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  • 1.
    Andersson, John
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Oudin, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Sundström, Anna
    Umeå University, Faculty of Social Sciences, Department of Psychology. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Road traffic noise, air pollution, and risk of dementia: results from the Betula project2018In: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 166, p. 334-339Article in journal (Refereed)
    Abstract [en]

    Background: There is growing evidence for a negative impact of traffic-related air pollution on risk of dementia.However, the contribution of noise exposure to this association has been rarely examined.

    Objective: We aimed to investigate the individual and combined effect of noise and air pollution on risk ofdementia.

    Methods: Data on dementia incidence over a 15 year period was obtained from the Betula project, a longitudinalstudy on health and ageing. Estimates of annual mean levels of nitrogen oxides (NOx) at the participants’ residentialaddress were obtained using a land-use regression model. Modelled data provided road traffic noiselevels (Leq. 24 h) at the participants’ residential address at baseline. Cox proportional hazard regression was usedto calculate hazard ratios (HR).

    Results: Of 1721 participants at baseline, 302 developed dementia during the follow up period. Exposure to noiselevels (Leq. 24 h)> 55 dB had no significant effect on dementia risk (HR 0.95; CI: 0.57, 1.57). Residing in thetwo highest quartiles of NOx exposure was associated with an increased risk of dementia. The risk associatedwith NOx was not modified by adjusting for noise. Moreover, we found no significant interaction effects betweenNOx and road traffic noise on dementia risk.

    Conclusion: We found no evidence that exposure to road traffic noise, either independently or in combinationwith traffic air pollution, was associated with risk of dementia in our study area. Our results suggest that pollutionshould be considered the main component in the association between traffic related exposures and dementia.

  • 2. Cain, William S.
    et al.
    de Wijk, René A.
    Nordin, Steven
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Independence of odor Quality and Absolute Sensitivity in a Study of Aging2008In: Chemosensory perception., ISSN 1936-5802, Vol. 1, p. 24-33Article in journal (Refereed)
  • 3.
    Claeson, Anna-Sara
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Lidén, Edvard
    Nordin, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nordin, Steven
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    The role of perceived pollution and health risk perception in annoyance and health symptoms: a population-based study of odorous air pollution2013In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 86, no 3, p. 367-374Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Health effects associated with air pollution at exposure levels below toxicity may not be directly related to level of exposure, but rather mediated by perception of the air pollution and by top-down processing (e.g., beliefs that the exposure is hazardous). The aim of the study was to test a model that describes interrelations between odorous air pollution at non-toxic exposure levels, perceived pollution, health risk perception, annoyance and health symptoms.

    METHODS: A population-based questionnaire study was conducted in a Swedish community of residents living near a biofuel facility that emitted odorous substances. Individuals aged 18-75 years were selected at random for participation (n = 1,118); 722 (65 %) agreed to participate. Path analyses were performed to test the validity of the model.

    RESULTS: The data support a model proposing that exposure level does not directly influence annoyance and symptoms, and that these relations instead are mediated by perceived pollution and health risk perception.

    CONCLUSIONS: Perceived pollution and health risk perception play important roles in understanding and predicting environmentally induced annoyance and health symptoms in odorous environments at non-toxic levels of exposure.

  • 4. Dragano, Nico
    et al.
    Siegrist, Johannes
    Nyberg, Solja T.
    Lunau, Thorsten
    Fransson, Eleonor I.
    Alfredsson, Lars
    Bjorner, Jakob B.
    Borritz, Marianne
    Burr, Hermann
    Erbel, Raimund
    Fahlen, Goran
    Goldberg, Marcel
    Hamer, Mark
    Heikkila, Katriina
    Joeckel, Karl-Heinz
    Knutsson, Anders
    Madsen, Ida E. H.
    Nielsen, Martin L.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology. Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Oksanen, Tuula
    Pejtersen, Jan H.
    Pentti, Jaana
    Rugulies, Reiner
    Salo, Paula
    Schupp, Juergen
    Singh-Manoux, Archana
    Steptoe, Andrew
    Theorell, Tores
    Vahtera, Jussi
    Westerholm, Peter J. M.
    Westerlund, Hugo
    Virtanen, Marianna
    Zins, Marie
    Batty, G. David
    Kivimaki, Mika
    Effort-Reward Imbalance at Work and Incident Coronary Heart Disease A Multicohort 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 multicohort study (the “IPD-Work” consortium) was based on harmonized individual-level data from 11 European prospective cohort studies. Stressful work in 90,164 men and women without coronary heart disease at baseline was assessed by validated effort–reward imbalance and job strain questionnaires. We defined incident coronary heart disease as the first nonfatal myocardial infarction or coronary death. Study-specific estimates were pooled by random effects meta-analysis.

    Results: At baseline, 31.7% of study members reported effort–reward imbalance at work and 15.9% reported job strain. During a mean follow-up of 9.8 years, 1,078 coronary events were recorded. After adjustment for potential confounders, a hazard ratio of 1.16 (95% confidence interval, 1.00–1.35) was observed for effort–reward imbalance compared with no imbalance. The hazard ratio was 1.16 (1.01–1.34) for having either effort–reward imbalance or job strain and 1.41 (1.12–1.76) for having both these stressors compared to having neither effort–reward imbalance nor job strain.

    Conclusions: Individuals with effort–reward imbalance at work have an increased risk of coronary heart disease, and this appears to be independent of job strain experienced. These findings support expanding focus beyond just job strain in future research on work stress.

  • 5. du Prel, Jean-Baptist
    et al.
    Runeson-Broberg, Roma
    Westerholm, Peter
    Alfredsson, Lars
    Fahlen, Goran
    Knutsson, Anders
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology. Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Peter, Richard
    Work overcommitment: Is it a trait or a state?2018In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 91, no 1, p. 1-11Article in journal (Refereed)
    Abstract [en]

    Purpose: Effort–reward imbalance (ERI) is a well-tested work-related stress model with three components, the two extrinsic components “efforts” and “rewards” and the one intrinsic component “overcommitment”. While an imbalance between “efforts” and “rewards” leads to strain reactions, “work-related overcommitment” (OC) has been described as a personal characteristic with a set of attitudes, behaviours, and emotions reflecting excessive striving combined with a strong desire for approval. However, the question whether OC is a personality trait or a response pattern sensitive to changes in the work context (state) is still open.

    Methods: 2940 Swedish industrial employees were included in this longitudinal analysis of the WOLF-Norrland data over 5 years. A change of OC index or its subscales were regressed against a change of freedom of choice at work, extra work, and ERI adjusted for age, sex, and education.

    Results: While OC was insensitive to changes in freedom of choice at work and extra work, it was clearly associated with changes of work-related stress over time. Three of four OC subscales exhibited statistically significant associations with ERI.

    Conclusions: For the first time, we studied fundamental characteristics of OC as an independent personality variable (trait) or an outcome variable subject to changes in the work environment (state). The association between external ERI and OC over time supports our hypothesis of OC being a state. Further investigations are needed to establish OC as a trait or a state.

  • 6.
    Eriksson, Jeanette
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Wahlström, Jens
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Hofverberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Pettersson-Strömbäck, Anita
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Längre arbetsliv: om samverkan mellan företagshälsovård och personalavdelningar inom norrländska kommuner och landsting2014Report (Other academic)
  • 7. Fahlén, Göran
    et al.
    Knutsson, Anders
    Peter, Richard
    Åkerstedt, Torbjörn
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Alfredsson, Lars
    Westerholm, Peter
    Effort-reward imbalance, sleep disturbances and fatigue.2006In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 79, no 5, p. 371-8Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The objective of this study was to investigate the validity of the effort-reward imbalance (ERI) model in relation to disturbed sleep and fatigue.

    METHODS: The study population derived from a subset of the WOLF (WOrk, Lipids, Fibrinogen) cohort study of cardiovascular risk in a working population who replied to the ERI-questionnaire comprising 789 men and 214 women. Cox regression analysis was used to calculate the prevalence ratio (PR) for sleep disorders and fatigue in relation to the components of ERI.

    RESULTS: As sleep disturbances and fatigue, based on literature, were defined to be represented by the uppermost quintile, 14% of the men and 23% of the women were affected by sleep disturbances while 14 and 26%, respectively, were affected by fatigue. Higher levels of exposure for the ERI components were associated with increased prevalence of sleep disturbances and fatigue. For men, the strongest association was seen between high overcommitment and fatigue (PR 5.77, 95% confidence interval 2.89-11.5). For women, high effort and sleep disturbances (PR 4.04, CI 1.53-10.7), high effort/reward ratio and sleep disturbances (PR 4.13, CI 1.62-10.5), and between low reward and fatigue (PR 4.36, CI 1.79-10.6) yielded the most obvious associations.

    CONCLUSIONS: The present study adds sleep disturbances and fatigue to the list of adverse consequences of effort-reward imbalance.

  • 8. Ferrie, Jane E.
    et al.
    Virtanen, Marianna
    Jokela, Markus
    Madsen, Ida E. H.
    Heikkila, Katriina
    Alfredsson, Lars
    Batty, G. David
    Bjorner, Jakob B.
    Borritz, Marianne
    Burr, Hermann
    Dragano, Nico
    Elovainio, Marko
    Fransson, Eleonor I.
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Kouvonen, Anne
    Kumari, Meena
    Nielsen, Martin L.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Oksanen, Tuula
    Pahkin, Krista
    Pejtersen, Jan H.
    Pentti, Jaana
    Salo, Paula
    Shipley, Martin J.
    Suominen, Sakari B.
    Tabak, Adam
    Theorell, Toeres
    Vaananen, Ari
    Vahtera, Jussi
    Westerholm, Peter J. M.
    Westerlund, Hugo
    Rugulies, Reiner
    Nyberg, Solja T.
    Kivimaki, 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: I-2 = 24%, p = 0.2; multivariable-adjusted model: I-2 = 27%, p = 0.2). In the multivariable-adjusted analysis restricted to high-quality studies, in which the diabetes diagnosis was ascertained from electronic medical records or clinical examination, the association was similar to that in the main analysis (adjusted OR 1.19, 95% CI 1.04-1.35). Interpretation: Our findings suggest that self-reported job insecurity is associated with a modest increased risk of incident diabetes. Health care personnel should be aware of this association among workers reporting job insecurity.

