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Objective: To test the hypothesis of low emotional support being associated with lifestyle and biomedical cardiovascular disease (CVD) risk factors, estimated risk of CVD morbidity and mortality, and subclinical atherosclerosis in middle-aged healthy adults.

Methods and measures: Cross-sectional data were obtained from participants aged 40–60 years who had one or more conventional CVD risk factor. They underwent assessment based on questionnaires, clinical examination, blood sampling, and carotid ultrasound of plaque formation and carotid intima-media wall thickness (cIMT). Based on the Interview Schedule for Social Interaction, the participants were categorised as either low in emotional support (n = 884) or as a referent (n = 2570). Logistic regression analyses were conducted to study the associations.

Results: Logistic regression analyses showed that low emotional support was significantly associated with smoking, alcohol consumption and physical inactivity (OR = 1.53 − 1.94), estimated risk of CVD morbidity and mortality (OR = 1.56 − 1.68), and plaque formation (OR = 1.39). No significant associations were found regarding biomedical CVD risk factors or cIMT.

Conclusion: The findings suggest that low social support is associated with lifestyle CVD risk factors, estimated risk of CVD morbidity and mortality, and subclinical atherosclerosis in middle-aged healthy adults, encouraging causal evaluation with longitudinal data investigating an impact of emotional support on mechanisms underlying CVD.

The Shirom-Melamed Burnout Questionnaire/Measure (SMBQ/SMBM) is a self-report instrument frequently used for assessing degree of burnout and screening for stress-related exhaustion disorder. The aim of the present study was three-fold. First, to examine reliability and construct validity of different versions of SMBM with 6–22 items in a clinical context. Second, to examine the criterion validity by assessing sensitivity and specificity and determining clinical cut-offs for these versions of the SMBM, and third to examine the prevalence of burnout in a general population and primary care sample using the proposed cut-offs. Two Swedish samples were used for the first two purposes: a clinical sample of patients diagnosed with exhaustion disorder (n = 149), and a matched sample of healthy controls (n = 60). For the third purpose a sample from the general population (n = 3406), and a primary care clinical sample (n = 326) was used. The modified versions of the SMBM showed good internal consistency, construct validity, dimensionality and model fit on the clinical exhaustion disorder sample, as well as configural measurement invariance across clinical and non-clinical samples. The sensitivity (94.6%–95.3%) and specificity (93.3%–95.0%) in identifying cases with exhaustion disorder based on the cut-off of 4.0 for the 19-, 16- and 11-items versions, and on the cut-off of 3.75 for the 6-item version was high. The prevalence of burnout was 81.2% in the primary care sample and 16.6% in the general population sample. The findings indicate that the SMBM is a useful instrument for screening for exhaustion disorder and burnout.

Objective: Hypotheses were tested of associations between indicators of somatic and mental distress and number of different types of environmental intolerances, referred to as symptoms attributed to environmental factors (SAEFs), and these indicators predicting development of additional SAEFs in a general population. The SAEFs regarded chemicals, buildings, electromagnetic fields and sounds.

Methods: Data were used from a Swedish population-based sample of 2336 adults. Cross-sectional and 3-year longitudinal analyses were conducted based on validated questionnaire instruments assessing somatic symptom distress, perceived stress, anxiety and depression.

Results: Prevalence percentage of the SAEFs ranged from 2.1 % to 13.4 %; 16.2 % had one SAEF, 4.9 % had two SAEFs, and 1.2 % had three or four SAEFs. Cross-sectionally, Kendall rank correlation analyses and ANOVAs showed that somatic symptom distress (rtau-b = 0.214), perceived stress (rtau-b = 0.137), anxiety (rtau-b = 0.145) and depression (rtau-b = 0.100) increased with number of SAEF. In the longitudinal analysis, all four indicators were found to be predictors of an increase in number of SAEFs three years later (odds ratios = 1.021–1.049 for each scale step), with somatic symptom distress as the strongest predictor.

Conclusion: The results suggest that all four types of SAEFs are associated with all four indicators of negative affectivity, and that the level of these indicators is associated with number of SAEFs and predict development of additional SAEFs. Among the studied indicators, somatic symptom distress appears to be particularly associated with development of multiple SAEFs, perhaps driven by the motive to find a cause for bothersome symptoms (misattribution).

Background: The role of cognitive abilities in the development of arteriosclerotic disease is still not fully understood. The purpose of the present study was to evaluate the mediating role of lifestyle, socioeconomic status (SES) and conventional cardiovascular disease (CVD) risk factors in the association between cognitive ability at age 19 and subclinical atherosclerosis at age 60 years.

