    Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden.
    Sjölander, Arvid
    Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden.
    Dahl Aslan, Anna K.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden.
    Karlsson, Ida K.
    Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden.
    Åkerstedt, Torbjörn
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Pedersen, Nancy Lee
    Department of Psychology, University of Southern California, Los Angeles, United States.
    Shift work and risk of incident dementia: a study of two population-based cohorts2018In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 33, no 10, p. 977-987Article in journal (Refereed)
    Abstract [en]

    This study aimed to investigate the association between shift work and incident dementia in two population-based cohorts from the Swedish Twin Registry (STR). The STR-1973 sample included 13,283 participants born 1926–1943 who received a mailed questionnaire in 1973 that asked about status (ever/never) and duration (years) of shift work employment. The Screening Across the Lifespan Twin (SALT) sample included 41,199 participants born 1900–1958 who participated in a telephone interview in 1998–2002 that asked about night work status and duration. Dementia diagnoses came from Swedish patient registers. Cox proportional-hazards regression was used to estimate hazard ratios (HR) with 95% confidence intervals (CI). Potential confounders such as age, sex, education, diabetes, cardiovascular disease and stroke were included in adjusted models. In genotyped subsamples (n = 2977 in STR-1973; n = 10,366 in SALT), APOE ε4 status was considered in models. A total of 983 (7.4%) and 1979 (4.8%) dementia cases were identified after a median of 41.2 and 14.1 years follow-up in the STR-1973 and SALT sample, respectively. Ever shift work (HR 1.36, 95% CI 1.15–1.60) and night work (HR 1.12, 95% CI 1.01–1.23) were associated with higher dementia incidence. Modest dose-response associations were observed, where longer duration shift work and night work predicted increased dementia risk. Among APOE ε4 carriers, individuals exposed to ≥ 20 years of shift work and night work had increased dementia risk compared to day workers. Findings indicate that shift work, including night shift work, compared to non-shift jobs is associated with increased dementia incidence. Confirmation of findings is needed. 

  • 13.
    Bouillon, Kim
    et al.
    Department of Epidemiology and Public Health, University College London, London, UK.
    Kivimäki, Mika
    Department of Epidemiology and Public Health, University College London, London, UK.
    Hamer, Mark
    Department of Epidemiology and Public Health, University College London, London, UK.
    Sabia, Severine
    Department of Epidemiology and Public Health, University College London, London, UK.
    Fransson, Eleonor
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Singh-Manoux, Archana
    Department of Epidemiology and Public Health, University College London, London, UK.
    Gale, Catharine R.
    MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
    Batty, G. David
    Department of Epidemiology and Public Health, University College London, London, UK.
    Measures of frailty in population-based studies: An overview2013In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 13, no 64Article in journal (Refereed)
    Abstract [en]

    Background: Although research productivity in the field of frailty has risen exponentially in recent years, there remains a lack of consensus regarding the measurement of this syndrome. This overview offers three services: first, we provide a comprehensive catalogue of current frailty measures; second, we evaluate their reliability and validity; third, we report on their popularity of use.

    Methods: In order to identify relevant publications, we searched MEDLINE (from its inception in 1948 to May 2011); scrutinized the reference sections of the retrieved articles; and consulted our own files. An indicator of the frequency of use of each frailty instrument was based on the number of times it had been utilized by investigators other than the originators.

    Results: Of the initially retrieved 2,166 papers, 27 original articles described separate frailty scales. The number (range: 1 to 38) and type of items (range of domains: physical functioning, disability, disease, sensory impairment, cognition, nutrition, mood, and social support) included in the frailty instruments varied widely. Reliability and validity had been examined in only 26% (7/27) of the instruments. The predictive validity of these scales for mortality varied: for instance, hazard ratios/odds ratios (95% confidence interval) for mortality risk for frail relative to non-frail people ranged from 1.21 (0.78; 1.87) to 6.03 (3.00; 12.08) for the Phenotype of Frailty and 1.57 (1.41; 1.74) to 10.53 (7.06; 15.70) for the Frailty Index. Among the 150 papers which we found to have used at least one of the 27 frailty instruments, 69% (n = 104) reported on the Phenotype of Frailty, 12% (n = 18) on the Frailty Index, and 19% (n = 28) on one of the remaining 25 instruments.

    Conclusions: Although there are numerous frailty scales currently in use, reliability and validity have rarely been examined. The most evaluated and frequently used measure is the Phenotype of Frailty.

  • 14.
    Cernerud, Lars
    et al.
    Mälardalens högskola.
    Keller, Christina
    Jönköping University, Jönköping International Business School, JIBS, Business Informatics.
    Modell för kvalitetsbedömning av högskoleutbildningar i folkhälsovetenskap2000In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 77, no 2, p. 122-125Article in journal (Refereed)
  • 15.
    Cordier, Reinie
    et al.
    School of Occupational Therapy and Social Work, Curtin University, Perth, WA, Australia.
    Wilson, Nathan J.
    School of Nursing and Midwifery, University of Western Sydney, Richmond, NSW, Australia.
    Stancliffe, Roger J.
    Intellectual Disability, University of Sydney, Lidcombe, NSW, Australia .
    MacCallum, Judith
    School of Education, Murdoch University, Perth, WA, Australia .
    Vaz, Sharmila
    School of Occupational Therapy and Social Work, Curtin University, Perth, WA, Australia.
    Buchanan, Angus
    School of Occupational Therapy and Social Work, Curtin University, Perth, WA, Australia.
    Ciccarelli, Marina
    School of Occupational Therapy and Social Work, Curtin University, Perth, WA, Australia.
    Falkmer, Torbjörn
    Jönköping University, School of Health and Welfare, HHJ. CHILD. Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. School of Occupational Therapy and Social Work, Curtin University, Perth, WA, Australia.
    Formal intergenerational mentoring at Australian Men's Sheds: a targeted survey about mentees, mentors, programmes and quality2016In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, Vol. 24, no 6, p. e131-e143Article in journal (Refereed)
    Abstract [en]

    Intergenerational mentoring enables a purposeful exchange of skills and knowledge to enhance individual and social outcomes for sub-groups at risk of health and social disparities. Male intergenerational mentoring may be an approach to help address these disparities in young men. Over 1000 Men's Sheds operate in Australia with 39% providing some form of mentoring mainly to youth. Yet, little is known about the variables intrinsic to creating and running quality programmes. This study aimed to identify the characteristics of formal intergenerational mentoring programmes, review their quality against the Australian Youth Mentoring Network (AYMN) quality benchmarks, and identify the factors that predict quality in these programmes. All known Australian Men's Sheds were invited to participate in an online cross-sectional survey. Forty sheds with formal mentor programmes completed the survey for a total of 387 mentees (mean = 9.7 mentees/programme), the majority being male. The majority of mentor programme facilitators were unpaid male volunteers aged 61 years and older, and programmes were unfunded. Promoting social and emotional well-being of the mentees was the primary focus in more than half of the programmes, and working on a shared construction project was the most common activity. Respondents rated the three most important factors that influenced programme effectiveness as being: (i) meaningful activities; (ii) mentors’ approach; and (iii) a safe environment. Univariate analyses revealed that mentoring programmes that had a system in place for screening mentors, trained mentors and evaluated the programme were most likely to rate highly against the AYMN quality benchmarks. 