  • 9. Fransson, Eleonor I
    et al.
    Heikkilä, Katriina
    Nyberg, Solja T
    Zins, Marie
    Westerlund, Hugo
    Westerholm, Peter
    Väänänen, Ari
    Virtanen, Marianna
    Vahtera, Jussi
    Theorell, Töres
    Suominen, Sakari
    Singh-Manoux, Archana
    Siegrist, Johannes
    Sabia, Séverine
    Rugulies, Reiner
    Pentti, Jaana
    Oksanen, Tuula
    Nordin, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nielsen, Martin L
    Marmot, Michael G
    Magnusson Hanson, Linda L
    Madsen, Ida EH
    Lunau, Thorsten
    Leineweber, Constanze
    Kumari, Meena
    Kouvonen, Anne
    Koskinen, Aki
    Koskenvuo, Markku
    Knutsson, Anders
    Kittel, France
    Jöckel, Karl-Heinz
    Joensuu, Matti
    Houtman, Irene L
    Hooftman, Wendela E
    Goldberg, Marcel
    Geuskens, Goedele A
    Ferrie, Jane E
    Erbel, Raimund
    Dragano, Nico
    De Bacquer, Dirk
    Clays, Els
    Casini, Annalisa
    Burr, Hermann
    Borritz, Marianne
    Bonenfant, Sébastien
    Bjorner, Jakob B
    Alfredsson, Lars
    Hamer, Mark
    Batty, G 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, review/survey (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 19851988 to 20062008) 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 29 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.

  • 10. Fransson, Eleonor I.
    et al.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Magnusson Hanson, Linda L.
    Westerlund, Hugo
    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.

  • 11. Fransson, Eleonor I.
    et al.
    Nyberg, Solja T.
    Heikkila, Katriina
    Alfredsson, Lars
    Bacquer, De Dirk
    Batty, G. David
    Bonenfant, Sebastien
    Casini, Annalisa
    Clays, Els
    Goldberg, Marcel
    Kittel, France
    Koskenvuo, Markku
    Knutsson, Anders
    Leineweber, Constanze
    Hanson, Linda L. Magnusson
    Nordin, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Singh-Manoux, Archana
    Suominen, Sakari
    Vahtera, Jussi
    Westerholm, Peter
    Westerlund, Hugo
    Zins, Marie
    Theorell, Tores
    Kivimaki, 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, p. 62-Article 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.

  • 12. Fransson, Eleonor I.
    et al.
    Nyberg, Solja T.
    Heikkila, 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
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Oksanen, Tuula
    Pentti, Jaana
    Pejtersen, Jan H.
    Rugulies, Reiner
    Salo, Paula
    Shipley, Martin J.
    Steptoe, Andrew
    Suominen, Sakari B.
    Theorell, Toeres
    Toppinen-Tanner, Salla
    Vahtera, Jussi
    Virtanen, Marianna
    Vaananen, Ari
    Westerholm, Peter J. M.
    Westerlund, Hugo
    Zins, Marie
    Britton, Annie
    Brunner, Eric J.
    Singh-Manoux, Archana
    Batty, G. David
    Kivimaki, 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.

  • 13. Fransson, Eleonor I
    et al.
    Stadin, Magdalena
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology. Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Malm, Dan
    Knutsson, Anders
    Alfredsson, Lars
    Westerholm, Peter J M
    The Association between Job Strain and Atrial Fibrillation: Results from the Swedish WOLF Study2015In: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, article id 371905Article in journal (Refereed)
    Abstract [en]

    Introduction: Atrial fibrillation (AF) is a common heart rhythmdisorder. Several life-style factors have been identified as risk factors for AF, but less is known about the impact of work-related stress. This study aims to evaluate the association between work-related stress, defined as job strain, and risk of AF. Methods: Data from the Swedish WOLF study was used, comprising 10,121 working men and women. Job strain was measured by the demand-control model. Information on incident AF was derived from national registers. Cox proportional hazard regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between job strain and AF risk. Results: In total, 253 incident AF cases were identified during a total follow-up time of 132,387 person-years. Job strain was associated with AF risk in a time-dependent manner, with stronger association after 10.7 years of follow-up (HR 1.93, 95% CI 1.10-3.36 after 10.7 years, versus HR 1.11, 95% CI 0.67-1.83 before 10.7 years). The results pointed towards a dose-response relationship when taking accumulated exposure to job strain over time into account. Conclusion: This study provides support to the hypothesis that work-related stress defined as job strain is linked to an increased risk of AF.

  • 14. Fransson, Eleonor
    et al.
    Nordin, Maria
    Knutsson, Anders
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Westerlund, Hugo
    Westerholm, Peter
    Alfredsson, Lars
    Associations between physically demanding work and life-style: results from the Swedish WOLF study2014In: 11th International Symposium on Human Factors in Organisational Design and Management & 46th Annual Nordic Ergonomics Society Conference, 2014, p. 45-46Conference paper (Refereed)
  • 15. Heikkila, K.
    et al.
    Madsen, I. E. H.
    Nyberg, S. T.
    Fransson, E. I.
    Westerlund, H.
    Westerholm, P. J. M.
    Virtanen, M.
    Vahtera, J.
    Vaananen, A.
    Theorell, T.
    Suominen, S. B.
    Shipley, M. J.
    Salo, P.
    Rugulies, R.
    Pentti, J.
    Pejtersen, J. H.
    Oksanen, T.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nielsen, M. L.
    Kouvonen, A.
    Koskinen, A.
    Koskenvuo, M.
    Knutsson, A.
    Ferrie, J. E.
    Dragano, N.
    Burr, H.
    Borritz, M.
    Bjorner, J. B.
    Alfredsson, L.
    Batty, G. D.
    Singh-Manoux, A.
    Kivimaki, M.
    Job strain and the risk of severe asthma exacerbations: a meta-analysis of individual-participant data from 100 000 European men and women2014In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 69, no 6, p. 775-783Article in journal (Refereed)
    Abstract [en]

    Background

    Many patients and healthcare professionals believe that work-related psychosocial stress, such as job strain, can make asthma worse, but this is not corroborated by empirical evidence. We investigated the associations between job strain and the incidence of severe asthma exacerbations in working-age European men and women.

    Methods

    We analysed individual-level data, collected between 1985 and 2010, from 102 175 working-age men and women in 11 prospective European studies. Job strain (a combination of high demands and low control at work) was self-reported at baseline. Incident severe asthma exacerbations were ascertained from national hospitalization and death registries. Associations between job strain and asthma exacerbations were modelled using Cox regression and the study-specific findings combined using random-effects meta-analyses.

    Results

    During a median follow-up of 10years, 1 109 individuals experienced a severe asthma exacerbation (430 with asthma as the primary diagnostic code). In the age- and sex-adjusted analyses, job strain was associated with an increased risk of severe asthma exacerbations defined using the primary diagnostic code (hazard ratio, HR: 1.27, 95% confidence interval, CI: 1.00, 1.61). This association attenuated towards the null after adjustment for potential confounders (HR: 1.22, 95% CI: 0.96, 1.55). No association was observed in the analyses with asthma defined using any diagnostic code (HR: 1.01, 95% CI: 0.86, 1.19).

    Conclusions

    Our findings suggest that job strain is probably not an important risk factor for severe asthma exacerbations leading to hospitalization or death.

  • 16. Heikkila, Katriina
    et al.
    Fransson, Eleonor I.
    Nyberg, Solja T.
    Zins, Marie
    Westerlund, Hugo
    Westerholm, Peter
    Virtanen, Marianna
    Vahtera, Jussi
    Suominen, Sakari
    Steptoe, Andrew
    Salo, Paula
    Pentti, Jaana
    Oksanen, Tuula
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Marmot, Michael G.
    Lunau, Thorsten
    Ladwig, Karl-Heinz
    Koskenvuo, Markku
    Knutsson, Anders
    Kittel, France
    Jockel, Karl-Heinz
    Goldberg, Marcel
    Erbel, Raimund
    Dragano, Nico
    DeBacquer, Dirk
    Clays, Els
    Casini, Annalisa
    Alfredsson, Lars
    Ferrie, Jane E.
    Singh-Manoux, Archana
    Batty, G. David
    Kivimaki, Mika
    Job Strain and Health-Related Lifestyle: Findings From an Individual-Participant Meta-Analysis of 118 000 Working Adults2013In: American Journal of Public Health, ISSN 0090-0036, E-ISSN 1541-0048, Vol. 103, no 11, p. 2090-2097Article in journal (Refereed)
    Abstract [en]

    Objectives. We examined the associations of job strain, an indicator of work-related stress, with overall unhealthy and healthy lifestyles. Methods. We conducted a meta-analysis of individual-level data from 11 European studies (cross-sectional data: n = 118 701; longitudinal data: n = 43 971). We analyzed job strain as a set of binary (job strain vs no job strain) and categorical (high job strain, active job, passive job, and low job strain) variables. Factors used to define healthy and unhealthy lifestyles were body mass index, smoking, alcohol intake, and leisure-time physical activity. Results. Individuals with job strain were more likely than those with no job strain to have 4 unhealthy lifestyle factors (odds ratio [OR] = 1.25; 95% confidence interval [CI] = 1.12, 1.39) and less likely to have 4 healthy lifestyle factors (OR = 0.89; 95% CI = 0.80, 0.99). The odds of adopting a healthy lifestyle during study follow-up were lower among individuals with high job strain than among those with low job strain (OR = 0.88; 95% CI = 0.81, 0.96). Conclusions. Work-related stress is associated with unhealthy lifestyles and the absence of stress is associated with healthy lifestyles, but longitudinal analyses suggest no straightforward cause-effect relationship between work-related stress and lifestyle.

