Umeå University's logo

Aims: Patient characteristics and treatment setting are potential predictors of premature dropout from lifestyle interventions, but their relative importance is unknown.

Methods: From the quality registry of the unit for behavioral medicine, Umeå University hospital, we identified 2589 patients who had been enrolled in a multimodal lifestyle intervention for cardiometabolic risk reduction between 2006 and 2015. Baseline characteristics predicting dropout before 1-year follow-up were selected by a stepwise logistic regression algorithm.

Results: Better physical health and older age predicted full participation, with odds ratios for premature dropout (ORs) of.44 (95% confidence interval (CI).31-.63), and.47 (95% CI.34-.65) in the highest compared to the lowest quartile, respectively. Odds of premature dropout were also lower among female participants,.71 (95% CI.58-.89). Premature dropout was predicted by higher BMI, snuffing tobacco, and smoking, with ORs of 1.53 (95% CI 1.13-2.08) in the highest compared to the lowest quartile of BMI, 1.37 (95% CI 1.03-1.81) comparing snuff user with non-users and 2.53 (95% CI 1.79-3.61) comparing smokers with non-smokers. Odds ratio for premature dropout among inpatients compared with outpatients was.84 (95% CI.68-1.04).

Conclusion: Higher risk at baseline predicts premature dropout.

Fatigue is a common presenting problem in healthcare settings, often attributed to chronic psychosocial stress. Understanding of fatigue and development of evidence-based treatments is hampered by a lack of consensus regarding diagnostic definitions and outcomes to be measured in clinical trials. This study aimed to map outcome domains of importance to the Swedish diagnosis stress-induced exhaustion disorder (ED; ICD-10, code F43.8 A). An online survey was distributed nationwide in Sweden to individuals who reported to have been diagnosed with ED and to healthcare professionals working with ED patients. To identify outcome domains, participants replied anonymously to four open-ended questions about symptoms and expectations for ED-treatment. Qualitative content analysis was conducted of a randomized subsample of respondents, using a mathematical model to determine data saturation. Six hundred seventy participants (573 with reported ED, 97 healthcare professionals) completed the survey. Qualitative content analysis of answers supplied by 105 randomized participants identified 87 outcomes of importance to ED encompassing physical, cognitive, and emotional symptoms as well as functional disability. Self-rating scales indicated that many ED participants, beyond reporting fatigue, also reported symptoms of moderate to severe depression, anxiety, insomnia, poor self-rated health, and sickness behavior. This study presents a map of outcome domains of importance for ED. Results shed light on the panorama of issues that individuals with ED deal with and can be used as a step to further understand the condition and to reach consensus regarding outcome domains to measure in clinical trials of chronic stress and fatigue.

Preregistration: Open Science Framework (osf.io) with DOI https://doi.org/10.17605/OSF.IO/4VUAG.

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.

Background: Symptoms related to chronic stress are prevalent and entail high societal costs, yet there is a lack of international consensus regarding diagnostics and treatment. A new stress-related diagnosis, exhaustion disorder, was introduced into the Swedish version of ICD-10 in 2005. Since then, use of the diagnosis has increased rapidly.

Aims: To create the first comprehensive synthesis of research on exhaustion disorder to report on the current state of knowledge. Preregistration: Open Science Framework (osf.io), doi 10.17605/OSF.IO/VFDKW.

Method: A PRISMA-guided scoping review of all empirical studies of exhaustion disorder was conducted. Searches were run in the MEDLINE, PsycInfo and Web of Science databases. Data were systematically charted and thematically categorised based on primary area of investigation.

Results: Eighty-nine included studies were sorted into six themes relating to lived experience of exhaustion disorder (n = 9), symptom presentation and course (n = 13), cognitive functioning (n = 10), biological measures (n = 24), symptom measurement scales (n = 4) and treatment (n = 29). Several studies indicated that individuals with exhaustion disorder experience a range of psychiatric and somatic symptoms beyond fatigue, but robust findings within most thematic categories were scarce. The limited number of studies, lack of replication of findings and methodological limitations (e.g. small samples and scarcity of specified primary outcomes) preclude firm conclusions about the diagnostic construct.

