Background

Previous studies indicate that ambulance personnel have an increased risk of ill health. Shift work and time spent on physical behaviours during work and leisure are factors that could be related to health, however the research is limited. Thus, the aim of this study was to describe patterns of physical behaviours during and after work among Swedish ambulance personnel and to analyse the associations between physical behaviours and different work shifts.

Methods

In this observational study, the physical behaviours of 63 ambulance personnel were measured over seven days using two accelerometers. Accelerometer data was processed using the MATLAB program Acti4, to identify physical behaviours i.e. sleep, being sedentary, light physical activity (LPA), and moderate to vigorous physical activity (MVPA), during and after work. To determine the association between shift types (independent) and patterns of physical behaviours (dependent), a Multivariate Analysis of Variance was performed on data processed according to compositional data analysis.

Results

At work, the highest proportion of both MVPA and being sedentary occurred during day shifts, compared to night and 24-h shifts (MVPA: 7% vs 4% and 5%; sedentary time: 62% vs 44% and 54% respectively). Night and 24-h shifts included 31% and 18% sleep, respectively. During the after-work periods, the highest proportions of MVPA were observed after 24-h shifts (8%). Overall, there was no statistically significant difference in physical behaviours during work and after work for various shift types. However, in a sub-analysis restricted to night and 24-h shifts, a statistically significant association between shift type and composition of physical behaviours during work was observed (eta(2)(p) = 0.42, p < 0.001), with a lower proportion of sleep time relative to awake time during 24-h shifts compared to night shift (eta(2)(p) = 0.34, p < 0.001).

Conclusions

In general, ambulance personnel were physically active both during and after work. At the same time, work hours entailed a substantial amount of sedentary time. Shift type was not associated with the pattern of physical behaviours among ambulance personnel. However, during 24-h shift a lower proportion of the time was spent sleeping compared to during night shift. Studies with larger sample sizes are needed to confirm these results.

Bakgrund/Syfte*: Aktivitetsbalans har visat sig relatera till hälsa och aktivitetsobalans till stress. Relationen mellan aktivitetsbalans och hälsoaspekter har dock ofta innefattat självskattning och få studier har inkluderat objektiva mått. Ett sätt att mäta stress över tid, på annat sätt än självskattning, är att mäta nivån av kortisol i hår (HCC).

Syftet med denna studie var att jämföra HCC hos ambulanspersonal med en populationsbaserad referensgrupp, analysera skillnader mellan män och kvinnor samt skillnader beroende på arbetsrelaterade faktorer.

Metod/Tillvägagångssätt*: Ambulanspersonal (28 kvinnor och 51 män) i en svensk region besvarade ett frågeformulär om olika arbetsrelaterade faktorer inklusive aktivitetsbalans. Därutöver analyserades en centimeter hår närmast hårbotten avseende HCC, för att mäta stress över den senaste månaden.

Resultat/Förväntat resultat*: Inga skillnader i HCC mellan ambulanspersonal och referensgruppen eller könsskillnader i HCC identifierades. Vidare sågs inga associationer mellan HCC och arbetsrelaterade faktorer.

Aktivitetsbalans var däremot positivt korrelerat med HCC (r_p=0,240; p=0,044) och associationen var signifikant efter justering för kön och ålder.

Slutsats/Praktisk tillämpning*: Studien ger ett något annorlunda resultat avseende relationen mellan aktivitetsbalans och stress när ett objektivt mått på stress, hårkortisol, används jämfört med självskattade mått. Korrelationen är svag och inga slutsatser kan dras men den indikerar att högre HCC, som mått på stress, associeras till bättre aktivitetsbalans.

På så sätt ger studien också en indikation på komplexiteten i relationen mellan aktiviteter och hälsa. Nya frågor väcks om relationen mellan vad vi tycker om våra aktiviteter och vad vi faktiskt gör. Fortsatt forskning behövs där både självskattade och objektiva mått används samtidigt. 

Aims: To assess the associations of onset of workplace conflict on incident cardiovascular disease (CVD) and changes in biomarkers.

Methods: The study included 2704 employees aged 18–65 years and free of workplace conflict at baseline (T0), from the Swedish Work, Lipids, Fibrinogen study (proportion of women: 17 %). Exposure to onset of workplace conflict was ascertained at T1 using self-reports (mean interval between T0 and T1: 5 years). Participants were linked to nationwide registers to ascertain incident CVD. Changes in biomarkers, including body mass index, waist-hip ratio, high-density lipoprotein cholesterol, triglycerides, glucose and fibrinogen, were measured and calculated between T0 and T1. Cox regressions and linear regressions were applied for analyses on conflicts in relation to CVD and conflicts in relation to changes in biomarkers, respectively. Age, sex, educational level, marital status, pre-existing comorbidities, employment contract, and shift work were adjusted for in the main analyses.