  • 17. Heikkila, Katriina
    et al.
    Madsen, Ida E. H.
    Nyberg, Solja T.
    Fransson, Eleonor I.
    Ahola, Kirsi
    Alfredsson, Lars
    Bjorner, Jakob B.
    Borritz, Marianne
    Burr, Hermann
    Dragano, Nico
    Ferrie, Jane E.
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Nielsen, Martin L.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Pejtersen, Jan H.
    Pentti, Jaana
    Rugulies, Reiner
    Oksanen, Tuula
    Shipley, Martin J.
    Suominen, Sakari B.
    Theorell, Tores
    Vaananen, Ari
    Vahtera, Jussi
    Virtanen, Marianna
    Westerlund, Hugo
    Westerholm, Peter J. M.
    Batty, G. David
    Singh-Manoux, Archana
    Kivimaki, Mika
    Job strain and the risk of inflammatory bowel diseases: individual-participant meta-analysis of 95 000 men and women2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 2, p. e88711-Article in journal (Refereed)
    Abstract [en]

    Background and Aims: Many clinicians, patients and patient advocacy groups believe stress to have a causal role in inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis. However, this is not corroborated by clear epidemiological research evidence. We investigated the association between work-related stress and incident Crohn's disease and ulcerative colitis using individual-level data from 95 000 European adults. Methods: We conducted individual-participant data meta-analyses in a set of pooled data from 11 prospective European studies. All studies are a part of the IPD-Work Consortium. Work-related psychosocial stress was operationalised as job strain (a combination of high demands and low control at work) and was self-reported at baseline. Crohn's disease and ulcerative colitis were ascertained from national hospitalisation and drug reimbursement registers. The associations between job strain and inflammatory bowel disease outcomes were modelled using Cox proportional hazards regression. The study-specific results were combined in random effects meta-analyses. Results: Of the 95 379 participants who were free of inflammatory bowel disease at baseline, 111 men and women developed Crohn's disease and 414 developed ulcerative colitis during follow-up. Job strain at baseline was not associated with incident Crohn's disease (multivariable-adjusted random effects hazard ratio: 0.83, 95% confidence interval: 0.48, 1.43) or ulcerative colitis (hazard ratio: 1.06, 95% CI: 0.76, 1.48). There was negligible heterogeneity among the study-specific associations. Conclusions: Our findings suggest that job strain, an indicator of work-related stress, is not a major risk factor for Crohn's disease or ulcerative colitis.

  • 18. Heikkila, Katriina
    et al.
    Madsen, Ida E. H.
    Nyberg, Solja T.
    Fransson, Eleonor I.
    Ahola, Kirsi
    Alfredsson, Lars
    Bjorner, Jakob B.
    Borritz, Marianne
    Burr, Hermann
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Nielsen, Martin L.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Pahkin, Krista
    Pentti, Jaana
    Rugulies, Reiner
    Salo, Paula
    Shipley, Martin J.
    Suominen, Sakari B.
    Theorell, Tores
    Vaananen, Ari
    Vahtera, Jussi
    Virtanen, Marianna
    Westerholm, Peter J. M.
    Batty, G. David
    Singh-Manoux, Archana
    Kivimaki, Mika
    Job strain and COPD exacerbations: an individual-participant meta-analysis2014In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 44, no 1, p. 247-251Article in journal (Refereed)
  • 19. Heikkila, Katriina
    et al.
    Nyberg, Solja T.
    Fransson, Eleonor I.
    Alfredsson, Lars
    De Bacquer, Dirk
    Bjorner, Jakob B.
    Bonenfant, Sebastien
    Borritz, Marianne
    Burr, Hermann
    Clays, Els
    Casini, Annalisa
    Dragano, Nico
    Erbel, Raimund
    Geuskens, Goedele A.
    Goldberg, Marcel
    Hooftman, Wendela E.
    Houtman, Irene L.
    Joensuu, Matti
    Joeckel, Karl-Heinz
    Kittel, France
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Kouvonen, Anne
    Leineweber, Constanze
    Lunau, Thorsten
    Madsen, Ida E. H.
    Hanson, Linda L. Magnusson
    Marmot, Michael G.
    Nielsen, Martin L.
    Nordin, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Faculty of Social Sciences, Department of Psychology.
    Pentti, Jaana
    Salo, Paula
    Rugulies, Reiner
    Steptoe, Andrew
    Siegrist, Johannes
    Suominen, Sakari
    Vahtera, Jussi
    Virtanen, Marianna
    Vaananen, Ari
    Westerholm, Peter
    Westerlund, Hugo
    Zins, Marie
    Theorell, Tores
    Hamer, Mark
    Ferrie, Jane E.
    Singh-Manoux, Archana
    Batty, G. David
    Kivimaeki, Mika
    Job Strain and Tobacco Smoking: An Individual-Participant Data Meta-Analysis of 166 130 Adults in 15 European Studies2012In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, no 7, p. e35463-Article in journal (Refereed)
    Abstract [en]

    Background: Tobacco smoking is a major contributor to the public health burden and healthcare costs worldwide, but the determinants of smoking behaviours are poorly understood. We conducted a large individual-participant meta-analysis to examine the extent to which work-related stress, operationalised as job strain, is associated with tobacco smoking in working adults. Methodology and Principal Findings: We analysed cross-sectional data from 15 European studies comprising 166 130 participants. Longitudinal data from six studies were used. Job strain and smoking were self-reported. Smoking was harmonised into three categories never, ex- and current. We modelled the cross-sectional associations using logistic regression and the results pooled in random effects meta-analyses. Mixed effects logistic regression was used to examine longitudinal associations. Of the 166 130 participants, 17% reported job strain, 42% were never smokers, 33% ex-smokers and 25% current smokers. In the analyses of the cross-sectional data, current smokers had higher odds of job strain than never-smokers (age, sex and socioeconomic position-adjusted odds ratio: 1.11, 95% confidence interval: 1.03, 1.18). Current smokers with job strain smoked, on average, three cigarettes per week more than current smokers without job strain. In the analyses of longitudinal data (1 to 9 years of follow-up), there was no clear evidence for longitudinal associations between job strain and taking up or quitting smoking. Conclusions: Our findings show that smokers are slightly more likely than non-smokers to report work-related stress. In addition, smokers who reported work stress smoked, on average, slightly more cigarettes than stress-free smokers.

  • 20. Heikkila, Katriina
    et al.
    Nyberg, Solja T.
    Fransson, Eleonor I.
    Alfredsson, Lars
    De Bacquer, Dirk
    Bjorner, Jakob B.
    Bonenfant, Sebastien
    Borritz, Marianne
    Burr, Hermann
    Clays, Els
    Casini, Annalisa
    Dragano, Nico
    Erbel, Raimund
    Geuskens, Goedele A.
    Goldberg, Marcel
    Hooftman, Wendela E.
    Houtman, Irene L.
    Joensuu, Matti
    Joeckel, Karl-Heinz
    Kittel, France
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Kouvonen, Anne
    Leineweber, Constanze
    Lunau, Thorsten
    Madsen, Ida E. H.
    Hanson, Linda L. Magnusson
    Marmot, Michael G.
    Nielsen, Martin L.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Pentti, Jaana
    Salo, Paula
    Rugulies, Reiner
    Steptoe, Andrew
    Siegrist, Johannes
    Suominen, Sakari
    Vahtera, Jussi
    Virtanen, Marianna
    Vaananen, Ari
    Westerholm, Peter
    Westerlund, Hugo
    Zins, Marie
    Theorell, Tores
    Hamer, Mark
    Ferrie, Jane E.
    Singh-Manoux, Archana
    Batty, G. David
    Kivimaki, Mika
    Job Strain and Alcohol Intake: A Collaborative Meta-Analysis of Individual-Participant Data from 140 000 Men and Women2012In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, no 7, p. e40101-Article in journal (Refereed)
    Abstract [en]

    Background: The relationship between work-related stress and alcohol intake is uncertain. In order to add to the thus far inconsistent evidence from relatively small studies, we conducted individual-participant meta-analyses of the association between work-related stress (operationalised as self-reported job strain) and alcohol intake. Methodology and Principal Findings: We analysed cross-sectional data from 12 European studies (n = 142 140) and longitudinal data from four studies (n = 48 646). Job strain and alcohol intake were self-reported. Job strain was analysed as a binary variable (strain vs. no strain). Alcohol intake was harmonised into the following categories: none, moderate (women: 1-14, men: 1-21 drinks/week), intermediate (women: 15-20, men: 22-27 drinks/week) and heavy (women: > 20, men: > 27 drinks/week). Cross-sectional associations were modelled using logistic regression and the results pooled in random effects meta-analyses. Longitudinal associations were examined using mixed effects logistic and modified Poisson regression. Compared to moderate drinkers, non-drinkers and (random effects odds ratio (OR): 1.10, 95% CI: 1.05, 1.14) and heavy drinkers (OR: 1.12, 95% CI: 1.00, 1.26) had higher odds of job strain. Intermediate drinkers, on the other hand, had lower odds of job strain (OR: 0.92, 95% CI: 0.86, 0.99). We found no clear evidence for longitudinal associations between job strain and alcohol intake. Conclusions: Our findings suggest that compared to moderate drinkers, non-drinkers and heavy drinkers are more likely and intermediate drinkers less likely to report work-related stress.

  • 21. Heikkila, Katriina
    et al.
    Nyberg, Solja T.
    Madsen, Ida E. H.
    de Vroome, Ernest
    Alfredsson, Lars
    Bjorner, Jacob J.
    Borritz, Marianne
    Burr, Hermann
    Erbel, Raimund
    Ferrie, Jane E.
    Fransson, Eleonor I.
    Geuskens, Goedele A.
    Hooftman, Wendela E.
    Houtman, Irene L.
    Jöckel, Karl-Heinz
    Knutsson, Anders
    Koskenvuo, Markku
    Lunau, Thorsten
    Nielsen, Martin L.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology. Stress Research Institute, Stockholm University, Stockholm SE-106 91.
    Oksanen, Tuula
    Pejtersen, Jan H.
    Pentti, Jaana
    Shipley, Martin J.
    Steptoe, Andrew
    Suominen, Sakari B.
    Theorell, Töres
    Vahtera, Jussi
    Westerholm, Peter J. M.
    Westerlund, Hugo
    Dragano, Nico
    Rugulies, Reiner
    Kawachi, Ichiro
    Batty, G. David
    Singh-Manoux, Archana
    Virtanen, Marianna
    Kivimäki, Mika
    Long working hours and cancer risk: a multi-cohort study2016In: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 114, no 7, p. 813-818Article in journal (Refereed)
    Abstract [en]

    Background: Working longer than the maximum recommended hours is associated with an increased risk of cardiovascular disease, but the relationship of excess working hours with incident cancer is unclear. Methods: This multi-cohort study examined the association between working hours and cancer risk in 116 462 men and women who were free of cancer at baseline. Incident cancers were ascertained from national cancer, hospitalisation and death registers; weekly working hours were self-reported. Results: During median follow-up of 10.8 years, 4371 participants developed cancer (n colorectal cancer: 393; n lung cancer: 247; n breast cancer: 833; and n prostate cancer: 534). We found no clear evidence for an association between working hours and the overall cancer risk. Working hours were also unrelated the risk of incident colorectal, lung or prostate cancers. Working >= 55 h per week was associated with 1.60-fold (95% confidence interval 1.12-2.29) increase in female breast cancer risk independently of age, socioeconomic position, shift-and night-time work and lifestyle factors, but this observation may have been influenced by residual confounding from parity. Conclusions: Our findings suggest that working long hours is unrelated to the overall cancer risk or the risk of lung, colorectal or prostate cancers. The observed association with breast cancer would warrant further research.

