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  • 1. Akerstedt, T.
    et al.
    Alfredsson, L.
    Westerholm, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Fischer, H.
    Nilsson, L. -G
    Nordin, M.
    Fatigue/sleepiness and important aspects of sleep restoration improve across aging2014In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 23, p. 241-241Article in journal (Other academic)
  • 2. 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
    Fahlén, Göran
    Goldberg, Marcel
    Hamer, Mark
    Heikkilä, Katriina
    Jöckel, Karl-Heinz
    Knutsson, Anders
    Madsen, Ida E H
    Nielsen, Martin L
    Nordin, Maria
    Oksanen, Tuula
    Pejtersen, Jan H
    Pentti, Jaana
    Rugulies, Reiner
    Salo, Paula
    Schupp, Jürgen
    Singh-Manoux, Archana
    Steptoe, Andrew
    Theorell, Töres
    Vahtera, Jussi
    Westerholm, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Westerlund, Hugo
    Virtanen, Marianna
    Zins, Marie
    Batty, G David
    Kivimäki, Mika
    Effort-Reward Imbalance at Work and Incident Coronary Heart Disease: A Multicohort Study of 90,164 Individuals.2017In: 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.

  • 3.
    du Prel, J. B.
    et al.
    Univ Ulm, Inst Hist Philosophy & Eth Med, D-89069 Ulm, Germany..
    Runeson-Broberg, Roma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Westerholm, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Nordin, M.
    Stockholm Univ, Stress Res Inst, S-10691 Stockholm, Sweden..
    Fahlen, G.
    Natl Agcy Special Needs Educ & Sch, Harnosand, Sweden..
    Alfredsson, L.
    Karolinska Inst, Stockholm, Sweden..
    Knutsson, A.
    Mid Sweden Univ, Sundsvall, Sweden..
    Peter, R.
    Univ Ulm, Inst Hist Philosophy & Eth Med, D-89069 Ulm, Germany..
    Work-Related Overcommitment: Is it a State or a Trait? - Results from the Swedish WOLF-Study2015In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 44, p. 263-263Article in journal (Other academic)
  • 4. du Prel, Jean-Baptist
    et al.
    Runeson-Broberg, Roma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Westerholm, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Alfredsson, Lars
    Fahlén, Göran
    Knutsson, Anders
    Nordin, Maria
    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.