Methods: An observational study design was employed. Data on the results from cognitive tests of conscripts tested at age 19 were collected for 1009 men. At the age of 60, they were included in the trial VIsualiZation of asymptomatic Atherosclerotic disease for optimum cardiovascular prevention, which was conducted as part of the Västerbotten Intervention Program (VIPVIZA). VIPVIZA is a randomised controlled trial, aimed at primary prevention of CVD in Västerbotten County, Sweden. Prior to any intervention, they underwent carotid ultrasonography and CVD risk factor assessment. Lifestyle habits and marital status were self-reported, and education and urban or rural residency were registered. Crude associations between cognitive ability at age 19 and the risk of CVD, assessed with the European Systematic Coronary Risk Evaluation 2 (SCORE2), as well as subclinical atherosclerosis, as demonstrated by the presence of carotid plaques (no plaque, plaque unilateral, or plaque bilateral), were evaluated. A path-analytic model tested mediating factors from cognitive ability in young adulthood to subclinical atherosclerosis at age 60.

Results: Results from cognitive tests at age 19 were in separate unadjusted analyses inversely and linearly associated with SCORE2 and with subclinical atherosclerosis. The association with carotid plaque at age 60 was mainly indirect and mediated by adult SES, which in turn had its main effect through adherence to healthy lifestyle habits via CVD risk of carotid plaques.

Conclusions: Cognitive ability at age 19 is a factor that is upstream of adult SES and our study indicates that cognitive ability at a young age has long-term consequences via SES and lifestyle habits for CVD risk and atherosclerosis.

Acrolein is considered a risk factor for indoor air health problems due to its reactivity. An objective of the study was to investigate prevalence of sensory irritation in terms of time-dependent detection and perceived intensity of symptoms in human volunteers. Another objective was to investigate individual variation in sensory irritation. Participants (n=40) were exposed twice in an exposure chamber (15 min), once to heptane and once to acrolein and heptane. Symptoms and sensory irritation thresholds were rated continuously and 70% of the participants detected eye irritation from the acrolein exposure. A significant interaction between time and exposure (ƞp2=0.19) was identified, indicating time-dependent activation. This group also reported a higher level of stress and lower self-reported health (p<0.05). The results suggest that the eye is the primary system affected by exposure to acrolein, and that duration of exposure and perceived stress play important roles in symptom reactions due to acrolein exposure.

Background: Factor analyses have indicated that somatic symptom burden can be separated into local symptom domain factors (e.g., cardiopulmonary, fatigue, gastrointestinal, pain) and a general propensity toward being symptomatic. This study aimed to determine what specific physical symptoms, and correlates, that are most strongly associated with this general factor.

Method: A systematic review was based on factor analyses of the Patient Health Questionnaire 15 (PHQ-15) and Somatic Symptom Scale 8 (SSS-8).

Results: There was heterogeneity in the included studies, in terms of the exact specification of the factor structure, and to some extent regarding item inclusion for factor analysis. Among 11 analyses of the PHQ-15, the highest mean and median factor loadings on the general symptom burden factor were seen for fatigue (M = 0.65) followed by dizziness (0.63). Among three analyses of the SSS-8, the mean was highest for chest pain and shortness of breath (0.69), followed by fatigue (0.62). The PHQ-15 general factor exhibited variable, but usually moderate to strong, associations with anxiety and depression symptoms, health anxiety, somatosensory amplification, and functional somatic syndromes.

Conclusions: Cardiopulmonary symptoms and fatigue appear to be especially closely associated with general somatic symptom burden. The close associations between this general factor and indicators of poor mental health and functional somatic syndromes allow for numerous interpretations; both causal and due to overlapping definitions.

Burnout is an increasing public health problem. Although research indicate that cognitive and affective factors are related to burnout, there is a lack of knowledge about the extent to which specific cognitive and affective symptoms are related to burnout, and whether there are sex-related differences. An aim of this study was to identify specific self-reported cognitive and affective symptoms that are particularly associated with burnout, both in the population in general and in men and women separately. Another aim was to examine the risk of burnout for specific symptoms and total number of symptoms in the general population and in men and women separately. Cross-sectional data were used from a large population-based questionnaire study consisting of 3406 participants (18–79 years) randomly selected from a general population in northern Sweden. Eleven cognitive and affective symptoms were assessed with a subsection of the Environmental Hypersensitivity Symptom Inventory, and the 22-item Shirom-Melamed Burnout Questionnaire (SMBQ) was used to assess burnout. The findings suggest that burnout is associated with a rather large number of cognitive and affective symptoms, in particular feeling tired/lethargic, having concentration difficulties, sleep disturbance, feeling depressed and being absent minded. Women with burnout (SMBQ score ≥ 4) reported higher prevalence of feeling tired/lethargic and sleep disturbance. The results add to the understanding of affective and cognitive symptomatology in burnout, which might have implications for early identification and prevention of burnout and exhaustion disorder.