  • 22. Heikkila, Katriina
    et al.
    Nyberg, Solja T.
    Theorell, Tores
    Fransson, Eleonor I.
    Alfredsson, Lars
    Bjorner, Jakob B.
    Bonenfant, Sebastien
    Borritz, Marianne
    Bouillon, Kim
    Burr, Herman
    Dragano, Nico
    Geuskens, Goedele A.
    Goldberg, Marcel
    Hamer, Mark
    Hooftman, Wendela E.
    Houtman, Irene L.
    Joensuu, Matti
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Kouvonen, Anne
    Madsen, Ida E. H.
    Magnusson, Linda L.
    Marmot, Michael G.
    Nielsen, Martin L.
    Nordin, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Oksanen, Tuula
    Pentti, Jaana
    Salo, Paula
    Rugulies, Reiner
    Steptoe, Andrew
    Suominen, Sakari
    Vahtera, Jussi
    Virtanen, Marianna
    Vaananen, Ari
    Westerholm, Peter
    Westerlund, Hugo
    Zins, Marie
    Ferrie, Jane E.
    Singh-Manoux, Archana
    Batty, G. David
    Kivimaki, Mika
    Work stress and risk of cancer: meta-analysis of 5700 incident cancer events in 116 000 European men and women2013In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 346, p. f165-Article in journal (Refereed)
    Abstract [en]

    Objective To investigate whether work related stress, measured and defined as job strain, is associated with the overall risk of cancer and the risk of colorectal, lung, breast, or prostate cancers.

    Design Meta-analysis of pooled prospective individual participant data from 12 European cohort studies including 116 056 men and women aged 17-70 who were free from cancer at study baseline and were followed-up for a median of 12 years. Work stress was measured and defined as job strain, which was self reported at baseline. Incident cancers (all n=5765, colorectal cancer n=522, lung cancer n=374, breast cancer n=1010, prostate cancer n=865) were ascertained from cancer, hospital admission, and death registers. Data were analysed in each study with Cox regression and the study specific estimates pooled in meta-analyses. Models were adjusted for age, sex, socioeconomic position, body mass index (BMI), smoking, and alcohol intake

    Results A harmonised measure of work stress, high job strain, was not associated with overall risk of cancer (hazard ratio 0.97, 95% confidence interval 0.90 to 1.04) in the multivariable adjusted analyses. Similarly, no association was observed between job strain and the risk of colorectal (1.16, 0.90 to 1.48), lung (1.17, 0.88 to 1.54), breast (0.97, 0.82 to 1.14), or prostate (0.86, 0.68 to 1.09) cancers. There was no clear evidence for an association between the categories of job strain and the risk of cancer.

    Conclusions These findings suggest that work related stress, measured and defined as job strain, at baseline is unlikely to be an important risk factor for colorectal, lung, breast, or prostate cancers.

  • 23.
    Kaiser, Niclas
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Lundberg, MattiasUmeå University, Faculty of Social Sciences, Department of Psychology.Nordin, MariaUmeå University, Faculty of Social Sciences, Department of Psychology.Sandström, AgnetaSemb, OlofUmeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development.Westerberg, KristinaUmeå University, Faculty of Social Sciences, Department of Psychology.
    Psykologi för vårdprofessioner2018Collection (editor) (Other academic)
  • 24. Kivimaeki, Mika
    et al.
    Virtanen, Marianna
    Kawachi, Ichiro
    Nyberg, Solja T.
    Alfredsson, Lars
    Batty, G. David
    Bjorner, Jakob B.
    Borritz, Marianne
    Brunner, Eric J.
    Burr, Hermann
    Dragano, Nico
    Ferrie, Jane E.
    Fransson, Eleonor I.
    Hamer, Mark
    Heikkila, Katriina
    Knutsson, Anders
    Koskenvuo, Markku
    Madsen, Ida E. H.
    Nielsen, Martin L.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Oksanen, Tuula
    Pejtersen, Jan H.
    Pentti, Jaana
    Rugulies, Reiner
    Salo, Paula
    Siegrist, Johannes
    Steptoe, Andrew
    Suominen, Sakari
    Theorell, Tres
    Vahtera, Jussi
    Westerholm, Peter J. M.
    Westerlund, Hugo
    Singh-Manoux, Archana
    Jokela, Markus
    Long working hours, socioeconomic status, and the risk of incident type 2 diabetes: a meta-analysis of published and unpublished data from 222 120 individuals2015In: The Lancet Diabetes & Endocrinology, ISSN 2213-8587, Vol. 3, no 1, p. 27-34Article in journal (Refereed)
    Abstract [en]

    Background: Working long hours might have adverse health effects, but whether this is true for all socioeconomic status groups is unclear. In this meta-analysis stratified by socioeconomic status, we investigated the role of long working hours as a risk factor for type 2 diabetes.

    Methods: We identified four published studies through a systematic literature search of PubMed and Embase up to April 30, 2014. Study inclusion criteria were English-language publication; prospective design (cohort study); investigation of the effect of working hours or overtime work; incident diabetes as an outcome; and relative risks, odds ratios, or hazard ratios (HRs) with 95% CIs, or sufficient information to calculate these estimates. Additionally, we used unpublished individual-level data from 19 cohort studies from the Individual-Participant-Data Meta-analysis in Working-Populations Consortium and international open-access data archives. Effect estimates from published and unpublished data from 222 120 men and women from the USA, Europe, Japan, and Australia were pooled with random-effects meta-analysis.

    Findings: During 1·7 million person-years at risk, 4963 individuals developed diabetes (incidence 29 per 10 000 person-years). The minimally adjusted summary risk ratio for long (≥55 h per week) compared with standard working hours (35–40 h) was 1·07 (95% CI 0·89–1·27, difference in incidence three cases per 10 000 person-years) with significant heterogeneity in study-specific estimates (I2=53%, p=0·0016). In an analysis stratified by socioeconomic status, the association between long working hours and diabetes was evident in the low socioeconomic status group (risk ratio 1·29, 95% CI 1·06–1·57, difference in incidence 13 per 10 000 person-years, I2=0%, p=0·4662), but was null in the high socioeconomic status group (1·00, 95% CI 0·80–1·25, incidence difference zero per 10 000 person-years, I2=15%, p=0·2464). The association in the low socioeconomic status group was robust to adjustment for age, sex, obesity, and physical activity, and remained after exclusion of shift workers.

    Interpretation: In this meta-analysis, the link between longer working hours and type 2 diabetes was apparent only in individuals in the low socioeconomic status groups.

  • 25. Kivimaki, Mika
    et al.
    Kuosma, Eeva
    Ferrie, Jane E.
    Luukkonen, Ritva
    Nyberg, Solja T.
    Alfredsson, Lars
    Batty, G. David
    Brunner, Eric J.
    Fransson, Eleonor
    Goldberg, Marcel
    Knutsson, Anders
    Koskenvuo, Markku
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Oksanen, Tuula
    Pentti, Jaana
    Rugulies, Reiner
    Shipley, Martin J.
    Singh-Manoux, Archana
    Steptoe, Andrew
    Suominen, Sakari B.
    Theorell, Tores
    Vahtera, Jussi
    Virtanen, Marianna
    Westerholm, Peter
    Westerlund, Hugo
    Zins, Marie
    Hamer, Mark
    Bell, Joshua A.
    Tabak, Adam G.
    Jokela, Markus
    Overweight, obesity, and risk of cardiometabolic multimorbidity: pooled analysis of individual-level data for 120 813 adults from 16 cohort studies from the USA and Europe2017In: LANCET PUBLIC HEALTH, ISSN 2468-2667, Vol. 2, no 6, p. E277-E285Article in journal (Refereed)
    Abstract [en]