Results: About 10 % experienced onset of workplace conflict between T0 and T1. Among 2682 participants who were free from CVD at T0, 87 CVD events were recorded (mean follow-up from T1: 7.8 years, incidence rate: 41.5/10,000 person-year). Onset of workplace conflict at T1 was associated with 2.42 times (95 %CI 1.42, 4.12) higher risk of developing CVD during the follow-up period. Among 877 participants with information on changes in fibrinogen, onset of workplace conflict at T1 was associated with fibrinogen increase from T0 to T1 (mean difference=0.14; 95 %CI 0.02, 0.25) and onset of high fibrinogen (OR=1.41; 95 %CI 1.04,1.90). These associations were largely robust for additional adjustments, restrictions and consideration of selection bias and were not likely to be affected by reverse causation.

Conclusions: Onset of workplace conflict was related to higher risks of developing CVD and fibrinogen increase.

Background

The salutogenic theory forms the basis for health promotion and describes health as a continuum from a dis-ease pole of health to an ease pole. The core concept for the salutogenic theory is sense of coherence (SOC). For a strong SOC, general resistance resources, such as solid economic situation, are essential. The aim was to explore how people – despite self-reported economic difficulties – comprehend, manage and find it meaningful to achieve the level of physical activity recommended by World Health Organisation (WHO).

Method

The study is based on interviews with people achieving the recommended physical activity (PA) level despite economic difficulties. The interviews were conducted at primary health care centres and family centres after a targeted health dialogue. We used a qualitative deductive content analysis based on sense of coherence as the main category, with the three generic categories of comprehensibility, manageability and meaningfulness.

Result

The findings elucidate a pattern of a process. In this process, the participants comprehend their knowledge of the health benefits of PA and have a plan for performing their PA. They utilise their resources in order to manage to apply their knowledge and plan for PA in their lives despite their challenges. When PA becomes meaningful to them, they have an intrinsic motivation to perform it and experience its benefits.

Conclusion

This study suggests a possible process that might help in achieving the recommended PA level among people with economic difficulties and other challenges. The findings might be used in health promotion work, such as targeted health dialogues in primary health care, to reduce health inequalities when supporting people who are not achieving the recommended levels of PA.

Trial registration

Not applicable.

Objectives. This study aimed to describe work-, lifestyle-, and health-related factors among ambulance personnel, and to analyse differences between women and men.

Methods. The cross-sectional study (N = 106) included self-reported and objective measures of work, lifestyle, and health in 10 Swedish ambulance stations. The data collection comprised clinical health examination, blood samples, tests of physical capacity, and questionnaires.

Results. A high proportion of the ambulance personnel reported heavy lifting, risk of accidents, threats and violence at work. A low level of smoking and alcohol use, and a high level of leisure-time physical activity were reported. The ambulance personnel had, on average, good self-rated health, high work ability and high physical capacity. However, the results also showed high proportions with risk factors for cardiovascular disease (CVD), e.g., high blood pressure, and high levels of blood lipids. More women than men reported high work demands. Furthermore, women performed better in tests of physical capacity and had a lower level of CVD risk factors.

Conclusions. Exposure to work-related factors that might affect health was common among ambulance personnel. Lifestyle- and health-related factors were somewhat contradictory, with a low proportion reporting lifestyle-related risk factors, but a high proportion having risk factors for CVD.

Background: It is important that easy-to-use measures like subjective questions about physical activity (PA) and sedentary behaviour are valid and reliable providing accurate measures, when they are used in health promotion work aiming to support people to improve their lifestyle habits such as PA. The aim of this study was to evaluate the concurrent validity of a structured interview form estimating self-reported PA and a question about sitting time used in Swedish targeted health dialogues in the context of primary health care. Method: The study was conducted in the southern part of Sweden. To evaluate concurrent validity of the interview form, time spent in moderate-to-vigorous physical activities (MVPA) and energy expenditure related to MVPA estimated by an interview form was compared with the same measures assessed by an ActiGraph GT3X-BT accelerometer. To evaluate a question about sitting time, the Swedish School of Sport and Health Sciences’ single-item question about sitting time (SED-GIH) was compared with measures from an activPAL inclinometer. Statistical analyses included deriving Bland‒Altman plots and calculating Spearman’s rank correlation coefficients. Result: Bland‒Altman plots indicated lower absolute variation in the difference between self-reported and device-based PA measures for lower PA levels, both for energy expenditure and time spent in MVPA. No systematic over- or underestimation was observed. The Spearman’s correlation coefficient between self-reported and device-based PA measures was 0.27 (p = 0.014) for time spent in MVPA and 0.26 (p = 0.022) for energy expenditure. The correlation coefficient between the single item question and device-based sitting time measures was 0.31 (p = 0.002). Sitting time was underestimated by 74% of the participants. Conclusion: The PA interview form and the SED-GIH question on sitting time may be of value in targeted health dialogues in primary health care with the intention to support sedentary and insufficiently physically active persons in increasing their physical activity and limiting their sitting time. The questionnaires are easy to use and are more cost effective than device-based measures, especially regarding population-based interventions conducted in primary health care for thousands of participants such as targeted health dialogues. Clinical trial registration: Not applicable.