  • 5.
    Ferrie, Jane E.
    et al.
    UCL, Dept Epidemiol & Publ Hlth, London, England.;Univ Bristol, Sch Community & Social Med, Bristol, Avon, England..
    Virtanen, Marianna
    Finnish Inst Occupat Hlth, Helsinki, Finland.;Finnish Inst Occupat Hlth, Tampere, Finland.;Finnish Inst Occupat Hlth, Turku, Finland..
    Jokela, Markus
    Univ Helsinki, Inst Behav Sci, Helsinki, Finland..
    Madsen, Ida E. H.
    Working Environm, Copenhagen, Denmark..
    Heikkila, Katriina
    Finnish Inst Occupat Hlth, Helsinki, Finland.;Finnish Inst Occupat Hlth, Tampere, Finland.;Finnish Inst Occupat Hlth, Turku, Finland..
    Alfredsson, Lars
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden.;Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden..
    Batty, G. David
    UCL, Dept Epidemiol & Publ Hlth, London, England.;Univ Edinburgh, Ctr Cognit Ageing & Cognit Epi demiol, Edinburgh, Midlothian, Scotland..
    Bjorner, Jakob B.
    Working Environm, Copenhagen, Denmark..
    Borritz, Marianne
    Bispebjerg Hosp, Dept Occupat & Environm Med, Copenhagen, Denmark..
    Burr, Hermann
    Fed Inst Occupat Safety & Hlth, Berlin, Germany..
    Dragano, Nico
    Univ Dusseldorf, Inst Med Sociol, Fac Med, Dusseldorf, Germany..
    Elovainio, Marko
    Jonkoping Univ, Natl Inst Hlth & Welf, Helsinki, Finland..
    Fransson, Eleonor I.
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden.;Jonkoping Univ, Sch Hlth Sci, Jonkoping, Sweden.;Stockholm Univ, Stress Res Inst, Stockholm, Sweden..
    Knutsson, Anders
    Mid Sweden Univ, Dept Hlth Sci, Sundsvall, Sweden..
    Koskenvuo, Markku
    Univ Helsinki, Dept Publ Hlth, Helsinki, Finland..
    Koskinen, Aki
    Finnish Inst Occupat Hlth, Tampere, Finland.;Finnish Inst Occupat Hlth, Turku, Finland..
    Kouvonen, Anne
    Univ Helsinki, Dept Social Res, Helsinki, Finland..
    Kumari, Meena
    Univ Essex, Inst Social & Econ Res, Colchester, Essex, England..
    Nielsen, Martin L.
    Frederiksberg Univ Hosp, Unit Social Med, Copenhagen, Denmark..
    Nordin, Maria
    Umea Univ, Dept Psychol, Umea, Sweden..
    Oksanen, Tuula
    Finnish Inst Occupat Hlth, Helsinki, Finland.;Finnish Inst Occupat Hlth, Tampere, Finland.;Finnish Inst Occupat Hlth, Turku, Finland..
    Pahkin, Krista
    Finnish Inst Occupat Hlth, Helsinki, Finland.;Finnish Inst Occupat Hlth, Tampere, Finland.;Finnish Inst Occupat Hlth, Turku, Finland..
    Pejtersen, Jan H.
    Danish Natl Ctr Social Res, Copenhagen, Denmark..
    Pentti, Jaana
    Finnish Inst Occupat Hlth, Helsinki, Finland.;Finnish Inst Occupat Hlth, Tampere, Finland.;Finnish Inst Occupat Hlth, Turku, Finland..
    Salo, Paula
    Finnish Inst Occupat Hlth, Helsinki, Finland.;Finnish Inst Occupat Hlth, Tampere, Finland.;Finnish Inst Occupat Hlth, Turku, Finland.;Univ Turku, Dept Psychol, Turku, Finland..
    Shipley, Martin J.
    UCL, Dept Epidemiol & Publ Hlth, London, England..
    Suominen, Sakari B.
    Univ Turku, Dept Publ Hlth, Turku, Finland.;Folkhalsan Res Ctr, Helsinki, Finland.;Univ Skovde, Skovde, Sweden..
    Tabak, Adam
    UCL, Dept Epidemiol & Publ Hlth, London, England.;Semmelweis Univ, Dept Med 1, Fac Med, Budapest, Hungary..
    Theorell, Toeres
    Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden..
    Vaananen, Ari
    Finnish Inst Occupat Hlth, Helsinki, Finland.;Finnish Inst Occupat Hlth, Tampere, Finland.;Finnish Inst Occupat Hlth, Turku, Finland..
    Vahtera, Jussi
    Finnish Inst Occupat Hlth, Helsinki, Finland.;Finnish Inst Occupat Hlth, Tampere, Finland.;Finnish Inst Occupat Hlth, Turku, Finland.;Univ Turku, Dept Publ Hlth, Turku, Finland.;Turku Univ Hosp, Turku, Finland..
    Westerholm, Peter J. M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Westerlund, Hugo
    Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden..
    Rugulies, Reiner
    Working Environm, Copenhagen, Denmark.;Univ Copenhagen, Dept Publ Hlth, Copenhagen, Denmark.;Univ Copenhagen, Dept Psychol, Copenhagen, Denmark..
    Nyberg, Solja T.
    Finnish Inst Occupat Hlth, Helsinki, Finland.;Finnish Inst Occupat Hlth, Tampere, Finland.;Finnish Inst Occupat Hlth, Turku, Finland..
    Kivimaki, Mika
    UCL, Dept Epidemiol & Publ Hlth, London, England.;Finnish Inst Occupat Hlth, Helsinki, Finland.;Finnish Inst Occupat Hlth, Tampere, Finland.;Finnish Inst Occupat Hlth, Turku, Finland.;Univ Helsinki, Inst Behav Sci, Helsinki, Finland..
    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.

  • 6. Fransson, Eleonor I
    et al.
    Heikkilä, Katriina
    Nyberg, Solja T
    Zins, Marie
    Westerlund, Hugo
    Westerholm, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    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
    Nielsen, Martin L
    Marmot, Michael G
    Magnusson Hanson, Linda L
    Madsen, Ida E H
    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 in journal (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 1985-1988 to 2006-2008) 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 2-9 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.

  • 7. 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
    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.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    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.

  • 8. Fransson, Eleonor I.
    et al.
    Nyberg, Solja T.
    Heikkilä, Katriina
    Alfredsson, Lars
    Bacquer, De Dirk
    Batty, G. David
    Bonenfant, Sébastien
    Casini, Annalisa
    Clays, Els
    Goldberg, Marcel
    Kittel, France
    Koskenvuo, Markku
    Knutsson, Anders
    Leineweber, Constanze
    Hanson, Linda L. Magnusson
    Nordin, Maria
    Singh-Manoux, Archana
    Suominen, Sakari
    Vahtera, Jussi
    Westerholm, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Westerlund, Hugo
    Zins, Marie
    Theorell, Töres
    Kivimäki, 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.

