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Background: Better understanding for persistent physical symptoms (PPS) may improve prevention of symptoms from becoming persistent and deteriorating over time. This study tested the hypotheses of age and level of mental distress symptoms of anxiety, depression, sleep disturbance and burnout statistically predicting rate of PPS and deterioration of PPS over three and six years in a general adult population. We also addressed whether sex is associated with these two aspects of PPS.

Method: A population-based sample ( n = 1837) aged 18–79 years from Västerbotten in Sweden was used. Longitudinal data were collected based on the 15-item Patient Health Questionnaire for PPS assessment as well as other validated questionnaire instruments at baseline and 3- and 6-year follow-up. Deterioration was assessed with the reliable change index paradigm. Chi-square tests and analyses of covariance were applied.

Results: Old age was found to statistically predict deterioration, but not long-term rate, of PPS over three and six years, and female sex to predict rate, but not deterioration. Symptom levels of all four types of mental distress predicted both PPS rate (η2 = 0.097–0.202) and deterioration (η2 = 0.007–0.023) over both three and six years. When controlling for the other three types of mental distress, sleep disturbance, and in particular burnout, explained most unique variance in predicting rate and deterioration.

Conclusions: The findings encourage healthcare professionals to assess PPS at an early stage, especially in persons at old age, in women and in patients with mental distress.

Objective: Our knowledge on the prevalence of self-reported sensitivities to environmental factors is poor. The lack of accepted criteria/assessment makes findings of different studies difficult to compare; the way of assessment might play a role in the reported prevalence rates. The present study aimed to report the prevalence rates of five environmental sensitivities for the German general population, to compare three of them with Swedish and Finnish data, and to demonstrate the impact of strictness of criterion on the results.

Methods: Data from a German ( n = 2515), a Swedish ( n = 3253) and a Finnish ( n = 1467) population-based survey was used. Sentitivities were rated on ordinal scales in all samples.

Results: In the German sample, about 25 % of participants reported mild reactions to sounds, chemicals, and buildings, and about 10 % to electromagnetic fields (EMFs) and wind turbines, with a similar pattern for strong reactions, but with proportions of 1–2 %. Data from the Nordic countries show consistent similarities between these two countries, with prevalences exceeding 34 % for mild reactions to chemicals and sounds and about 5 % to EMFs, with a similar pattern for strong reactions, but with proportions of 1–8 %. Prevalence of sensitivity to EMFs was higher, whereas prevalence of sensitivity to chemicals and sounds was lower in Germany. Classification criteria significantly impacted the reported prevalence rates.

Conclusion: Various environmental sensitivities affect a considerable proportion of the general populations of the three countries. To improve comparability, self-report assessment of sensitivities should be based on at least an ordinal scale instead of the widely used yes-or-no question.

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: The management of persistent physical symptoms poses a challenge in many healthcare settings, including primary care. Psychological treatments that involve exposure have shown promise for several conditions where patients suffer from persistent physical symptoms and unwanted responses to these. It is unclear, however, to what extent exposure therapy has effects beyond existing routine care interventions and who benefits the most.

Methods: A randomized controlled trial at a primary care center in Stockholm, Sweden compared 10 weeks of internet-delivered exposure therapy (n = 80) to healthy lifestyle promotion (HLP; n = 81) for patients bothered by at least one persistent physical symptom. The primary outcome was the mean reduction in subjective somatic symptom burden (Patient Health Questionnaire 15) as measured week-by-week up to the post-treatment assessment. Secondary outcomes included symptom preoccupation, anxiety, depression symptoms, and functional impairment.

Results: Patients contributed 1544 datapoints during treatment. The primary analysis showed no significant advantage of exposure therapy versus HLP in the reduction of mean somatic symptom burden (d = 0.14; p = 0.220). In secondary analyses, exposure showed superiority in the reduction of symptom preoccupation (d = 0.31; p = 0.033) but not anxiety, depression symptoms, or functional impairment. A higher somatic symptom burden or symptom preoccupation before treatment was predictive of a larger advantage of exposure versus HLP.

Conclusions: Exposure therapy does not appear to show noteworthy average benefit over HLP, with the exception of symptom preoccupation. Substantial benefits are seen in patients with very high symptom burden or symptom preoccupation.

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.

Background: Lifestyle modification plays a key role in prevention of cardiovascular disease (CVD), but often fails due to non-adherence to lifestyle recommendations. Previous research has highlighted the importance of psychosocial factors in non-adherence, though focused on secondary rather than primary prevention. The aim of this scoping review was to provide an overview of the moderating role of psychosocial factors on the effect of lifestyle interventions in primary CVD prevention.

Methods: A literature search of scientific databases was performed to identify studies published in peer-reviewed journals, that evaluated lifestyle interventions in primary prevention in adult populations (18 years and older), with a composite CVD risk score or a CVD risk factor (diet, physical activity, smoking or alcohol) as outcome, and assessed the moderating effect of a psychosocial factor.

Results: Thirty-five studies published between 2000 and 2025 were included in this review. Most were randomized controlled trials (RCT), included middle-aged participants, and investigated samples in which women were in majority. The outcomes differed, with fourteen studies reporting on physical activity, eleven on diet, six on body weight, two on smoking and one on alcohol. One study used a CVD risk score as the outcome. The studies included a broad array of psychological factors that were grouped into five categories: self-efficacy or motivation (n = 11), social support or relationship quality (n = 8), mental health (n = 6), personality or emotions (n = 6), and cognitive factors (n = 4). Sixteen (44%) of the studies did not use validated instruments in the assessment of the psychosocial factor.

Conclusions: This review highlights the potential role of psychosocial factors on the effectiveness of lifestyle interventions. However, our ability to draw detailed conclusions or identify any general trends were limited by the heterogeneity amongst the studies in terms of study design, assessment of outcomes and moderators, and populations. Still, we identified a lack of RCTs (1) with long follow-up time, (2) with sufficient sample size, (3) using validated instruments to assess the psychosocial moderator, and (4) using interaction analyses to assess moderating effect.

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

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

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

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

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

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

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

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

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