  • 16.
    Dahl, Anna
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health. Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Fauth, Elizabeth
    Department of Family, Consumer, and Human Development, Utah State University, Logan, Utah.
    Ernsth-Bravell, Marie
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Hassing, Linda
    University of Gothenburg.
    Ram, Nilam
    Department of Human Development and Family Studies, Pennsylvania State University, University Park, Pennysylvania.
    Gerstorf, Denis
    Department of Psychology, Humboldt University, Berlin, Germany.
    Body Mass Index, Change in Body Mass Index, and Survival in Old and Very Old Persons2013In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 61, no 4, p. 512-518Article in journal (Refereed)
    Abstract [en]

    Background: Current recommendations from the World Health Organization (WHO) are that individuals should seek to maintain a body mass index (BMI) between 18.5-25 kg/m2, independent of age. However, there is an ongoing discussion whether the WHO recommendations apply to old (70 ≥ 80 years) and very old persons (80+ years). In the present study we examine how BMI status and change in BMI are associated with mortality among old and very old individuals.

    Design: Pooled data from three multidisciplinary prospective population-based studies OCTO-twin, GENDER, and NONA.

    Setting: Sweden.

    Participants: 882 individuals aged 70 to 95 years.

    Measurements: Body Mass Index was calculated from measured height and weight as kg/m2. Information about survival status and time of death was obtained from Swedish Civil Registration System

    Results: Mortality hazard was 20% lower for the overweight group relative to the normal/underweight group (RR = 0.80, p < .05), and the mortality hazard for the obese group did not differ significantly from the normal/underweight group (RR = 0.93, > .10), independent of age, education, and multimorbidity. Furthermore, mortality hazard was 141% higher for the BMI loss group relative to the BMI stable group (RR = 1.65, p < .05); and 178% higher for the BMI gain group relative to BMI stable group (RR = 1.53, p < .05).  However, the BMI change differences were moderated by age, i.e. the higher mortality risks associated with both loss in BMI and BMI gain were less severe in very old age.

    Conclusion: Old persons who were overweight had a decreased mortality risk compared to old persons having a BMI below 25, even after controlling for weight change and multimorbidity. Compared to persons who had a stable BMI those who increased or decreased in BMI had a higher mortality risk, particularly among people aged 70 to 80. This study lends further support for the opinion that the WHO guidelines are overly restrictive in old age.

  • 17.
    Dahl, Anna
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health. Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Reynolds, Chandra A.
    Deparment of Psychology, University of California – Riverside, Riverside, United States of America.
    Accuracy of Recalled Body Weight-A Study with 20-years of Follow-Up2013In: Obesity, ISSN 1930-7381, E-ISSN 1930-739X, Vol. 21, no 6, p. 1293-1298Article in journal (Refereed)
    Abstract [en]

    Objective:

    Weight changes may bean important indicator of an ongoing pathological process.Retrospective self-report might be the only possibility to capture prior weight. The objective of the study was to evaluate the accuracy of retrospective recallof body weight in old age and factors that might predict accuracy.

    Design and Methods:

    In 2007, 646 participants (mean age, 71.6 years) of the Swedish Adoption/Twin Study of Aging (SATSA)answered questions about their present weight and how much they weighed 20-years ago. Of these, 436 had self-reported their weighttwenty years earlier and among these 134 had also had their weight assessed at this time point.

    Results:

    Twenty yearretrospectively recalled weight underestimated the prior assessed weight by -1.89 ± 5.9 kg and underestimatedprior self-reported weight by -0.55 ±5.2 kg.Moreover, 82.4% of the sample were accurate within 10%, and 45.8% were accurate within 5% of their prior assessed weights;similarly, 84.2% and 58.0 %were accurate within 10% and 5% respectively, forprior self-reported weight. Current higher body mass index and preferences of reporting weights ending with zero or five was associated with an underestimation of prior weight, while greater weight change over 20 year, and low Mini-Mental State Scores (MMSE) (<25) led to an overestimation of prior weight.

    Conclusions:

    Recalled weight comes close to the assessed population mean, but at the individual level there is a large variation. The accuracy is affected by current BMI, changes in weight, end-digit preferences, and current cognitive ability. Recalled weight should be used with caution.

  • 18.
    Dahl, Anna
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health. Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Reynolds, Chandra
    Department of Psychology, University of California Riverside, Riverside, CA 92521, USA.
    Fall, Tove
    Uppsala University.
    Magnusson, Patrik
    Karolinska Institutet.
    Pedersen, Nancy
    Karolinska Institutet.
    Multifactorial analysis of changes in body mass index across the adult life course: a study with 65 years of follow-up2014In: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 38, no 8, p. 1133-1141Article in journal (Refereed)
    Abstract [en]

    Background: Although the negative consequences on health of being obese are well known, most adults gain weight across the lifespan. The general increase in body mass index (BMI) is mainly considered to originate from behavioral and environmental changes; however, few studies have evaluated the influence of these factors on change in BMI in the presence of genetic risk. We aimed to study the influence of multifactorial causes of change in BMI, over 65 years.

    Methods and Findings: Totally, 6130 participants from TwinGene, who had up to five assessments, and 536 from the Swedish Adoption/Twin Study of Aging, who had up to 12 assessments, ranging over 65 years were included. The influence of lifestyle factors, birth cohort, cardiometabolic diseases and an individual obesity genetic risk score (OGRS) based on 32 single nucleotide polymorphisms on change in BMI was evaluated with a growth model. For both sexes, BMI increased from early adulthood to age of 65 years, after which the increase leveled off; BMI declined after age of 80 years. A higher OGRS, birth after 1925 and cardiometabolic diseases were associated with higher average BMI and a steeper increase in BMI prior to 65 years of age. Among men, few factors were identified that influence BMI trajectories in late life, whereas for women type 2 diabetes mellitus and dementia were associated with a steeper decrease in BMI after the age of 65 years.