BACKGROUND: Oral diseases have been associated with cardiovascular diseases, and persons with continuous positive airway pressure [CPAP]-treated obstructive sleep apnoea [OSA] have an increased risk for negative consequences for both oral and general health. CPAP treatment is often life-long and adherence to treatment is essential. Xerostomia is a common side-effect which can lead to treatment abandonment. Oral health is a changeable part of our general health and well-being and exploring the views of oral health determinants from persons with experience of CPAP-treatment is important to prevent adverse oral health outcomes. The purpose of this study was to explore what persons with experience of CPAP-treated OSA view as determinants for their oral health.

METHODS: Eighteen persons with long-term experience of CPAP-treated OSA were purposively selected. Data were collected by semi-structured individual interviews. A code book based on the World Dental Federation's [FDI] theoretical framework for oral health was developed and used to analyse the data using directed content analysis. The domains in the framework's component driving determinants were used as pre-determined categories. Using the description of driving determinants as a guide, meaning units were extracted from the interview transcripts through an inductive approach. Then, by employing a deductive approach the code book was used to categorise the meaning units into the pre-determined categories.

FINDINGS: The views on oral health determinants described by the informants were compatible with the five domains in the component driving determinants in the FDI's theoretical framework. Ageing, heredity, and salivation (biological and genetic factors), influences from family and the wider society (social environment), location and re-localisation (physical environment), oral hygiene habits, motivation, willingness to change, professional support (health behaviours), and availability, control, finances, and trust (access to care) were viewed as important oral health determinants by the informants.

CONCLUSION: The study points to a variety of individual oral health-related experiences that oral healthcare professionals could consider when designing interventions to reduce xerostomia and prevent adverse oral health outcomes for persons undergoing long-term CPAP-treatment.

Ambulance personnel in emergency medical services are exposed to physical demands and stress during work, and an increased prevalence of ill health has been observed in this group. The aim was to compare hair cortisol concentration (HCC) among Swedish ambulance personnel with HCC in a population-based reference sample, to analyse differences between women and men, and differences due to work-related factors. Samples of hair 1 cm closest to the skin (5-10 mg) were collected and analysed for cortisol by radioimmunoassay. Moreover, the participants responded to a questionnaire regarding their work environment. The HCC among the ambulance personnel did not differ from the HCC in the population-based reference sample (median 19.2 vs. 22.2 pg/mg, p = 0.319), nor were there statistically significant differences between women and men. Furthermore, no associations were found between HCC and physical and psychosocial work demands, work stress, or rest and recovery from work. However, occupational balance was positively correlated with HCC (r_p = 0.240; p = 0.044). The association remained statistically significant after adjustment for sex, age, hair bleaching, and corticosteroid treatment in a linear regression model. This study adds knowledge regarding HCC among ambulance personnel, and thus contributes to the overall picture of work environment and health for this group.

Introduction: The World Dental Federation (FDI) has recently proposed a new definition and theoretical framework of oral health. The theoretical framework includes 4 main components and describes the relationships amongst them. In 2020, an international work group proposed the minimum Adult Oral Health Standard Set (AOHSS) of variables to measure oral health, which was mapped onto the FDI's theoretical framework. By using an empirical data set, the proposed variables in the AOHSS and the potential interactions amongst the components of the FDI's theoretical framework can be tested. The purpose of this research was to investigate structural relations of the components of the FDI's theoretical framework of oral health based on data from a general adult population.

Methods: Data from a previously conducted Swedish cross-sectional study focusing on oral health were utilised (N = 630; women, 55.2%; mean age, 49.7 years [SD, 19.2]). Variable selection was guided by the AOHSS. Structural equation modeling was used to analyse relationships amongst the components of the FDI's theoretical model (core elements of oral health, driving determinants, moderating factors, and overall health and well-being).

Results: The Oral Health Impact Profile (OHIP)-14, xerostomia, and aesthetic satisfaction had statistically significant direct effects on overall health and well-being (p < .05). Driving determinants and moderating factors had statistically significant direct effects on all core elements of oral health (p < .05) except aesthetic satisfaction (p = .616). The predictors explained 24.1% of the variance of the latent variable overall health and well-being. Based on several indices, the proposed model showed acceptable model fit.

Conclusions: The FDI's theoretical framework can be used to describe different components of oral health and the relationship amongst them in an adult general population. Further research based on the FDI's theoretical framework in other populations and settings is needed to explore complex interactions and possible relationships that form oral health and to investigate other or additional important social determinants.