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

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

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

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

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

Background: Regular physical activity is recommended for all aged 5 years and older, but the health benefits gained might differ across population subgroups. The aim of this study was to examine these benefits in terms of years lived free from major non-communicable diseases in subgroups with varying levels of risk factors.

Methods: Our analysis was based on a multicohort study of initially healthy European adults from the IPD-Work Consortium and initially healthy participants from the UK Biobank study. Self-reported leisure-time physical activity levels at baseline (1986–2010) were categorised as low (no or very little), intermediate (between low and recommended levels), and WHO-recommended (≥2·5 h of moderate or ≥1·25 h of vigorous physical activity per week). We divided the study population into 36 overlapping subgroups based on socioeconomic factors, lifestyle, and mental health at baseline, and assessed disease-free years between ages 40 years and 75 years for both the overall population and subgroups, accounting for coronary heart disease, stroke, type 2 diabetes, cancer, asthma, and chronic obstructive pulmonary disease.

Findings: 14 IPD-Work studies were assessed and six studies were excluded due to missing outcome data and unavailable data for pooling, resulting in the inclusion of eight studies with 124 909 participants. After the exclusion of 7685 participants due to prevalent diseases and 9265 due to missing data, the sample consisted of 107 959 initially healthy European adults (63 567 [58·9%] females and 44 392 [41·1%] males) from the IPD-Work consortium. For the UK Biobank sample, 9 238 453 million individuals were invited, 8 736 094 (94·6%) were non-respondents, and 502 359 participated in the baseline examination. After the exclusion of 73 460 participants, 428 899 participants had data on at least one measure of physical activity. 236 258 (55·1%) were female and 192 641 (44·9%) were male. During 1·6 million person-years at risk, 21 231 IPD-Work participants developed a non-communicable disease, while 101 319 UK Biobank participants developed a non-communicable disease over 4·8 million person-years at risk. Compared with individuals with low physical activity, those meeting the recommended physical activity levels during leisure-time gained an additional 1·1 (95% CI 1·0–1·2) to 2·0 (1·7–2·3) disease-free years, depending on sex and study. In males from the IPD-Work and UK Biobank cohorts, greater gains in disease-free years were observed in current smokers (2·4 [95% CI 2·1–2·8]) versus never smokers (0·7 [0·5–0·9]); those with low education (1·4 [1·1–1·7]) versus high education (0·8 [0·7–1·0]); low socioeconomic status (1·7 [1·5–2·0]) versus high socioeconomic status (0·9 [0·7–1·1]); and those with (1·6 [1·3–1·9]) versus without depressive symptoms (1·0 [0·9–1·1]; p value range <0·0001–0·0008). Similar differences were seen in women for smoking (2·3 [95% CI 1·9–2·7] vs 0·9 [0·7–1·1]), socioeconomic status (1·7 [1·4–2·0] vs 0·8 [0·5–1·0]), depressive symptoms (1·4 [1·1–1·7] vs 1·0 [0·9–1·1]), and for heavy drinkers compared with moderate drinkers (1·4 [1·1–1·6] vs 0·9 [0·7–1·1]; p value range <0·0001–0·010). No differences in physical activity-related health gains were observed between risk groups and non-risk groups by BMI, history of depression, and, in men, alcohol use (p value range 0·11–0·86).

Interpretation: In addition to confirming the association between leisure-time physical activity and increased disease-free years across population subgroups, our findings show that these health benefits are often more pronounced among individuals with pre-existing health risks or disadvantaged backgrounds than in those with more favourable risk factor profiles. This suggests that enhancing population-wide physical activity initiatives could help reduce health disparities, while incorporating physical activity into targeted strategies addressing social disadvantage, unhealthy lifestyles, and depression might enhance their effectiveness.

Funding: Wellcome Trust, UK Medical Research Council, US National Institute on Aging, and Research Council of Finland.

This study explored stress, anxiety, depression, sleep, and somatic ill-health as predictors of burnout symptoms in a general population. The objectives were to identify underlying latent symptom categories of burnout as well as other aspects of mental and somatic health and to examine whether these symptom categories can predict burnout symptoms 3 years later. Longitudinal data with 3-year follow-up time using validated questionnaires from 1722 participants from a general population in northern Sweden were analysed using exploratory factor analysis (EFA) and structural equation modelling (SEM). The EFA showed overlap between instruments and 10 latent categories of symptoms were identified and used as predictors of burnout in SEM analyses. Two SEM models were tested: one unadjusted and the other adjusting for burnout symptoms at baseline. The symptom categories of anxious tension and gastrointestinal problems were the strongest predictors of burnout symptoms 3 years later, in both models. Sleep problems, depressive symptoms, and self-efficacy for coping with stress were also important predictors in the unadjusted model. One important contribution of this study is the identification of the symptom category anxious tension which may well describe the experiential aspect of stress, incorporating feelings of anxiety, tension, and nervousness. The results indicate that anxious tension includes components that predict burnout symptoms. Gastrointestinal problems were also important predictors of burnout symptoms, and more research is needed to explain the mechanisms of these relationships, several possible mechanisms are proposed in this study. The study found burnout symptoms to be stable over time, potentially masking other symptoms. Anxious tension and gastrointestinal symptoms predicted burnout independently of baseline symptoms, whereas sleep problems, depressive symptoms, and low self-efficacy emerged as predictors only when baseline burnout was not adjusted for.