    Conclusions: There are two turning points in BMI in late adulthood, one at the age of 65 years and one at the age 80 years. Factors associated with an increase in BMI in midlife were not associated with an increase in BMI after the age of 65 years. These findings indicate that the causes and consequences of change in BMI differ across the lifespan. Current health recommendations need to be adjusted accordingly.

  • 19.
    Dahl Aslan, Anna K.
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Starr, John M.
    Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh.
    Pattie, Alison
    Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh.
    Deary, Ian
    Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh.
    Cognitive consequences of overweight and obesity in the ninth decade of life?2015In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 44, no 1, p. 59-65Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/OBJECTIVES: the association between late-life obesity and late-life cognitive abilities is poorly understood. We studied the association between body mass index (BMI) and cognitive change in longitudinal population-based study spanning over the ninth decade of life.

    SUBJECTS/METHODS: in total, 475 participants free of dementia at baseline from the Lothian Birth Cohort 1921 (mean age: 79.1 years, SD: 0.6) were included. Height and weight were assessed at baseline. BMI was calculated as kg/m(2). Cognitive abilities were assessed at age ∼11 years and at age ∼79, ∼83, ∼87 and ∼90 years.

    RESULTS: latent growth models showed that men being overweight and obese had a 0.65 (SD: 0.3) and 1.10 (SD: 0.5) points less steep decline in general cognitive ability (as measured by the Moray House Test) for each year than people of normal weight. These associations were to some extent confounded by childhood intelligence. No other association between BMI and cognition was significant, either for men or women. People who were obese in old age had significantly lower childhood intelligence (m = 43.6, SD: 1.3) than people who were normal in weight (m = 47.0, SD: 0.8) and persons being overweight (m = 47.5, SD: 0.8), F (472, 3) = 3.2, P = 0.043.

    CONCLUSIONS: the current study shows weak or no evidence for an association between BMI in old age and cognitive function, especially not when childhood intelligence is controlled for. Lower intelligence at the age of 11 years predicted obesity at the age of 79 years.

  • 20.
    Dahlin, Sofia
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Jämlikt stöd för jämlik hälsa: En fallstudie av förbättringsmetodik i primärvårdens hälsofrämjande arbete för jämlik hälsa2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
  • 21.
    Darin-Mattsson, Alexander
    et al.
    Aging Research Center (ARC), Karolinska Institutet/Stockholm University, Sweden.
    Andel, Ross
    University of South Florida and International Clinical Research Center, Tampa, USA.
    Celeste, Roger Keller
    Federal University of Rio Grande do Sul, Faculdade de Odontologia, Department Preventive and Social Dentistry, Porto Alegre, Brazil.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Aging Research Center (ARC), Karolinska Institutet/Stockholm University, Sweden.
    Linking financial hardship throughout the life-course with psychological distress in old age: Sensitive period, accumulation of risks, and chain of risks hypotheses.2018In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Elsevier, Vol. 201, p. 111-119Article in journal (Refereed)
    Abstract [en]

    The primary objective was to investigate the life course hypotheses - sensitive period, chain of risks, and accumulation of risks - in relation to financial hardship and psychological distress in old age. We used two Swedish longitudinal surveys based on nationally representative samples. The first survey includes people 18-75 years old with multiple waves, the second survey is a longitudinal continuation, including people 76 + years old. The analytical sample included 2990 people at baseline. Financial hardship was assessed in childhood (retrospectively), at the mean ages of 54, 61, 70, and 81 years. Psychological distress (self-reported anxiety and depressive symptoms) was assessed at the same ages. Path analysis with WLSMV estimation was used. There was a direct path from financial hardship in childhood to psychological distress at age 70 (0.26, p = 0.002). Financial hardship in childhood was associated with increased risk of psychological distress and financial hardship both at baseline (age 54), and later. Financial hardship, beyond childhood, was not independently associated with psychological distress at age 81. Higher levels of education and employment decreased the negative effects of financial hardship in childhood on the risk of psychological distress and financial hardship later on. There was a bi-directional relationship between psychological distress and financial hardship; support for health selection was slightly higher than for social causation. We found that psychological distress in old age was affected by financial hardship in childhood through a chain of risks that included psychological distress earlier in life. In addition, financial hardship in childhood seemed to directly affect psychological distress in old age, independent of other measured circumstances (i.e., chains of risks). Education and employment could decrease the effect of an adverse financial situation in childhood on later-life psychological distress. We did not find support for accumulation of risks when including tests of all hypotheses in the same model.

    The full text will be freely available from 2019-02-17 00:00
  • 22.
    Darin-Mattsson, Alexander
    et al.
    Karolinska Institutet, Solna, Sweden; Stockholm University, Sweden .
    Andel, Ross
    School af Aging Studies, University of South Florida, Tampa, USA; International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic .
    Fors, Stefan
    Karolinska Institutet, Solna, Sweden; Stockholm University, Sweden.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Karolinska Institutet, Solna, Sweden; Stockholm University, Sweden.
    Are Occupational Complexity and Socioeconomic Position Related to Psychological Distress 20 Years Later?2015In: Journal of Aging and Health, ISSN 0898-2643, E-ISSN 1552-6887, Vol. 27, no 7, p. 1266-1285Article in journal (Refereed)
    Abstract [en]

    Objective: To assess occupational complexity in midlife in relation to psychological distress in older adulthood (69+ years) and explore the role of socioeconomic position.

    Method: Baseline data from the Swedish Level of Living Survey and follow-up data from the Swedish Longitudinal Study ofLiving Conditions of the Oldest Old were combined, resulting in 20+ years of follow-up. Data were analyzed using ordered logistic regressions.

    Results: Higher occupational complexity was associated with less psychological distress 20 years later adjusted for age, sex, follow-up year, hours worked the year before baseline, and psychological distress at baseline. Higher socioeconomic position yielded the same pattern of results. Socioeconomic position partially accounted for the association between occupational complexity and psychological distress.

    Discussion: With social gradient not easily amenable to modification, efforts to increase engagement at work may offer a viable option to attenuate the influence of work environment on psychological distress later in life.