    Background Although overweight and obesity have been studied in relation to individual cardiometabolic diseases, their association with risk of cardiometabolic multimorbidity is poorly understood. Here we aimed to establish the risk of incident cardiometabolic multimorbidity (ie, at least two from: type 2 diabetes, coronary heart disease, and stroke) in adults who are overweight and obese compared with those who are a healthy weight. Methods We pooled individual-participant data for BMI and incident cardiometabolic multimorbidity from 16 prospective cohort studies from the USA and Europe. Participants included in the analyses were 35 years or older and had data available for BMI at baseline and for type 2 diabetes, coronary heart disease, and stroke at baseline and follow-up. We excluded participants with a diagnosis of diabetes, coronary heart disease, or stroke at or before study baseline. According to WHO recommendations, we classified BMI into categories of healthy (20.0-24.9 kg/m(2)), overweight (25.0-29.9 kg/m(2)), class I (mild) obesity (30.0-34.9 kg/m(2)), and class II and III (severe) obesity (>= 35.0 kg/m(2)). We used an inclusive definition of underweight (<20 kg/m(2)) to achieve sufficient case numbers for analysis. The main outcome was cardiometabolic multimorbidity (ie, developing at least two from: type 2 diabetes, coronary heart disease, and stroke). Incident cardiometabolic multimorbidity was ascertained via resurvey or linkage to electronic medical records (including hospital admissions and death). We analysed data from each cohort separately using logistic regression and then pooled cohort-specific estimates using random-effects meta-analysis. Findings Participants were 120 813 adults (mean age 51.4 years, range 35-103; 71445 women) who did not have diabetes, coronary heart disease, or stroke at study baseline (1973-2012). During a mean follow-up of 10.7 years (1995-2014), we identified 1627 cases of multimorbidity. After adjustment for sociodemographic and lifestyle factors, compared with individuals with a healthy weight, the risk of developing cardiometabolic multimorbidity in overweight individuals was twice as high (odds ratio [OR] 2.0, 95% CI 1.7-2.4; p<0.0001), almost five times higher for individuals with class I obesity (4.5, 3.5- 5.8; p<0.0001), and almost 15 times higher for individuals with classes II and III obesity combined (14.5, 10.1-21.0; p<0.0001). This association was noted in men and women, young and old, and white and non-white participants, and was not dependent on the method of exposure assessment or outcome ascertainment. In analyses of different combinations of cardiometabolic conditions, odds ratios associated with classes II and III obesity were 2.2 (95% CI 1.9-2.6) for vascular disease only (coronary heart disease or stroke), 12.0 (8.1-17.9) for vascular disease followed by diabetes, 18.6 (16.6-20.9) for diabetes only, and 29.8 (21.7-40.8) for diabetes followed by vascular disease. Interpretation The risk of cardiometabolic multimorbidity increases as BMI increases; from double in overweight people to more than ten times in severely obese people compared with individuals with a healthy BMI. Our findings highlight the need for clinicians to actively screen for diabetes in overweight and obese patients with vascular disease, and pay increased attention to prevention of vascular disease in obese individuals with diabetes. Copyright (C) The Author(s). 

  • 26. Kivimaki, Mika
    et al.
    Nyberg, Solja T
    Fransson, Eleonor I
    Heikkila, Katriina
    Alfredsson, Lars
    Casini, Annalisa
    Clays, Els
    De Bacquer, Dirk
    Dragano, Nico
    Ferrie, Jane E
    Goldberg, Marcel
    Hamer, Mark
    Jokela, Markus
    Karasek, Robert
    Kittel, France
    Knutsson, Anders
    Koskenvuo, Markku
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Oksanen, Tuula
    Pentti, Jaana
    Rugulies, Reiner
    Salo, Paula
    Siegrist, Johannes
    Suominen, Sakari B
    Theorell, Tores
    Vahtera, Jussi
    Virtanen, Marianna
    Westerholm, Peter JM
    Westerlund, Hugo
    Zins, Marie
    Steptoe, Andrew
    Singh-Manoux, Archana
    Batty, G David
    Associations of job strain and lifestyle risk factors with risk of coronary artery disease: a meta-analysis of individual participant data2013In: CMJA. Canadian Medical Association Journal. Onlineutg. Med tittel: ECMAJ. ISSN 1488-2329, ISSN 0820-3946, E-ISSN 1488-2329, Vol. 185, no 9, p. 763-769Article in journal (Refereed)
    Abstract [en]

    Background: It is unclear whether a healthy lifestyle mitigates the adverse effects of job strain on coronary artery disease. We examined the associations of job strain and lifestyle risk factors with the risk of coronary artery disease.

    Methods: We pooled individual-level data from 7 cohort studies comprising 102 128 men and women who were free of existing coronary artery disease at baseline (1985-2000). Questionnaires were used to measure job strain (yes v. no) and 4 lifestyle risk factors: current smoking, physical inactivity, heavy drinking and obesity. We grouped participants into 3 lifestyle categories: healthy (no lifestyle risk factors), moderately unhealthy (1 risk factor) and unhealthy (2-4 risk factors). The primary outcome was incident coronary artery disease (defined as first nonfatal myocardial infarction or cardiac-related death).

    Results: There were 1086 incident events in 743 948 person-years at risk during a mean follow-up of 7.3 years. The risk of coronary artery disease among people who had an unhealthy lifestyle compared with those who had a healthy lifestyle (hazard ratio [HR] 2.55, 95% confidence interval [CI] 2.18-2.98; population attributable risk 26.4%) was higher than the risk among participants who had job strain compared with those who had no job strain (HR 1.25, 95% CI 1.06-1.47; population attributable risk 3.8%). The 10-year incidence of coronary artery disease among participants with job strain and a healthy lifestyle (14.7 per 1000) was 53% lower than the incidence among those with job strain and an unhealthy lifestyle (31.2 per 1000).

    Interpretation: The risk of coronary artery disease was highest among participants who reported job strain and an unhealthy lifestyle; those with job strain and a healthy lifestyle had half the rate of disease. A healthy life style may substantially reduce disease risk among people with job strain.

  • 27. Kivimäki, Mika
    et al.
    Jokela, Markus
    Nyberg, Solja T
    Singh-Manoux, Archana
    Fransson, Eleonor I
    Alfredsson, Lars
    Bjorner, Jakob B
    Borritz, Marianne
    Burr, Hermann
    Casini, Annalisa
    Clays, Els
    De Bacquer, Dirk
    Dragano, Nico
    Erbel, Raimund
    Geuskens, Goedele A
    Hamer, Mark
    Hooftman, Wendela E
    Houtman, Irene L
    Jöckel, Karl-Heinz
    Kittel, France
    Knutsson, Anders
    Koskenvuo, Markku
    Lunau, Thorsten
    Madsen, Ida E H
    Nielsen, Martin L
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology. Stress Research Institute, Stockholm University, Stockholm, Sweden .
    Oksanen, Tuula
    Pejtersen, Jan H
    Pentti, Jaana
    Rugulies, Reiner
    Salo, Paula
    Shipley, Martin J
    Siegrist, Johannes
    Steptoe, Andrew
    Suominen, Sakari B
    Theorell, Töres
    Vahtera, Jussi
    Westerholm, Peter J M
    Westerlund, Hugo
    O'Reilly, Dermot
    Kumari, Meena
    Batty, G David
    Ferrie, Jane E
    Virtanen, Marianna
    Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603 838 individuals2015In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 386, no 10005, p. 1739-1746Article in journal (Refereed)
    Abstract [en]

    Background: Long working hours might increase the risk of cardiovascular disease, but prospective evidence is scarce, imprecise, and mostly limited to coronary heart disease. We aimed to assess long working hours as a risk factor for incident coronary heart disease and stroke. Methods: We identified published studies through a systematic review of PubMed and Embase from inception to Aug 20, 2014. We obtained unpublished data for 20 cohort studies from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium and open-access data archives. We used cumulative random-effects meta-analysis to combine effect estimates from published and unpublished data. Findings: We included 25 studies from 24 cohorts in Europe, the USA, and Australia. The meta-analysis of coronary heart disease comprised data for 603 838 men and women who were free from coronary heart disease at baseline; the meta-analysis of stroke comprised data for 528 908 men and women who were free from stroke at baseline. Follow-up for coronary heart disease was 5.1 million person-years (mean 8.5 years), in which 4768 events were recorded, and for stroke was 3.8 million person-years (mean 7.2 years), in which 1722 events were recorded. In cumulative meta-analysis adjusted for age, sex, and socioeconomic status, compared with standard hours (35-40 h per week), working long hours (>= 55 h per week) was associated with an increase in risk of incident coronary heart disease (relative risk [RR] 1.13, 95% CI 1.02-1.26; p=0.02) and incident stroke (1.33, 1.11-1.61; p=0.002). The excess risk of stroke remained unchanged in analyses that addressed reverse causation, multivariable adjustments for other risk factors, and different methods of stroke ascertainment (range of RR estimates 1.30-1.42). We recorded a dose-response association for stroke, with RR estimates of 1.10 (95% CI 0.94-1.28; p=0.24) for 41-48 working hours, 1.27 (1.03-1.56; p=0.03) for 49-54 working hours, and 1.33 (1.11-1.61; p=0.002) for 55 working hours or more per week compared with standard working hours (p(trend)<0.0001). Interpretation: Employees who work long hours have a higher risk of stroke than those working standard hours; the association with coronary heart disease is weaker. These findings suggest that more attention should be paid to the management of vascular risk factors in individuals who work long hours.

  • 28. Kivimäki, Mika
    et al.
    Luukkonen, Ritva
    Batty, G. David
    Ferrie, Jane E.
    Pentti, Jaana
    Nyberg, Solja T.
    Shipley, Martin J.
    Alfredsson, Lars
    Fransson, Eleonor I.
    Goldberg, Marcel
    Knutsson, Anders
    Koskenvuo, Markku
    Kuosma, Eeva
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology. Division of Epidemiology, Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Suominen, Sakari B.
    Theorell, Töres
    Vuoksimaa, Eero
    Westerholm, Peter
    Westerlund, Hugo
    Zins, Marie
    Kivipelto, Miia
    Vahtera, Jussi
    Kaprio, Jaakko
    Singh-Manoux, Archana
    Umeå University, Faculty of Social Sciences, Department of Psychology. Department of Epidemiology and Public Health, University College London, London, UK; Population-based Epidemiologic Cohort Unit, UMS 011, Inserm, Villejuif, France.
    Jokela, Markus
    Umeå University, Faculty of Social Sciences, Department of Psychology. Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland.
    Body mass index and risk of dementia: Analysis of individual-level data from 1.3 million individuals2018In: Alzheimer's & Dementia, ISSN 1552-5260, E-ISSN 1552-5279, Vol. 14, no 5, p. 601-609Article in journal (Refereed)
    Abstract [en]

    Introduction: Higher midlife body mass index (BMI) is suggested to increase the risk of dementia, but weight loss during the preclinical dementia phase may mask such effects. Methods: We examined this hypothesis in 1,349,857 dementia-free participants from 39 cohort studies. BMI was assessed at baseline. Dementia was ascertained at follow-up using linkage to electronic health records (N = 6894). We assumed BMI is little affected by preclinical dementia when assessed decades before dementia onset and much affected when assessed nearer diagnosis. Results: Hazard ratios per 5-kg/m(2) increase in BMI for dementia were 0.71 (95% confidence interval = 0.66-0.77), 0.94 (0.89-0.99), and 1.16 (1.05-1.27) when BMI was assessed 10 years, 10-20 years, and >20 years before dementia diagnosis. Conclusions: The association between BMI and dementia is likely to be attributable to two different processes: a harmful effect of higher BMI, which is observable in long follow-up, and a reverse-causation effect that makes a higher BMI to appear protective when the follow-up is short. 