Activity-based Flexible Offices (AFOs) provide employees with a variety of workspaces to choose from based on their tasks, rather than having assigned desks. While the adoption of AFOs is increasing due to flexibility and cost-efficiency, there is limited research about the consequences of transitioning to AFOs from the perspective of staff managers. The purpose of this study is to explore how managers experience and cope with challenges that may arise in AFOs. Our qualitative descriptive study is based on two case studies that investigate the consequences of AFOs. Data collection involved semi-structured interviews with a total of 33 managers in two organisations, 12–18 months post-relocation. An inductive, bottom-up process was used for coding and thematization of the interview transcripts. Our results show that AFOs can enhance communication and collaboration depending on the units’ collaboration needs and prior geographical distribution. However, this effect was overshadowed by task-environment misalignments on within-team communication, distractions, and limitations on adjustments and recruitments. Additionally, managers faced conflicting loyalties between defending the organisation’s decision to implement AFOs while ensuring compliance with legal work environment requirements despite limited resources. There is a risk that the implementation of flexible offices will fragment and complicate managers’ tasks, such as ensuring that daily operations run smoothly, meeting legal responsibilities, and managing and recruiting staff. This poses a risk to managers’ productivity and health, and consequently, the achievement of organisational goals. The study uncovers managerial experiences, challenges, and coping strategies in AFOs, offering valuable insights for organisations considering this office type.

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

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

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

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

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

Poor working conditions and high employee turnover in eldercare have frequently been addressed over the years. The aim of the study is to examine the relation between work overcommitment and employee well-being and turnover intentions in eldercare and whether leader support and role clarity moderate the relation between overcommitment and employee outcomes. A questionnaire was distributed to workplaces in eight Swedish municipalities. The results show that overcommitment was related to employees’ impaired well-being, as well as to their turnover intentions. We also found that leader support buffered the negative effects of overcommitment. The role clarity was quite high; however, it did not have a moderating effect.

The aim of this study was to investigate how self-rated health (SRH) reflects ongoing ill-health and how SRH is associated with previous ill-health and/or predicts future ill-health such as burnout, disturbed sleep, and somatic symptoms. The study used two waves from the population-based Västerbotten Environmental and Health Study in which 2 336 adult persons participated by answering a questionnaire at two time points three years apart. Hierarchical and logistic regression analyses were conducted, thus treating all variables both continuously (degree) and categorically (case). The analyses were performed both cross-sectionally and longitudinally. The results showed bidirectionality between suboptimal SRH and burnout, disturbed sleep and somatic severity caseness. Moreover, degree of poor SRH was more likely to occur simultaneously to high degrees of burnout and somatic severity than to degree of poor sleep quality. Also, caseness of burnout, disturbed sleep and somatic severity increased the risk of simultaneous suboptimal SRH. Finally, the results showed that degree of burnout three years earlier, predicted degree of poor SRH, and that degree of poor SRH predicted degree of sleep three years later. In conclusion, in a population-based, normal adult sample there is a bidirectional relationship between suboptimal SRH and caseness of burnout, disturbed sleep quality and somatic symptoms, but not between degree of these symptoms. The results can have implications for health care meeting patients complaining about poor general health.

The overall aim of the present study was to examine the construct validity of different versions of the Shirom-Melamed Burnout Questionnaire/Measure (SMBQ/M) suggested in previous work, as well as to provide normative data for a large population-based sample in Sweden with a broad range in age. Cross-sectional data from the Västerbotten Environmental Health Study in Sweden were used. The 3406 participants (56% women) in this study, aged 18–79 years, constituted a random sample stratified for age and sex. Participants responded to a questionnaire including the 4-factor 22-item version of the SMBM as well as background questions and a number of validated questionnaire instruments assessing for example, sleep disturbance, depression, anxiety, perceived stress, and somatic symptoms. The dimensionality of different versions of the SMBM were examined with confirmatory factor analysis. A modified 4-factor 19-item model of the SMBM provided good model-fit, and two 2-factor models (11-item and 6-item) provided excellent model fit. The relationships to relevant psychological constructs provided support for convergent validity for the suggested versions of the SMBM. Finally, normative data were obtained for a broad age group for the different versions. In conclusion, we suggest that for assessing the core of the burnout construct in terms of emotional and physical exhaustion and cognitive weariness, the SMBM-11 or SMBM-6 for repeated measures, are to be used. For a broader assessment of burnout incorporating both symptoms and information about the process of exhaustion via the subscales of listlessness and tension, we recommend the use of the modified 4-factor SMBM-19.