  • 23.
    Darin-Mattsson, Alexander
    et al.
    Aging Research Centre (ARC), Karolinska Institutet, Stockholm University, Sweden.
    Fors, Stefan
    Aging Research Centre (ARC), Karolinska Institutet, Stockholm University, Sweden.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Aging Research Centre (ARC), Karolinska Institutet, Stockholm University, Sweden.
    Different indicators of socioeconomic status and their relative importance as determinants of health in old age2017In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 16, no 1, article id 173Article in journal (Refereed)
    Abstract [en]

    Background: Socioeconomic status has been operationalised in a variety of ways, most commonly as education, social class, or income. In this study, we also use occupational complexity and a SES-index as alternative measures of socioeconomic status. Studies show that in analyses of health inequalities in the general population, the choice of indicators influence the magnitude of the observed inequalities. Less is known about the influence of indicator choice in studies of older adults. The aim of this study is twofold: i) to analyse the impact of the choice of socioeconomic status indicator on the observed health inequalities among older adults, ii) to explore whether different indicators of socioeconomic status are independently associated with health in old age.

    Methods: We combined data from two nationally representative Swedish surveys, providing more than 20 years of follow-up. Average marginal effects were estimated to compare the association between the five indicators of SES, and three late-life health outcomes: mobility limitations, limitations in activities of daily living (ADL), and psychological distress.

    Results: All socioeconomic status indicators were associated with late-life health; there were only minor differences in the effect sizes. Income was most strongly associated to all indicators of late-life health, the associations remained statistically significant when adjusting for the other indicators. In the fully adjusted models, education contributed to the model fits with 0-3% (depending on the outcome), social class with 0-1%, occupational complexity with 1-8%, and income with 3-18%.

    Conclusions: Our results indicate overlapping properties between socioeconomic status indicators in relation to late-life health. However, income is associated to late-life health independently of all other variables. Moreover, income did not perform substantially worse than the composite SES-index in capturing health variation. Thus, if the primary objective of including an indicator of socioeconomic status is to adjust the model for socioeconomic differences in late-life health rather than to analyse these inequalities per se, income may be the preferable indicator. If, on the other hand, the primary objective of a study is to analyse specific aspects of health inequalities, or the mechanisms that drive health inequalities, then the choice of indicator should be theoretically guided. 

  • 24.
    Darin-Mattsson, Alexander
    et al.
    Karolinska Institutet, Sweden.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Karolinska Institutet, Sweden.
    Andel, Ross
    University of South Florida, Tampa, USA.
    Economic hardship and income before retirement in relation to anxiety and depression in older adulthood. (2015) Work-related stress in midlife and all-cause mortality: the role of sense of coherence.2015In: Life Courses in Cross-­National Comparison: Similarities and Differences: Abstract book, 2015, p. 69-Conference paper (Refereed)
  • 25.
    Deogan, Charlotte
    et al.
    Karolinska Institutet, Public Health Sciences, Stockholm, Sweden.
    Zarabi, Natalie
    Dental and Pharmaceutical Benefits Agency, Stockholm, Sweden.
    Stenström, Nils
    National Board of Health and Welfare, Stockholm, Sweden.
    Cost-Effectiveness of School-Based Prevention of Cannabis Use2015In: Applied Health Economics and Health Policy, ISSN 1175-5652, E-ISSN 1179-1896, ISSN ISSN 1175-5652, Vol. 13Article in journal (Refereed)
    Abstract [en]

    Background: Cannabis is the most frequently used illicit drug globally. Despite increasing evidence that cannabis use is associated with adverse health effects, the knowledge on preventative strategies is still limited. This study stemmed from a systematic review of effective prevention in which school-based programmes were identified as promising. The primary objective was to evaluate the cost effectiveness of Project ALERT (Adolescent, Learning, Experiences, Resistance, and Training), compared with ordinary ATOD (Alcohol, Tobacco, and Other Drug) education, among Swedish students in the eighth grade of compulsory school.

    Methods: The cost-effectiveness analysis was performed from the societal perspective with quality-adjusted lifeyears (QALYs) as an outcome (willingness-to-pay threshold €50,000) and follow-up periods from 1 year to a lifetime, considering a discounting rate of 3 %, and with costs inflated to 2013 levels. A Markov model was constructed on the basis of the ‘states’ of single use, regular use, daily use and use of other illicit drugs, which were associated with ‘complications’ of psychosis, schizophrenia, traffic accidents, depression and amotivational syndrome. Health and cost consequences were linked to both states and complications.

    Results: The programme was cost saving on the basis of evidence from the USA (ratio 1:1.1), and was cost effective (incremental cost-effectiveness ratio €22,384 per QALY) after reasonable adjustment for the Swedish context and with 20 years of follow-up. When the target group was restricted to boys who were neither studying nor working/doing work experience, the programme was cost effective after 9 years and cost saving (ratio 1:3.2) after 20 years.

    Conclusion: School-based prevention such as Project ALERT has the potential to be cost effective and to be cost saving if implemented in deprived areas. In the light of the shifting landscape regarding legalization of cannabis, it seems rational to continue the health economic analysis of prevention initiated here.

  • 26. Dragano, Nico
    et al.
    Siegrist, Johannes
    Nyberg, Solja T
    Lunau, Thorsten
    Fransson, Eleonor I
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Alfredsson, Lars
    Bjorner, Jakob B
    Borritz, Marianne
    Burr, Hermann
    Erbel, Raimund
    Fahlén, Göran
    Goldberg, Marcel
    Hamer, Mark
    Heikkilä, Katriina
    Jöckel, Karl-Heinz
    Knutsson, Anders
    Madsen, Ida E H
    Nielsen, Martin L
    Nordin, Maria
    Oksanen, Tuula
    Pejtersen, Jan H
    Pentti, Jaana
    Rugulies, Reiner
    Salo, Paula
    Schupp, Jürgen
    Singh-Manoux, Archana
    Steptoe, Andrew
    Theorell, Töres
    Vahtera, Jussi
    Westerholm, Peter J M
    Westerlund, Hugo
    Virtanen, Marianna
    Zins, Marie
    Batty, G David
    Kivimäki, Mika
    Effort-reward imbalance at work and incident coronary heart disease: a multi-cohort study of 90,164 individuals2017In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 28, no 4, p. 619-626Article in journal (Refereed)
    Abstract [en]

    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 multi-cohort study (the 'IPD-Work' consortium) was based on harmonized individual-level data from 11 European prospective cohort studies. Stressful weappork 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 non-fatal 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, 1078 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 to 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.This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

  • 27.
    Elinder, Liselotte S.
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Heinemans, Nelleke
    Centre for Epidemiology and Community Medicine, Stockholm County Council, Solna, Sweden.
    Zeebari, Zangin
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Patterson, Emma
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Longitudinal changes in health behaviours and body weight among Swedish school children - Associations with age, gender and parental education - The SCIP school cohort2014In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, no 1, article id 640Article in journal (Refereed)
    Abstract [en]