Conclusions: More research is needed to build a solid knowledge base for exhaustion disorder. International collaboration regarding the conceptualisation of chronic stress and fatigue is warranted to accelerate the growth of evidence.

Purpose: The purpose was to develop a questionnaire instrument to measure difficulties in activities and participation, and impact of environmental factors in chemical intolerance, based on the International Classification of Functioning, Disability and Health, and to assess its validity and reliability.

Method: Development in three steps: (1) choosing items of relevance for chemical intolerance with an expert group, (2) conducting interviews with persons with chemical intolerance, using sampling to redundancy, (3) conducting a survey with 112 respondents at a first assessment and 91 at a second assessment for test-retest.

Results: The final version of the instrument consists of 57 items divided in three parts, which showed good internal consistency in each part, Cronbach alpha: 0.73-0.87. It had good content validity, readability and face validity. Test-retest showed good to very good (≥0.61) Kappa agreement for 37 items, and moderate (0.41-0.60) for 17 items. Three items had poor or fair (<0.41) Kappa agreement.

Conclusion: The instrument was found to be valid and reliable. It can be used as a clinical tool to help persons with chemical intolerance to receive the best suited help and support for each individual, identify key points in rehabilitation, measure rehabilitation outcome and establish priority for treatment. 

Background: Chemical intolerance (CI) is a term used for individuals experiencing symptoms triggered by odorous and pungent substances such as perfume, cleaning agents, mold smell and tobacco smoke. The prevalence of CI range from 0.5-52% depending on definition, and it is overrepresented among women. Living with CI can cause difficulties in daily life, with work, hobbies, social activities, and reduce quality of life. The International Classification of Functioning, Disability and Health (ICF) is a tool to measure an individual’s life situation related to a health condition, in the areas body functions, body structures, activities and participation, and environmental factors.

Aim: The aim of this thesis was to develop a tool that could be used to help persons with CI. Furthermore, the aim was to better understand and describe disability and health aspects of CI in the context of the biopsychosocial model of ICF.

Method: This thesis is based on the results from four studies with different methods: 1; The questionnaire development study in which a questionnaire instrument based on the ICF, for persons with CI, was developed and evaluated in terms of validity and reliability. 2; The survey study using the newly developed ICF-questionnaire, with 112 respondents. 3; The qualitative study with data collection from twelve women who wrote descriptive texts that were analyzed with qualitative content analysis. 4; The experimental study of health-related responses to the mold-smelling chemical trichloroanisole, comparing a CI-group (n=14) with a control-group (n=18). During exposure, symptom intensity, odor intensity and odor valence were rated, and physiological measures were recorded.

Results: The development of the ICF-based questionnaire resulted in a final version that consisted of 57 items divided in three parts. It showed good content validity, readability and face validity, and all parts showed good internal consistency, Cronbach alpha: 0.73-0.87. Test-retest showed good to very good (≥0.61) Kappa agreement for 37 items, moderate (0.41-0.60) for 17 items, and poor or fair (<0.41) for 3 items. Regarding the ICF areas activities and participation and environmental factors, the results from the survey study showed high ratings on difficulties in activities and participation, and environmental barriers. Six themes were identified in the qualitative study: Being limited in participating in society, being forced to behave incompatibly with one´s personality, experiencing lack of understanding and respect from others, experiencing insecurity, being dependent on others, and being forced to choose between the plague and cholera. Regarding the ICF area body functions, the survey study showed reports of several different symptoms and affective and behavioral reactions in response to odorous and pungent substances. The mean of severity of symptoms, was high, 79 on a scale from 1-100. The severity of symptoms was found to have the strongest association with degree of difficulty in activities and participation. The results of the experimental study did not show more health effects of the trichloranisole exposure in the CI-group than the control-group. However, the results showed a high inter-individual variation in ratings of odor intensity, odor valence and symptom intensity.