Coping strategies, perceived environmental exposure control and mental distress appear to be important concepts in persons with symptoms associated with environmental factors (SAEF), but their interplay is not well documented. The objective was to investigate (i) use of coping strategies, (ii) prevalence of perceived exposure control, (iii) whether the control is associated with mental distress and SAEF type, and (iv) whether coping strategies are associated with mental distress in SAEF regarding chemicals (SAEF-C), buildings (SAEF-B), electromagnetic fields (SAEF-EMF) and sounds (SAEF-S) in a general population. Cross-sectional population-based data (n = 391) and validated questionnaire instruments were used to assess symptoms of anxiety, depression, burnout and sleep disturbance, applying analysis of covariance and hierarchical regression analysis. The most used problem- and emotion-focused coping strategies were avoiding environments and accepting the situation, respectively. A majority of those with SAEF-C (71.7%), SAEFF-EMF (75.9%) and SAEF-S (64.1%), but not SAEF-B (36.4%) were able to control the adverse exposure, and low level of control was associated with anxiety, depression, burnout and sleep disturbance in all four SAEF types. Use of the strategies avoidance and eating/drinking/smoking were associated with depression, and reprioritizing with burnout. An implication of the results is that suitable coping strategies and perceived control may be considered as part of treatment of SAEF.

Objective: Not much is known on the development of symptoms associated with environmental factors (SAEF), also known as (idiopathic) environmental intolerances. Findings from qualitative studies suggest that appearance of symptoms might be the first step, followed by the acquisition of a specific attribution. The current study investigated cross-sectional and longitudinal (three years) associations between attribution and symptoms with respect to symptoms associated with chemical substances, certain indoor environments (buildings), sounds, and electromagnetic fields (EMFs).

Methods: We used data from the first two waves of the population-based Västerbotten Environmental Health Study (n = 2336). Participants completed the Patient Health Questionnaire Somatic Symptom Scale (PHQ-15), the Environmental Symptom-Attribution Scale, and answered single questions on the four aforementioned SAEFs.

Results: Using binary logistic regression analyses, all four SAEFs showed significant cross-sectional associations with somatic symptom distress and the respective attribution. In the longitudinal analysis, development of SAEF-Sound and SAEF-Chemicals were predicted by both somatic symptom distress and attribution. SAEF-EMFs was predicted only by attribution, whereas neither somatic symptom distress nor attribution forecasted SAEF-Buildings.

Conclusion: Overall, these findings suggest that attribution (i.e., a specific expectation) plays a substantial role in the development and maintenance of many SAEFs.

Background: Pictorial communication about subclinical atherosclerosis can improve cardiovascular disease (CVD) risk, but whether it leads to long-term shifts in self-rated CVD risk (risk perception) and beliefs about possibility to influence personal risk (efficacy beliefs) is unknown.

Purpose: To study the impact of personalized color-coded and age-related risk communication about atherosclerosis and motivational conversation, compared to traditional risk factor-based communication, on risk perception and efficacy beliefs. Also, whether risk perception increases with message severity.

Method: The effect of the pragmatic RCT Visualization of Asymptomatic Atherosclerotic Disease for Optimum Cardiovascular Prevention (VIPVIZA) was analyzed using a linear mixed effects model with risk perception and efficacy believes at 1-year and 3-year follow up as dependent variables. Participants’ (n = 3532) CVD risk perception and efficacy beliefs were assessed with visual analog scales (0–10). Fixed effects were group (intervention vs control), time point (1 year or 3 years) and interaction between group and time point. Further, the models were adjusted for corresponding baseline measurement of the dependent variable and a baseline × time point interaction. Effect of pictorial color-coded risk in the intervention group was investigated using a corresponding mixed effects model, but with pictorial risk group (message severity) as exposure instead of intervention group.

Results: After one year, the intervention group rated their CVD risk as higher (m = 0.46, 95% CI 0.32–0.59), with an effect also after 3 years (m = 0.57, 95% CI 0.43–0.70). The effect was consistent in stratified analyses by sex and education. Overall, no effect on efficacy beliefs was observed. In the intervention group, differences in CVD risk perception were found between participants with different color-coded risk messages on atherosclerosis status.

Conclusion: Personalized, color-coded and age-related risk communication about atherosclerosis had an effect on risk perception with an effect also after 3 years, whereas overall, no effect on efficacy beliefs was observed.