    In order to develop health promotion initiatives it is important to identify at what age gender and socioeconomic inequalities in health-related behaviours emerge. The aim of this longitudinal study was to analyse how health-related behaviours and weight status differed by age-group, gender, family socio-economic status and over time in three cohorts of school children. Methods. All children in grades 2, 4 and 7 in a Swedish semi-urban municipality were invited to participate (n = 1,359) of which 813 (60%) consented. At baseline and after 2 years a health questionnaire was answered by all children. Height and weight was measured. Fourteen outcomes were analysed. The main and interaction effects of time, gender and parental educational level on the health-related behaviours, weight status and body mass index standard deviation score (BMIsds) were analysed by the Weighted Least Squares method for categorical repeated measures and Analysis of Variance. Results: Nine of 12 health behaviours deteriorated over the two years: consumption of breakfast and lunch, vegetables and fruit, intake of sweetened drinks, TV viewing, club membership, being outdoors, and school recess activity; two behaviours were unchanged: intake of sweets, and active transport. Only sports participation increased with time. Girls consumed more vegetables, less sweetened drinks, performed less sports, were less physically active during recess, and had lower BMIsds, compared to boys. Those with more highly educated parents had more favourable or similar behaviours compared to those with less educated parents in 10 out of 12 health behaviours, the only exception being intake of sweets and being outdoors, and had lower BMIsds. Conclusions: This study adds to our knowledge regarding the temporal development of health behaviours and weight status in school children. Differences with regard to gender and socioeconomic status were seen already at a young age. These results contribute to our understanding of several important determinants of obesity and chronic diseases and may inform future interventions regarding how to decrease gender and social inequalities in health.

  • 28.
    Erlandsson, Lena-Karin
    et al.
    Lunds universitet, avdelningen för arbetsterapi och gerontologi.
    Håkansson, Carita
    Jönköping University, School of Health Science, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work.
    Aspects of daily occupations that promote life balance among women in Sweden2009In: Life balance: Multidisciplinary theories and research, Thorofare: Slack incorporated , 2009, p. 115-130Chapter in book (Other academic)
    Abstract [en]

    The book is a unique text that offers empirical research and theories to a concept not yet recognized in the scientific community. Dr Kathleen Matuska and Dr Charles Christiansen, joined by Dr Helene Polatajko and Dr Jane Davies proficiently address the various ways to conceptualize life balance as distinguishable among other positive state constructs. Resulting from an informed discussion among international scientists who gathered for a discussion on life balance, this text compiles conceptual commonalities, associations, and discrepancies affiliated with life balance research. This groundbreaking and forward-thinking text implements a multidisciplinary approach to learning about life balance with contributions from psychological, sociological, occupational, economical, leisure, and family studies.

  • 29.
    Fagerström, Cecilia
    et al.
    Blekinge Center of Competence, Karlskrona, Sweden.
    Wranker, Lena Sandin
    Department of Health Sciences, Division of Geriatric Medicine, Lund University, Lund, Sweden.
    Kabir, Zarina Nahar
    Division of Nursing, NVS, Karolinska Institute, Stockholm, Sweden.
    Sternäng, Ola
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Stockholm Centre for Health and Social Change (SCOHOST), Södertörn University, Huddinge, Sweden.
    Everyday Health among Older People: A Comparison between Two Countries with Variant Life Conditions2017In: Journal of Aging Research, ISSN 2090-2204, E-ISSN 2090-2212, article id 2720942Article in journal (Refereed)
    Abstract [en]

    This study described health factors of importance for everyday health, such as pain, tiredness, and sleeping problems, in a cross-national context. Data for persons 60+ years were obtained from the Poverty and Health in Aging study, Bangladesh, and the Swedish National Study on Aging and Care-Blekinge. The strongest associations with everyday health in Sweden were found for pain and tiredness, while in Bangladesh they were financial status, tiredness, and sleeping problems. As similarities were found regarding the associations of tiredness on everyday health, tiredness may be a universal predictor of everyday health in older adults irrespective of country context.

  • 30.
    Falkenberg, Helena
    et al.
    Department of Psychology, Stockholm University.
    Fransson, Eleonor
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Westerlund, Hugo
    Stress Research Institute, Stockholm University.
    Head, Jenny
    University College London.
    Short- and long-term effects of major organisational change on minor psychiatric disorder and self-rated health: Results from the Whitehall II study2013In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 70, no 10, p. 688-696Article in journal (Refereed)
    Abstract [en]

    Objective To investigate short- and long-term effects of major organisational change on minor psychiatric disorder and self-rated health for women and men in different employment grades.

    Methods Minor psychiatric disorder and self-rated health among 6710 British civil servants (1993 women and 4717 men) in three employment grades from the Whitehall II study were examined from 1985 to 1988 under stable employment conditions. The short-term effects of organisational change were investigated in 1991–1993 after a time of major restructuring aiming at increasing the influence of market forces in the civil service and the long-term effects were investigated in 1997–1999.

    Results Those who had experienced organisational change and those who anticipated organisational change reported more negative short-term health effects (minor psychiatric disorder and poor self-rated health) compared with those who reported no change. No major differences were found depending on employment grade or gender. The negative health effects had diminished during 1997–1999 for those who reported that a major change had happened before 1991–1993. Those who anticipated an organisational change in 1991–1993 still reported more ill-health in 1997–1999 (both minor psychiatric disorder and self-reported health) than those in the comparison group.

    Conclusions The results indicate that organisational change affects employees’ health negatively in the short term but also that it is possible to recover from such negative effects. As it was not possible to discern any definite difference between the gender and grades, the results point at the importance of working proactively to implement organisational change for women and men at all levels.