  • 29. Kivimäki, Mika
    et al.
    Nyberg, Solja T
    Batty, G David
    Fransson, Eleonor I
    Heikkilä, Katriina
    Alfredsson, Lars
    Bjorner, Jakob B
    Borritz, Marianne
    Burr, Hermann
    Casini, Annalisa
    Clays, Els
    De Bacquer, Dirk
    Dragano, Nico
    Ferrie, Jane E
    Geuskens, Goedele A
    Goldberg, Marcel
    Hamer, Mark
    Hooftman, Wendela E
    Houtman, Irene L
    Joensuu, Matti
    Jokela, Markus
    Kittel, France
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Kouvonen, Anne
    Kumari, Meena
    Madsen, Ida Eh
    Marmot, Michael G
    Nielsen, Martin L
    Nordin, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Oksanen, Tuula
    Pentti, Jaana
    Rugulies, Reiner
    Salo, Paula
    Siegrist, Johannes
    Singh-Manoux, Archana
    Suominen, Sakari B
    Väänänen, Ari
    Vahtera, Jussi
    Virtanen, Marianna
    Westerholm, Peter Jm
    Westerlund, Hugo
    Zins, Marie
    Steptoe, Andrew
    Theorell, Töres
    Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data2012In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 380, no 9852, p. 1491-1497Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Published work assessing psychosocial stress (job strain) as a risk factor for coronary heart disease is inconsistent and subject to publication bias and reverse causation bias. We analysed the relation between job strain and coronary heart disease with a meta-analysis of published and unpublished studies. METHODS: We used individual records from 13 European cohort studies (1985-2006) of men and women without coronary heart disease who were employed at time of baseline assessment. We measured job strain with questions from validated job-content and demand-control questionnaires. We extracted data in two stages such that acquisition and harmonisation of job strain measure and covariables occurred before linkage to records for coronary heart disease. We defined incident coronary heart disease as the first non-fatal myocardial infarction or coronary death. FINDINGS: 30 214 (15%) of 197 473 participants reported job strain. In 1·49 million person-years at risk (mean follow-up 7·5 years [SD 1·7]), we recorded 2358 events of incident coronary heart disease. After adjustment for sex and age, the hazard ratio for job strain versus no job strain was 1·23 (95% CI 1·10-1·37). This effect estimate was higher in published (1·43, 1·15-1·77) than unpublished (1·16, 1·02-1·32) studies. Hazard ratios were likewise raised in analyses addressing reverse causality by exclusion of events of coronary heart disease that occurred in the first 3 years (1·31, 1·15-1·48) and 5 years (1·30, 1·13-1·50) of follow-up. We noted an association between job strain and coronary heart disease for sex, age groups, socioeconomic strata, and region, and after adjustments for socioeconomic status, and lifestyle and conventional risk factors. The population attributable risk for job strain was 3·4%. INTERPRETATION: Our findings suggest that prevention of workplace stress might decrease disease incidence; however, this strategy would have a much smaller effect than would tackling of standard risk factors, such as smoking. FUNDING: Finnish Work Environment Fund, the Academy of Finland, the Swedish Research Council for Working Life and Social Research, the German Social Accident Insurance, the Danish National Research Centre for the Working Environment, the BUPA Foundation, the Ministry of Social Affairs and Employment, the Medical Research Council, the Wellcome Trust, and the US National Institutes of Health.

  • 30. Kivimäki, Mika
    et al.
    Nyberg, Solja T.
    Batty, G. David
    Kawachi, Ichiro
    Jokela, Markus
    Alfredsson, Lars
    Bjorner, Jakob B.
    Borritz, Marianne
    Burr, Hermann
    Dragano, Nico
    Fransson, Eleonor I.
    Heikkilä, Katriina
    Knutsson, Anders
    Koskenvuo, Markku
    Kumari, Meena
    Madsen, Ida E. H.
    Nielsen, Martin L.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology. Stress Research Institute, Stockholm University, Frescati Hagv€ag 16 A, 114 19 Stockholm, Sweden.
    Oksanen, Tuula
    Pejtersen, Jan H.
    Pentti, Jaana
    Rugulies, Reiner
    Salo, Paula
    Shipley, Martin J.
    Suominen, Sakari
    Theorell, Töres
    Vahtera, Jussi
    Westerholm, Peter
    Westerlund, Hugo
    Steptoe, Andrew
    Singh-Manoux, Archana
    Hamer, Mark
    Ferrie, Jane E.
    Virtanen, Marianna
    Tabak, Adam G.
    Long working hours as a risk factor for atrial fibrillation: a multi-cohort study2017In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 38, no 34, p. 2621-2628Article in journal (Refereed)
    Abstract [en]

    Aims Studies suggest that people who work long hours are at increased risk of stroke, but the association of long working hours with atrial fibrillation, the most common cardiac arrhythmia and a risk factor for stroke, is unknown. We examined the risk of atrial fibrillation in individuals working long hours (>= 55 per week) and those working standard 35-40 h/week. Methods and results In this prospective multi-cohort study from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium, the study population was 85 494 working men and women (mean age 43.4 years) with no recorded atrial fibrillation. Working hours were assessed at study baseline (1991-2004). Mean follow-up for incident atrial fibrillation was 10 years and cases were defined using data on electrocardiograms, hospital records, drug reimbursement registers, and death certificates. We identified 1061 new cases of atrial fibrillation (10-year cumulative incidence 12.4 per 1000). After adjustment for age, sex and socioeconomic status, individuals working long hours had a 1.4-fold increased risk of atrial fibrillation compared with those working standard hours (hazard ratio = 1.42, 95% CI= 1.13-1.80, P= 0.003). There was no significant heterogeneity between the cohort-specific effect estimates (I-2= 0%, P = 0.66) and the finding remained after excluding participants with coronary heart disease or stroke at baseline or during the follow-up (N= 2006, hazard ratio= 1.36, 95% CI= 1.05-1.76, P = 0.0180). Adjustment for potential confounding factors, such as obesity, risky alcohol use and high blood pressure, had little impact on this association. Conclusion Individuals who worked long hours were more likely to develop atrial fibrillation than those working standard hours.

  • 31.
    Lind, Nina
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Palmquist, Eva
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Claeson, Anna-Sara
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Millqvist, Eva
    University of Gothenburg, Sweden.
    Nordin, Steven
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Coping and Social Support in Asthma and Allergy: The Västerbotten Environmental Health Study2015In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 52, no 6, p. 622-629Article in journal (Refereed)
    Abstract [en]

    Objectives: Asthma and allergy are stressful conditions that require coping strategies and social support to reduce stress and enhance health-promoting behavior. However, research is limited regarding coping and social support in asthma and allergy. The aim was to better understand use of different coping strategies and perceived social support in low and high severity (exacerbation frequency) of asthma and allergy. Methods: Population-based data were used to provide ratings of coping strategies (Study I) and social support (Study II) from 124 and 94 participants, respectively, with asthma and/or allergy, categorized as low or high in severity. Problem- and emotion-focused coping strategies were assessed as well as emotional, instrumental and informative social support from seven sources. Results: Study I showed that avoiding certain environments (problem-based coping) and trying to accept one’s situation (emotion-based) were the most commonly used coping strategies. These behaviors did not differ due to severity. Study II showed that more emotional than instrumental and informative support was perceived. The highest rated support sources were the partner, family members, and the healthcare system. More social support was reported in low compared to high asthma/allergy severity. Conclusion: The most commonly used coping strategies in the population of persons with these four types of asthma and allergy are avoiding certain environments and trying to accept one’s situation. More emotional support than instrumental and informative is perceived to be received, and most of the support is received from one’s partner and other family members, and least from authorities and patient associations/support groups.

  • 32.
    Lind, Nina
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Palmquist, Eva
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nordin, Steven
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Psychological distress in asthma and allergy: the Västerbotten Environmental Health Study2014In: Psychology, Health & Medicine, ISSN 1354-8506, E-ISSN 1465-3966, Vol. 19, no 3, p. 316-323Article in journal (Refereed)
    Abstract [en]

    With the aim to better understand the association between asthma/allergy and psychological distress, it was hypothesized that levels of stress, exhaustion, anxiety, depression, and health worries for environmental pollution would be higher in allergic asthma, allergic rhinitis, and atopic dermatitis than in non-allergic asthma and in referents without asthma or allergy. Taking part in the population-based Vasterbotten Environmental Health Study (aged 18-79years), 76 respondents reported a physician-based diagnosis of allergic asthma, 86 reported non-allergic asthma, 190 reported allergic rhinitis, and 46 reported atopic dermatitis as the only form of asthma/allergy. A group of 2876 respondents without an asthma/allergy diagnosis constituted as referents. The participants responded to the Perceived Stress Scale, the Shirom-Melamed Burnout Questionnaire, the Hospital Anxiety and Depression Scale, and the Environmental Pollution subscale of the Modern Health Worries Scale. Levels of stress, exhaustion, and anxiety were higher in allergic asthma and atopic dermatitis than in non-allergic asthma, allergic rhinitis, and among referents, and there was a strong tendency of such group differences for depression and health worries. The results imply that stress reduction and treatment of negative affect may in certain cases be fruitful interventions in patients with atopy.