Conclusions: The ICF-based questionnaire is valid and reliable and can be used as a tool to measure difficulties in activities and participation, and impact of environmental factors. Individuals with relatively severe CI have major difficulties in activities and participation in the society. They also experience large barriers in society, both in form of triggers and in form of negative attitudes from others. The body functions in CI is affected in the form of a large variety of symptoms, as well as affective and behavioral reactions in response to odorous and pungent substances. TriCA does not seem to affect body functions for persons with CI in general, but for some individuals it can affect body functions. Both coping strategies exposing to and avoiding odorous and pungent substances can lead to increased difficulties with activities and participation. The severity of symptoms plays the most important role for the degree of difficulty in activities and participation.

Objectives: We tested the hypothesis of high comorbidity between asthma/allergy and chemical intolerance (CI) and between asthma/allergy and building intolerance (BI), and high multimorbidity between asthma/allergy, CI, and BI.

Methods: Population-based questionnaire data were used from 530 participants with asthma/allergy (allergic asthma, nonallergic asthma, allergic rhinitis, and/or atopic dermatitis), 414 with self-reported and 112 with physician-diagnosed CI, and 165 with self-reported and 47 with physician-diagnosed BI. Separate reference groups were formed for each of the five case groups.

Results: Adjusted odds ratios varied from 4.6 to 13.1 for comorbidity, and from 6.6 to 46.4 for multimorbidity.

Conclusion: The large comorbidity and multimorbidity between asthma/allergy, CI, and BI evokes the question as to whether there are similarities in underlying mechanisms between these conditions.

Nonspecific building-related symptoms (NBRS) is a combination of general, skin and mucosal symptoms related to certain buildings. Despite high prevalence in the general population and severe symptomatology in certain cases there is no scientific documentation of quality of life in NBRS. The purpose of this study was to illuminate how individuals with NBRS experience daily life. Data were collected through descriptive, written texts and through telephone interviews with 11 individuals diagnosed with NBRS, and qualitative content analysis was conducted. Three main content areas were identified: (1) attitudes from the surrounding (categories: being questioned and lack of understanding from others; from zero to full support); (2) consequences (difficulties with daily activities; financial difficulties; affecting family and friends; emotional consequences); and (3) coping (learning to accept and finding solutions; avoiding; struggling; finding the positive; making one's home a sanctuary). As a conclusion, NBRS may affect several aspects of daily life, resulting in considerable alterations, limitations and emotional impact for the afflicted person and his/her family. Both environmental factors and attitudes from the surrounding can contribute to this impact on daily life. Strategies needed to cope with this impact may include both problem-focused and emotion-focused strategies, such as struggling, avoiding trigger factors and finding positive aspects.

Background: Registers are increasingly used to monitor stroke care performance. Fair benchmarking requires sufficient data quality. We have validated acute care data in Riksstroke, the Swedish Stroke Register.

Methods: Completeness was assessed by comparisons with diagnoses at hospital discharge recorded in the compulsory National Patient Register and content validity by comparisons with (a) key variables identified by European stroke experts, and (b) items recorded in other European stroke care performance registers. Five test cases recorded by 67 hospitals were used to estimate inter-hospital reliability.

Results: All 72 Swedish hospitals admitting acute stroke patients participated in Riksstroke. The register was estimated to cover at least 90% of acute stroke patients. It includes 18 of 22 quality indicators identified by international stroke experts and 14 of 15 indicators used by at least 2 stroke performance registers in other European countries. Inter-hospital reliability was high (85%) in 77 of 81 Riksstroke items.

Conclusions: A nationwide stroke care register can be maintained with sufficient data quality to permit between-hospital performance benchmarking. Our experiences may serve as a model for other stroke registers while evaluating data quality.

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?