  • 31.
    Falkstedt, D.
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Möller, J.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Zeebari, Zangin
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Engström, K.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Multiple health-risk behaviors in women and men with different socio-economic trajectories2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, p. 97-97Article in journal (Refereed)
  • 32.
    Falkstedt, Daniel
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Möller, Jette
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Zeebari, Zangin
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Engström, Karin
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Prevalence, co-occurrence, and clustering of health-risk behaviors among people with different socio-economic trajectories: A population-based study2016In: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 93, p. 64-69Article in journal (Refereed)
    Abstract [en]

    Only a few previously published studies have investigated the co-occurrence and clustering of health-risk behaviors in people with different socio-economic trajectories from childhood to adulthood. This study was based on data collected through the Stockholm County Council's public health surveys. We selected the 24,241 participants aged 30 to 65 years, who responded to a postal questionnaire in 2010. Information on parents' and participants' educational levels was used for classification of four socio-economic trajectories, from childhood to adulthood: the ‘stable high’, the ‘upwardly mobile’, the ‘downwardly mobile’, and the ‘stable low’. Information on daily smoking, risky drinking, physical inactivity, and poor diet was used for assessment of health-risk behaviors: their prevalence, co-occurrence, and clustering. We found all health-risk behaviors to be more prevalent among women and men with a downwardly mobile or stable low socio-economic trajectory. Accordingly, having three or four co-occurring health-risk behaviors were much more likely (up to 4 times, in terms of odds ratios) in these groups as compared to the women and men with an upwardly mobile or a stable high socio-economic trajectory. However, clustering of the health-risk behaviors was not found to be stronger in those with a downwardly mobile or stable low socio-economic trajectory. Thus, the fact that women and men with a disadvantageous socio-economic career were found to have co-occurring health-risk behaviors more often than people with an advantageous socio-economic career seemed to be generated by differences in prevalence of the health-risk behaviors, not by differences in clustering of the behaviors.

  • 33. Ferrie, Jane E.
    et al.
    Virtanen, Marianna
    Jokela, Markus
    Madsen, Ida E. H.
    Heikkilä, Katriina
    Alfredsson, Lars
    Batty, G. David
    Bjorner, Jakob B.
    Borritz, Marianne
    Burr, Hermann
    Dragano, Nico
    Elovainio, Marko
    Fransson, Eleonor I.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Kouvonen, Anne
    Kumari, Meena
    Nielsen, Martin L
    Nordin, Maria
    Oksanen, Tuula
    Pahkin, Krista
    Pejtersen, Jan H.
    Pentti, Jaana
    Salo, Paula
    Shipley, Martin J
    Suominen, Sakari B.
    Tabák, Adam
    Theorell, Töres
    Väänänen, Ari
    Vahtera, Jussi
    Westerholm, Peter J. M.
    Westerlund, Hugo
    Rugulies, Reiner
    Nyberg, Solja T.
    Kivimäki, Mika
    Job insecurity and risk of diabetes: a meta-analysis of individual participant data2016In: CMJA. Canadian Medical Association Journal. Onlineutg. Med tittel: ECMAJ. ISSN 1488-2329, ISSN 0820-3946, E-ISSN 1488-2329, Vol. 188, no 17-18, p. E447-E455Article in journal (Refereed)
    Abstract [en]

    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: I2 = 24%, p = 0.2; multivariable-adjusted model: I2 = 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.

  • 34.
    Fismen, Anne-Siri
    et al.
    Norge.
    Smith, Otto Robert Frans
    Norge.
    Torsheim, Torbjørn
    Norge.
    Rasmussen, Mette
    Danmark.
    Pedersen Pagh, Trine
    Danmark.
    Augustine, Lilly
    Högskolan Kristianstad, Avdelningen för Humanvetenskap.
    Ojala, Kristiina
    Finland.
    Samdal, Oddrun
    Norge.
    Trends in food habits and their relation to socioeconomic status among Nordic adolescents 2001/2002-2009/20102016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 2Article in journal (Refereed)
    Abstract [en]

    Background

    In the Nordic countries, substantial policy and intervention efforts have been made to increase adolescents' consumption of fruit and vegetables and to reduce their intake of sweets and soft drinks. Some initiatives have been formulated in a Nordic collaboration and implemented at national level. In recent years, social inequalities in food habits have been attracted particular governmental interest and several initiatives addressing the socioeconomic gradient in food habits have been highlighted. However, few internationally published studies have evaluated how trends in adolescents' food habits develop in the context of Nordic nutrition policy, or have compared differences between the Nordic countries.

    Methods

    The study was based on Danish, Finnish, Norwegian and Swedish cross-sectional data from the international Health Behaviour in School-Aged Children (HBSC) study, collected via three nationally representative and comparable questionnaire surveys in 2001/2002, 2005/2006 and 2009/2010. Food habits were identified by students' consumption of fruit, vegetables, sweets and sugar sweetened soft drink. Socioeconomic status (SES) was measured with the Family Affluence Scale (FAS). Multilevel logistic regression was used to analyze the data.

    Results

    Trends in fruit consumption developed differently across countries, characterized by an increase in Denmark and Norway and more stable trends in Sweden and Finland. Vegetable consumption increased particularly in Denmark and to a lesser extent in Norway, whereas Sweden and Finland displayed stable trends. Decreased trends were observed for sweet and soft drink consumption and were similar in Norway, Sweden and Finland. Sweet consumption decreased across all survey years, whereas soft drink consumption decreased between 2001/2002–2005/2006 and was stable thereafter. Denmark displayed an increase between 2001/2002–2005/2006 followed by a similar decrease between 2005/2006–2009/2010 for both sweet and soft drink consumption. Socioeconomic inequalities in fruit and vegetable consumption were observed in all countries, with no cross-country differences, and no changes over time. Small but not significant cross-country variation was identified for SES inequalities in sweet consumption. Reduced SES inequalities were observed in Sweden between 2005/2006 and 2009/2010. SES was not associated with soft drink consumption in this study population, with the exception of Denmark for the survey year 2009/2010.

    Conclusion

    Different trends resulted in increased country differences in food habits during the time of observations. In survey year 2009/2010, Danish students reported a higher intake of fruit and vegetable consumption than their counterparts in the other Nordic countries. Finnish students reported the lowest frequency of sweets and soft drink consumption. Despite the positive dietary trends documented in the present study, the majority of Nordic adolescents are far from meeting national dietary recommendations. Our findings underline the need for more comprehensive initiatives targeting young people's food habits as well as a more deliberate and focused action to close gaps in social inequalities that affect food choices.