  • 33. Madsen, I. E. H.
    et al.
    Nyberg, S. T.
    Hanson, L. L. Magnusson
    Ferrie, J. E.
    Ahola, K.
    Alfredsson, L.
    Batty, G. D.
    Bjorner, J. B.
    Borritz, M.
    Burr, H.
    Chastang, J. -F
    de Graaf, R.
    Dragano, N.
    Hamer, M.
    Jokela, M.
    Knutsson, A.
    Koskenvuo, M.
    Koskinen, A.
    Leineweber, C.
    Niedhammer, I.
    Nielsen, M. L.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology. Stress Research Institute, Stockholm University, SE-106 91 Stockholm, Sweden.
    Oksanen, T.
    Pejtersen, J. H.
    Pentti, J.
    Plaisier, I.
    Salo, P.
    Singh-Manoux, A.
    Suominen, S.
    ten Have, M.
    Theorell, T.
    Toppinen-Tanner, S.
    Vahtera, J.
    Vaananen, A.
    Westerholm, P. J. M.
    Westerlund, H.
    Fransson, E. I.
    Heikkila, K.
    Virtanen, M.
    Rugulies, R.
    Kivimaki, M.
    Job strain as a risk factor for clinical depression: systematic review and meta-analysis with additional individual participant data2017In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 47, no 8, p. 1342-1356Article, review/survey (Refereed)
    Abstract [en]

    Adverse psychosocial working environments characterized by job strain (the combination of high demands and low control at work) are associated with an increased risk of depressive symptoms among employees, but evidence on clinically diagnosed depression is scarce. We examined job strain as a risk factor for clinical depression.

    We identified published cohort studies from a systematic literature search in PubMed and PsycNET and obtained 14 cohort studies with unpublished individual-level data from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium. Summary estimates of the association were obtained using random-effects models. Individual-level data analyses were based on a pre-published study protocol.

    We included six published studies with a total of 27 461 individuals and 914 incident cases of clinical depression. From unpublished datasets we included 120 221 individuals and 982 first episodes of hospital-treated clinical depression. Job strain was associated with an increased risk of clinical depression in both published [relative risk (RR) = 1.77, 95% confidence interval (CI) 1.47–2.13] and unpublished datasets (RR = 1.27, 95% CI 1.04–1.55). Further individual participant analyses showed a similar association across sociodemographic subgroups and after excluding individuals with baseline somatic disease. The association was unchanged when excluding individuals with baseline depressive symptoms (RR = 1.25, 95% CI 0.94–1.65), but attenuated on adjustment for a continuous depressive symptoms score (RR = 1.03, 95% CI 0.81–1.32).

    Job strain may precipitate clinical depression among employees. Future intervention studies should test whether job strain is a modifiable risk factor for depression.

  • 34.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Supporting Sleep: The Importance of Social Relations at Work2015Book (Refereed)
    Abstract [en]

    Up to 40 per cent of the working population report problems with their sleep. Sick-leave increases due to stress-related disorders, and by being closely related to stress, disturbed sleep plays an important role here. Being the opposite of stress, good sleep is a crucial health factor whereas sleep disturbance can be an early sign of ill-health. Social support is also an acknowledged health factor which should be considered when reducing sick-leave. This book analyses the positive effects of social support at work and how bullying at work can have a negative impact on sleep. Promoting healthy work by providing good conditions for strong social relationships and by preventing bullying or harassment can improve sleep and consequently employee health, increasing work productivity and efficiency overall.

  • 35.
    Nordin, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Andersson, Linus
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nordin, Steven
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Coping strategies, social support and responsibility in chemical intolerance2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 15/16, p. 2162-2173Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. To study coping strategies, social support and responsibility for improvement in chemical intolerance (CI).

    Background. Limited knowledge of CI among health professionals and lay persons places demands on the chemically intolerant individual’s coping strategies and perception of social support and ability to take responsibility for improvement. However, there is sparse literature on these issues in CI.

    Design. A cross-sectional, questionnaire-based, quasi-experimental study.

    Method. Fifty-nine persons with mild, 92 with moderate and 31 with severe CI participated by rating (i) usage and effectiveness of six problem- and six emotion-focused coping strategies, (ii) emotional, instrumental and informative support provided by various sources and (iii) society’s and the inflicted individual’s responsibility for improvement.

    Results. The participants reported that the most commonly used and effective coping strategies were avoiding odorous/pungent environments and asking persons to limit their use of odorous/pungent substances (problem-focused strategies) as well as accepting the situation and reprioritising (emotion-focused strategies). High intolerance severity was associated with problemfocused coping strategies and relatively low intolerance with emotion-focused strategies. More emotional than instrumental and informative support was perceived, predominantly from the partner and other family members. Responsibility attributed to society was also found to increase from mild to moderate/severe intolerance.

    Conclusions. Certain coping strategies are more commonly used and perceived as more effective than others in CI. However, intolerance severity plays a role regarding both coping strategies and responsibility. Emotional support appears to be the most available type of support.

  • 36.
    Nordin, Maria
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Bolin, Malin
    Do sex differences in the association between work exposure and health in the manufacturing industry depend on work context?: results from the WOLF-study2014In: Psychology, ISSN 2152-7180, Vol. 5, no 8, p. 896-907Article in journal (Refereed)
    Abstract [en]

    The aim of this study is to investigate the associations between work exposure such as psychosocial work factors and work posture, and health in men and women with the same type of occupation in the manufacturing industry. Two follow-ups with a follow-up rate of 67% from the WOrk, Lipids and Fibrinogen (WOLF) cohort from the Northern Sweden were used. The database included 1589 men and 286 women, which is representative of the proportions between men and women in the Swedish manufacturing industry. To be able to understand the importance of work context, the participants were categorized according to work tasks (working with things or symbols). Logistic regression was used for interaction analyses between sex and psychosocial work factors (such as demand, control, social support, role conflict, and work-family conflict) as well as physical work factors (such as work posture), and health outcomes (work overcommitment, fatigue, and neck and back pain). The results showed contextually different patterns of sex different associations between psychosocial work factors and health outcomes. For instance, women were at larger risk of ill-health (in the form of work overcommitment) when working with things, whereas men were at larger risk of both work overcommitment and fatigue when working with symbols. Women working with symbols had a larger risk of neck and back pain due to work-family conflict. The health outcome that was most sensitive to the sex different associations was work overcommitment. In conclusion, the work context matters for sex differences in the association between psychosocial work factors and health and since work overcommitment is a predictor of disease, it should be of interest for the Occupational Health Services and personnel departments to survey.

  • 37.
    Nordin, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Bolin, Malin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Hälsa hos kvinnor i industrin: Organisation, arbetsmiljö, yrke och kön2012Report (Other academic)
  • 38.
    Nordin, Maria
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Bucher, R.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Lind, Nina
    Nordin, Steven
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Is there a bidirectional relationship between sleep and asthma and allergy in a general population?2016In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 85, p. 75-76Article in journal (Other academic)
  • 39.
    Nordin, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Kaplan, Robert M
    Sleep discontinuity and impaired sleep continuity affect transition to and from obesity over time: results from the Alameda county study.2010In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 38, no 2, p. 200-207Article in journal (Refereed)
    Abstract [en]

    AIMS: To investigate the impact of development in sleep continuity on transition to and from obesity over time. METHOD: The study used self-reported sleep and body mass index (BMI) measures from the 1965, 1974, 1983, and 1994 waves of the longitudinal Alameda County Study. Sleep continuity was assessed by a question on whether the participants had any troubles falling or staying asleep. Change in sleep and BMI were estimated from the sleep and BMI questions in 1965 and 1994 respectively. Multinomial regression analyses were used to examine the risk/chance for a transition to and from obesity (BMI >or=30 kg/m(2)) due to development in sleep continuity. RESULTS: After adjustment for confounding variables, consistent sleep discontinuity both increases the risk for a transition to obesity and reduces the chance of losing weight, whereas impaired sleep continuity lowers the chance for weight loss. Effects for obesity were non-significant for those with improved sleep continuity. CONCLUSIONS: Consistent sleep discontinuity and impaired sleep continuity increases the risk of transition to obesity or of remaining obese.

  • 40.
    Nordin, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Knutsson, Anders
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Is disturbed sleep a mediator in the association between social support and myocardial infarction?2008In: Journal of Health Psychology, ISSN 1359-1053, E-ISSN 1461-7277, Vol. 13, no 1, p. 55-64Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to investigate a mediating relationship between social support and disturbed sleep in cases surviving myocardial infarction. The case-referent studies, Stockholm Heart Epidemiological Program (SHEEP) and Västernorrland Heart Epidemiological Program (VHEEP) were used comprising 6231 participants (2046 women). Referents were randomly selected. Disturbed sleep was operationalized by the Karolinska Sleep Questionnaire, network support by the Availability of Social Integration Index and emotional support by the Availability of Attachment Index. Mediating associations were tested with logistic regression. The results show that disturbed sleep may act as a mediator between low network support and myocardial infarction in women.

  • 41.
    Nordin, Maria
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Knutsson, Anders
    Sundbom, Elisabet
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Stegmayr, Birgitta
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine.
    Psychosocial factors, gender, and sleep.2005In: Journal of Occupational Health Psychology, ISSN 1076-8998, E-ISSN 1939-1307, Vol. 10, no 1, p. 54-63Article in journal (Refereed)
  • 42.
    Nordin, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Knutsson, Anders
    Sundbom, Elisabet
    Åkerstedt, Torbjörn
    Westerholm, Peter
    Alfredsson, Lars
    Low social support and vulnerability in the association with disturbed sleep: longitudinal results from the WOLF studyManuscript (preprint) (Other academic)
  • 43.
    Nordin, Maria
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Lantto, L.
    Claeson, Anna-Sara
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nordin, Steven
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Young women's mental health in northern Sweden2016In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 23, p. S3-S3Article in journal (Other academic)
  • 44.
    Nordin, Maria
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nordin, Steven
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Psychometric evaluation and normative data of the Swedish version of the 10-item perceived stress scale2013In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 54, no 6, p. 502-507Article in journal (Refereed)
    Abstract [en]

    The perceived stress scale (PSS) has been translated to several languages and validated in many cultures. The longer 14-item version (PSS-14), has been translated to Swedish and validated for Swedish use. However, the Swedish version of the shorter 10-item version (PSS-10) has not been validated before. Therefore, the aim of this study was to evaluate the Swedish version of the PSS-10 with regard to reliability and validity, and to provide normative data. Data from 3,406 individuals who took part in the Vasterbotten Environmental Health Study in Sweden were used. The respondents constitute a random sample, aged 18 to 79years, and stratified for age and sex. They responded to the Swedish version of the PSS-10 as well as to the hospital anxiety and depression scale, and the Shirom Melamed burnout questionnaire for assessment of construct validity. The results show that the PSS-10 provides approximately normally distributed data, has good internal reliability (Cronbach's alpha 0.84), and has good construct validity with anxiety (r=0.68), depression (r=0.57), and mental/physical exhaustion (r=0.71). The favorable psychometric properties of the Swedish version of the PSS-10 suggest use of the instrument for assessing perceived stress in Swedish and similar populations.

  • 45.
    Nordin, Maria
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology. Stress Research Institute, Stockholm University, Sweden.
    Nordin, Steven
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sleep and sleepiness in environmental intolerances: a population-based study2016In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 24, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Background: About one fourth of the general population report environmental intolerance (El) to odorous/pungent chemicals, certain buildings, electromagnetic fields (EMFs), and/or sounds. EI sufferers show various clinical features, of which sleep disturbance is one. Sleep disturbance is common also in the general population, but it is not known whether the disturbance is more prominent in EI sufferers than in individuals who do not experience EI. Therefore, El was compared on various sleep aspects with referents without El. 

    Methods: A population-based sample of 3406 individuals, aged 18-79 years, was recruited from Northern Sweden. Sleep quality, non-restorative sleep, daytime sleepiness, obstructive breathing, and nocturnal insomnia were assessed with the Karolinska Sleep Questionnaire. Single questions assessed time slept, amount of hours of needed sleep, and extent of enough time slept. 

    Results: All four EI groups, compared to the referents, reported significantly poorer sleep quality, more non-restorative sleep, more daytime sleepiness, more obstructive breathing and higher prevalence of nocturnal insomnia than the referents. Nocturnal insomnia was an important factor for El groups attributing their most prevalent symptoms to chemicals and sounds, irrespective of distress and certain syndromes. None of the EI groups differed significantly from the referents on time slept, but reported needing more sleep time (the EMF-intolerance group showing only a tendency), and all four groups reported to perceive enough sleep to a significantly lesser extent. 

    Conclusion: Sleep disturbance and daytime sleepiness are more common in individuals reporting El compared to normal referents. Moreover, nocturnal insomnia is an important symptom in its own right in various types of EI. This evokes the question of whether or not sleep therapy may attenuate the severity of the El.

  • 46.
    Nordin, Maria
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Westerholm, Peter
    Alfredsson, Lars
    Åkerstedt, Torbjörn
    Social support and sleep: Longitudinal relationships from the WOLF study2012In: Psychology, ISSN 2152-7180, E-ISSN 2152-7199, Vol. 3, no 12A, p. 1223-1230Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate the relationship between two social support dimensions (network and emotional support) and sleep quality and between two social support sources (at and outside work) and sleep quality. Methods: The three-wave prospective Work Lipids and Fibrinogen (WOLF) study from Northern Sweden was used including 2420 participants who had filled out a questionnaire on working life, life style and health. Sleep quality was assessed by the Karolinska Sleep Questionnaire (KSQ). Structure and function of social support were measured as network support both at and outside work by Availability of Social Integration (AVSI) and emotional support both at and outside work by Availability of Attachment (AVAT). Logistic regression was used, utilizing variables created to assess development over time. Moreover, reversed causation was tested. Results: Improved network support at work decreased the risk of disturbed sleep (OR .65; 95% CI .47 - .90) as did improved emotional support outside work (OR .69; 95% CI .49 - .96). Reporting a constant poor network support at work increased the risk of disturbed sleep (OR 1.53, 95% CI 1.10 - 2.11) as did reporting a constant poor emotional support outside work (OR 1.46; 95% CI 1.02 - 2.05). In men constant good network at work decreased the risk of disturbed sleep (OR .49, 95% CI .34 - .71). Reversed causation analyses indicate some bi-directionality. Conclusion: Being able to perceive social support is a human strength promoting sleep. Both dimension (structure and function) and source (at and outside work) of support matters in sleep quality and seem to be related since the structural dimension was more likely to affect sleep when derived from work, whereas the functional dimension affected sleep quality if it was provided outside work. Men’s sleep seems to be more sensitive to network support at work. Disturbed sleep may also alter the perception of social support.

  • 47.
    Nordin, Maria
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Åkerstedt, Torbjörn
    Nordin, Steven
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Psychometric evaluation and normative data for the Karolinska Sleep Questionnaire2013In: Sleep and Biological Rhythms, ISSN 1446-9235, E-ISSN 1479-8425, Vol. 11, no 4, p. 216-226Article in journal (Refereed)
    Abstract [en]

    The study objective was to validate the Karolinska Sleep Questionnaire with regard to dimensionality, internal consistency, and construct and criterion validity. Another objective was to provide normative data. Data from the cross-sectional Vasterbotten Environmental Health Study in Sweden were used. The 3406 participants in this study, 18 to 79 years old, constituted a random sample stratified for age and sex. Along with the Karolinska Sleep Questionnaire, the participants responded to the Hospital Anxiety and Depression Scale, the Perceived Stress Scale, and the Shirom Melamed Burnout Questionnaire for assessing construct validity. Factor analyses of the questions in the Karolinska Sleep Questionnaire that relate to nocturnal sleep revealed the dimensions sleep quality, non-restorative sleep, and sleep apnea. A separate factor analysis on the questions regarding day time sleepiness revealed a sleepiness dimension. The sleep quality, non-restorative sleep, and sleepiness dimensions showed approximate normal distributions, whereas the distribution for sleep apnea was positively skewed. All dimensions showed good internal consistency. Satisfactory construct validity was found for all dimensions. Using the DSM-IV criteria of insomnia, relevant questions in the Karolinska Sleep Questionnaire were combined into an index of nocturnal symptoms of insomnia as were questions of sleep apnea. Prevalences of insomnia and sleep apnea correspond well to those of other studies, indicating good criterion validity. The favorable psychometric properties of the dimensions and indexes from the Karolinska Sleep Questionnaire suggest their use for assessing sleep quality, non-restorative sleep, sleep apnea, sleepiness and nocturnal symptoms of insomnia.

  • 48.
    Nordin, Steven
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Palmquist, Eva
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nordin, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Psychometric evaluation and normative data for a Swedish version of the Patient Health Questionnaire 15-Item Somatic Symptom Severity Scale2013In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 54, no 2, p. 112-117Article in journal (Refereed)
    Abstract [en]

    The lack of an available Swedish version of the Patient Health Questionnaire 15-Item Somatic Symptom Severity Scale (PHQ-15) motivated the present psychometric evaluation of such a version as well as providing normative data for the PHQ-15. Data from 3,406 individuals who took part in the Vasterbotten Environmental Health Study in Sweden were used. The respondents constitute a random sample, aged 18 to 79years, stratified for age and sex. They responded to a Swedish translation of the PHQ-15 as well as the Hospital Anxiety and Depression Scale, the Perceived Stress Scale, and the Shirom Melamed Burnout Questionnaire for assessment of convergent validity. The distribution of PHQ-15 scores was positively skewed and mesokurtic in shape, and the internal consistency of the PHQ-15 was satisfactory. Correlation coefficients between PHQ-15 score and the measures of anxiety, depression, stress and mental/physical exhaustion indicate satisfactory validity. Normative data for PHQ-15 scores as well as for categories of somatic symptom severity are provided. The favorable psychometric properties of the Swedish version of the PHQ-15 suggest use of this instrument for quantification of somatization in Swedish and similar populations, and has the advantage of available normative data.

  • 49.
    Nordin, Steven
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Söderholm, Anna
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Palmquist, Eva
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Andersson, Linus
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Claeson, Anna-Sara
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nordin, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Miljökänslighet – den osynliga folksjukdomen: ett detektivarbete kring orsakerna till miljörelaterad överkänslighet2012In: Byggnadsrelaterad ohälsa i Kvarkenregionen: nio delprojekt om miljökänslighet, luftkvalitetoch sjuka hus ur ett tvärvetenskapligt perspektiv : slutrapport för projektet Kompetenscentrum Byggnad - Luftkvalitet - Hälsa 2 (KLUCK 2) / [ed] Martina Österberg, Vasa: Yrkeshögskolan Novia , 2012, p. 30-43Chapter in book (Other academic)
    Abstract [sv]

    När man besöker en annan persons hem känner man den vaga lukten av möbler, textilier, matlagning och olika ämnen som många av oss använder – parfymer, rengöringsmedel eller hårprodukter. Efter en stunds vistelse i bostaden registrerar de fl esta människor inte längre lukterna. Men för vissa personer går det precis tvärtom; lukterna försvinner inte utan blir i stället skarpare. De blir allt mer distinkta, till och med påträngande. Någon kanske försöker föra en konversation, men obehaget gör att man inte kan koncentrera sig vad den andra har att säga. I värsta fall drabbas man av huvudvärk, yrsel och andra symptom som gör tillvaron närmast outhärdlig. För en överkänslig person kan vardagen vara fylld av sådana här situationer. Men hur kommer det sig att endast vissa personer drabbas av miljökänslighet?

  • 50.
    Norlund, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Stenlund, Therese
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Ahlgren, Christina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Personal Resources and Support When Regaining the Ability to Work: An Interview Study with Exhaustion Disorder Patients2013In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 23, no 2, p. 270-279Article in journal (Refereed)
    Abstract [en]

    Purpose The aim of the study was to explore experiences and thoughts in the process of returning to work in employed patients with Exhaustion Disorder. Methods Twelve patients with Exhaustion Disorder (burnout) who had been referred to a Stress Rehabilitation Clinic were interviewed. All patients were employed but a majority was on full or part-time sick leave. Grounded Theory was used as the qualitative method. Results A core category, regaining the ability to work, was developed. Alongside, two categories, internal resources and the external support system, were experienced as being important to the process. The internal resources were expressed through three key features (sub-categories), perceived validation, insights and adaptive coping abilities. The external support system was diverse and described by the sub-categories practical/structural and/or emotional support. Four external support actors were identified; the workplace, health care, the Social Insurance Agency, and the union. The supervisor was described as the most important external actor. Conclusions Internal and external resources are intertwined in the process of regaining the ability to work. The internal resources and external support can directly increase the probability to regain the ability to work. Moreover, these resources can affect each other and thus indirectly have an effect on the process.

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