  • 35.
    Fransson, Eleonor
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Work stress and physical inactivity2013Conference paper (Refereed)
  • 36.
    Fransson, Eleonor
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Heikkilä, Katriina
    Nyberg, Solja
    Zins, Marie
    Westerlund, Hugo
    Westerholm, Peter
    Väänänen, Ari
    Virtanen, Marianna
    Vahtera, Jussi
    Theorell, Töres
    Suominen, Sakari
    Singh-Manoux, Archana
    Siegrist, Johannes
    Sabia, Severine
    Rugulies, Reiner
    Pentti, Jaana
    Oksanen, Tuula
    Nordin, Maria
    Nielsen, Martin
    Marmot, Michael
    Magnusson Hanson, Linda
    Madsen, Ida
    Lunau, Thorsten
    Leineweber, Constanze
    Kumari, Meena
    Kouvonen, Anne
    Koskinen, Aki
    Koskenvuo, Markku
    Knutsson, Anders
    Kittel, France
    Jöckel, Karl-Heinz
    Joensuu, Matti
    Houtman, Irene
    Hooftman, Wendela
    Goldberg, Marcel
    Geuskens, Goedele
    Ferrie, Jane
    Erbel, Raimund
    Dragano, Nico
    De Bacquer, Dirk
    Clays, Els
    Casini, Annalisa
    Burr, Hermann
    Borritz, Marianne
    Bonenfant, Sebastien
    Bjorner, Jakob
    Alfredsson, Lars
    Hamer, Mark
    Batty, David
    Kivimäki, Mika
    Job Strain as a Risk Factor for Leisure-Time Physical Inactivity: An Individual-Participant Meta-analysis of up to 170,000 Men and Women2012In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 176, no 12, p. 1078-1089Article in journal (Refereed)
    Abstract [en]

    Unfavorable work characteristics, such as low job control and too high or too low job demands, have been suggested to increase the likelihood of physical inactivity during leisure time, but this has not been verified in large-scale studies. The authors combined individual-level data from 14 European cohort studies (baseline years from 1985–1988 to 2006–2008) to examine the association between unfavorable work characteristics and leisure-time physical inactivity in a total of 170,162 employees (50% women; mean age, 43.5 years). Of these employees, 56,735 were reexamined after 2–9 years. In cross-sectional analyses, the odds for physical inactivity were 26% higher (odds ratio = 1.26, 95% confidence interval: 1.15, 1.38) for employees with high-strain jobs (low control/high demands) and 21% higher (odds ratio = 1.21, 95% confidence interval: 1.11, 1.31) for those with passive jobs (low control/low demands) compared with employees in low-strain jobs (high control/low demands). In prospective analyses restricted to physically active participants, the odds of becoming physically inactive during follow-up were 21% and 20% higher for those with high-strain (odds ratio = 1.21, 95% confidence interval: 1.11, 1.32) and passive (odds ratio = 1.20, 95% confidence interval: 1.11, 1.30) jobs at baseline. These data suggest that unfavorable work characteristics may have a spillover effect on leisure-time physical activity.

  • 37.
    Fransson, Eleonor I
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Nyberg, Solja T
    Heikkilä, Katriina
    Alfredsson, Lars
    Bjorner, Jakob B
    Borritz, Marianne
    Burr, Hermann
    Dragano, Nico
    Geuskens, Goedele A
    Goldberg, Marcel
    Hamer, Mark
    Hooftman, Wendela E
    Houtman, Irene L
    Joensuu, Matti
    Jokela, Markus
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Kumari, Meena
    Leineweber, Constanze
    Lunau, Thorsten
    Madsen, Ida E H
    Hanson, Linda L Magnusson
    Nielsen, Martin L
    Nordin, Maria
    Oksanen, Tuula
    Pentti, Jaana
    Pejtersen, Jan H
    Rugulies, Reiner
    Salo, Paula
    Shipley, Martin J
    Steptoe, Andrew
    Suominen, Sakari B
    Theorell, Töres
    Toppinen-Tanner, Salla
    Vahtera, Jussi
    Virtanen, Marianna
    Väänänen, Ari
    Westerholm, Peter J M
    Westerlund, Hugo
    Zins, Marie
    Britton, Annie
    Brunner, Eric J
    Singh-Manoux, Archana
    Batty, G David
    Kivimäki, Mika
    Job Strain and the Risk of Stroke: An Individual-Participant Data Meta-Analysis2015In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 46, no 2, p. 557-559Article in journal (Refereed)
    Abstract [en]

    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.

  • 38.
    Fransson, Eleonor I.
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Stadin, Magdalena
    Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Nordin, Maria
    Umeå Universitet.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Knutsson, Anders
    Mittuniversitetet.
    Alfredsson, Lars
    Karolinska Institutet.
    Westerholm, Peter J. M.
    Uppsala universitet.
    The association between job strain and atrial fibrillation: Results from the Swedish WOLF Study2015In: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, Vol. 2015, p. 1-7, article id 371905Article in journal (Refereed)
    Abstract [en]

    Introduction. Atrial fibrillation (AF) is a common heart rhythm disorder. 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.

  • 39.
    Fransson, Eleonor
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Karolinska Institutet and Stockholm University, Sweden.
    Kivimäki, Mika
    University of Helsinki and Finnish Institute of Occupational Health, Finland.
    Psychosocial work environment and risk of stroke: Findings from the IPD-Work Consortium2017In: European Journal of Preventive Cardiology / [ed] Massimo Francesco Piepoli, Sage Publications, 2017, Vol. 24 (Suppl 2), p. 10-10Conference paper (Refereed)
    Abstract [en]

    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.

  • 40.
    Fransson, Eleonor
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Nordin, Maria
    Umeå University.
    Knutsson, Anders
    Mid Sweden University.
    Westerholm, Peter
    Uppsala University.
    Alfredsson, Lars
    Karolinska Institutet.
    Exposure to exhaust fumes, combustion products or soot and the risk of atrial fibrillation: Results from the Swedish WOLF study2016In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 73, no Suppl 1, p. 140-141Article in journal (Refereed)
    Abstract [en]

    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.

    Method

    Data 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.

    Results

    During 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% CI

    Non exposed-Non-smoker   1         -

    Non exposed-Smoker         1.09   0.78-1.52

    Exposed-Non-smoker         0.69    0.40-1.19

    Exposed-Smoker               1.83   1.07-3.12

    *Adjusted for SES, life-style, job strain, waist circumference and hypertension

    Conclusion

    Preliminary results indicate that exposure to exhaust fumes, combustion products or soot in combination with smoking is associated with an increased risk of atrial fibrillation.

  • 41.
    Fransson, Eleonor
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health Science, HHJ. ADULT.
    Nordin, Maria
    Knutsson, Anders
    Westerlund, Hugo
    Westerholm, Peter
    Alfredsson, Lars
    Associations between physically demanding work and life-style: results from the Swedish WOLF study2014In: Human factors in organizational design and management -11 & Nordic ergonomics society annual conference -46 / [ed] Broberg O, Santa Monica: The IEA Press , 2014, p. 45-45Conference paper (Refereed)
  • 42.
    Fransson, Eleonor
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Nordin, Maria
    Knutsson, Anders
    Westerlund, Hugo
    Westerholm, Peter
    Alfredsson, Lars
    Associations betwwen physically demanding work and life-style: Results from the Swedish WOLF study2015Conference paper (Refereed)
  • 43.
    Fransson, Eleonor
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Psychology, Umeå University, Sweden.
    Nordin, Maria
    Umeå Universitet.
    Magnusson Hanson, Linda
    Stockholms universitet.
    Westerlund, Hugo
    Stockholms universitet.
    Job strain and atrial fibrillation – Results from the Swedish Longitudinal Occupational Survey of Health and meta-analysis of three studies2018In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 25, no 11, p. 1142-1149Article in journal (Refereed)
    Abstract [en]

    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.

  • 44.
    Fransson, Eleonor
    et al.
    Jönköping University, School of Health Science, HHJ. ADULT. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health. Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine.
    Nyberg, Solja
    Heikkilä, Katriina
    Theorell, Töres
    Kivimäki, Mika
    Agreement between alternative versions of Karasek's job demand-control scale: The IPD-Work Consortium2012Conference paper (Other academic)
  • 45.
    Fransson, Eleonor
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Nyberg, Solja T
    Heikkilä, Katriina
    Alfredsson, Lars
    De Bacquer, Dirk
    Batty, G David
    Bonenfant, Sébastien
    Casini, Annalisa
    Clays, Els
    Goldberg, Marcel
    Kittel, France
    Koskenvuo, Markku
    Knutsson, Anders
    Leineweber, Constanze
    Magnusson Hanson, Linda L
    Nordin, Maria
    Singh-Manoux, Archana
    Suominen, Sakari
    Vahtera, Jussi
    Westerholm, Peter
    Westerlund, Hugo
    Zins, Marie
    Theorell, Töres
    Kivimäki, Mika
    Comparison of alternative versions of the job demand-control scales in 17 European cohort studies: the IPD-Work consortium2012In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 12, no 62Article in journal (Refereed)
    Abstract [en]

    Background Job strain (i.e., high job demands combined with low job control) is a frequently used indicator of harmful work stress, but studies have often used partial versions of the complete multi-item job demands and control scales. Understanding whether the different instruments assess the same underlying concepts has crucial implications for the interpretation of findings across studies, harmonisation of multi-cohort data for pooled analyses, and design of future studies. As part of the 'IPD-Work' (Individual-participant-data meta-analysis in working populations) consortium, we compared different versions of the demands and control scales available in 17 European cohort studies.

    Methods Six of the 17 studies had information on the complete scales and 11 on partial scales. Here, we analyse individual level data from 70 751 participants of the studies which had complete scales (5 demand items, 6 job control items).

    Results We found high Pearson correlation coefficients between complete scales of job demands and control relative to scales with at least three items (r > 0.90) and for partial scales with two items only (r = 0.76-0.88). In comparison with scores from the complete scales, the agreement between job strain definitions was very good when only one item was missing in either the demands or the control scale (kappa > 0.80); good for job strain assessed with three demand items and all six control items (kappa > 0.68) and moderate to good when items were missing from both scales (kappa = 0.54-0.76). The sensitivity was >0.80 when only one item was missing from either scale, decreasing when several items were missing in one or both job strain subscales.

    Conclusions Partial job demand and job control scales with at least half of the items of the complete scales, and job strain indices based on one complete and one partial scale, seemed to assess the same underlying concepts as the complete survey instruments.

  • 46.
    Fransson, Eleonor
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health Science, HHJ. ADULT.
    Stadin, Magdalena
    Jönköping University, School of Health Science, HHJ. ADULT.
    Nordin, Maria
    Malm, Dan
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Knutsson, Anders
    Alfredsson, Lars
    Westerholm, Peter
    Job strain and the risk of atrial fibrillation: Results from the Swedish WOLF study2015Conference paper (Refereed)
  • 47.
    Fristedt, Sofi
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Fransson, Eleonor
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health Science, HHJ. ADULT.
    Fysisk aktivitet och träning - möjlig prevention av arbetsrelaterade belastningsbesvär2015Report (Other academic)
  • 48.
    Galanti, Maria R.
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Solna, Stockholm, Sweden.
    Virtanen, Suvi E.
    Department of Public Health Sciences, Karolinska Institutet, Solna, Stockholm, Sweden.
    Zeebari, Zangin
    Centre for Epidemiology and Community Medicine, Stockholm Health Care District, Solna, Sweden.
    Rohyo, Izla
    Dentistry Clinic Solvändan, Sörmland Health Care Region, Folktandvården Sörmland AB, Folktandvården, Mariefred, Sweden.
    Reply to Ms. PM-14-1161: Brief counseling for tobacco cessation in dental clinics: A toothless intervention?2015In: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 76, p. 124-125Article in journal (Other (popular science, discussion, etc.))
  • 49.
    Garcia-Ptacek, Sara
    et al.
    Karolinska institutet, Stockholm, Sweden.
    Farahmand, Bahman
    Karolinska institutet, Stockholm, Sweden.
    Kåreholt, Ingemar
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Karolinska institutet, Stockholm, Sweden.
    Religa, Dorota
    Karolinska institutet, Stockholm, Sweden.
    Luz Cuadrado, Maria
    Universidad Complutense, Madrid, Spain.
    Eriksdotter, Maria
    Karolinska institutet, Stockholm, Sweden.
    Mortality in dementia: Data from SveDem, Swedish dementia registry2014In: Alzheimer's & Dementia: the journal of the alzheimer's association, Elsevier, 2014, Vol. 10, p. 4, supplement-152Conference paper (Refereed)
  • 50.
    Gerbild, Helle
    et al.
    Health Sciences Research Centre, University College Lillebaelt, Odense, Denmark.
    Larsen, Camilla Marie
    Health Sciences Research Centre, University College Lillebaelt, Odense, Denmark.
    Graugaard, Christian
    Center for Sexology Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
    Areskoug Josefsson, Kristina
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Physical activity to improve erectile function: A systematic review of intervention studies2018In: Sexual Medicine, ISSN 2050-1161, Vol. 6, no 2, p. 75-89Article, review/survey (Refereed)
    Abstract [en]

    The leading cause of erectile dysfunction (ED) is arterial dysfunction, with cardiovascular disease as the most common comorbidity. Therefore, ED is typically linked to a web of closely interrelated cardiovascular risk factors such as physical inactivity, obesity, hypertension, and metabolic syndrome. Physical activity (PA) has proved to be a protective factor against erectile problems, and it has been shown to improve erectile function for men affected by vascular ED. This systematic review estimated the levels of PA needed to decrease ED for men with physical inactivity, obesity, hypertension, metabolic syndrome, and/or manifest cardiovascular diseases.

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