  • 9.
    Fransson, Eleonor I.
    et al.
    Jonkoping Univ, Sch Hlth Sci, S-55111 Jonkoping, Sweden.;Karolinska Inst, Inst Environm Med, S-17177 Stockholm, Sweden..
    Stadin, Magdalena
    Jonkoping Univ, Sch Hlth Sci, S-55111 Jonkoping, Sweden..
    Nordin, Maria
    Umea Univ, Dept Psychol, S-90187 Umea, Sweden.;Stockholm Univ, Stress Res Inst, S-10691 Stockholm, Sweden..
    Malm, Dan
    Jonkoping Univ, Sch Hlth Sci, S-55111 Jonkoping, Sweden.;Cty Hosp Ryhov, Dept Internal Med, S-55185 Jonkoping, Sweden..
    Knutsson, Anders
    Mid Sweden Univ, Dept Hlth Sci, S-85170 Sundsvall, Sweden..
    Alfredsson, Lars
    Karolinska Inst, Inst Environm Med, S-17177 Stockholm, Sweden..
    Westerholm, Peter J. M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    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.

  • 10. Heikkila, K.
    et al.
    Madsen, I. E. H.
    Nyberg, S. T.
    Fransson, E. I.
    Westerlund, H.
    Westerholm, Peter J. M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    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, M.
    Nielsen, M. L.
    Kouvonen, A.
    Koskinen, A.
    Koskenvuo, M.
    Knutsson, A.
    Ferrie, J. E.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    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]

    BackgroundMany 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. MethodsWe 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. ResultsDuring 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). ConclusionsOur findings suggest that job strain is probably not an important risk factor for severe asthma exacerbations leading to hospitalization or death.

  • 11. Heikkila, Katriina
    et al.
    Fransson, Eleonor I.
    Nyberg, Solja T.
    Zins, Marie
    Westerlund, Hugo
    Westerholm, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Virtanen, Marianna
    Vahtera, Jussi
    Suominen, Sakari
    Steptoe, Andrew
    Salo, Paula
    Pentti, Jaana
    Oksanen, Tuula
    Nordin, Maria
    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.

  • 12. 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
    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.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    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.

  • 13. 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
    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.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    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)
  • 14. 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
    Pentti, Jaana
    Salo, Paula
    Rugulies, Reiner
    Steptoe, Andrew
    Siegrist, Johannes
    Suominen, Sakari
    Vahtera, Jussi
    Virtanen, Marianna
    Vaananen, Ari
    Westerholm, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    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.

  • 15. 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
    Pentti, Jaana
    Salo, Paula
    Rugulies, Reiner
    Steptoe, Andrew
    Siegrist, Johannes
    Suominen, Sakari
    Vahtera, Jussi
    Virtanen, Marianna
    Vaananen, Ari
    Westerholm, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    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.

  • 16.
    Heikkila, Katriina
    et al.
    London Sch Hyg & Trop Med, Dept Hlth Serv Res & Policy, London WC1, England.;Finnish Inst Occupat Hlth, Tampere 33100, Finland.;Finnish Inst Occupat Hlth, Turku 205200, Finland..
    Nyberg, Solja T.
    Finnish Inst Occupat Hlth, Tampere 33100, Finland.;Finnish Inst Occupat Hlth, Turku 205200, Finland..
    Madsen, Ida E. H.
    Natl Res Ctr Working Environm, DK-2100 Copenhagen, Denmark..
    de Vroome, Ernest
    TNO, NL-2316 ZL Leiden, Netherlands..
    Alfredsson, Lars
    Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden.;Karolinska Inst, Inst Environm Med, S-17177 Stockholm, Sweden..
    Bjorner, Jacob J.
    Natl Res Ctr Working Environm, DK-2100 Copenhagen, Denmark..
    Borritz, Marianne
    Koge Hosp, DK-4600 Koge, Denmark..
    Burr, Hermann
    Fed Inst Occupat Safety & Hlth, D-10317 Berlin, Germany..
    Erbel, Raimund
    Univ Duisburg Essen, West German Heart Ctr Essen, Dept Cardiol, D-45122 Essen, Germany..
    Ferrie, Jane E.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.;Univ Bristol, Sch Social & Community Med, Bristol BS8 2PS, Avon, England..
    Fransson, Eleonor I.
    Karolinska Inst, Inst Environm Med, S-17177 Stockholm, Sweden.;Jonkoping Univ, Sch Hlth & Welf, SE-55111 Jonkoping, Sweden.;Stockholm Univ, Stress Res Inst, SE-10691 Stockholm, Sweden..
    Geuskens, Goedele A.
    TNO, NL-2316 ZL Leiden, Netherlands..
    Hooftman, Wendela E.
    TNO, NL-2316 ZL Leiden, Netherlands..
    Houtman, Irene L.
    TNO, NL-2316 ZL Leiden, Netherlands..
    Joeckel, Karl-Heinz
    Univ Duisburg Essen, Inst Med Informat Biometry & Epidemiol, Fac Med, D-45122 Essen, Germany..
    Knutsson, Anders
    Mid Sweden Univ, Dept Hlth Sci, S-85170 Sundsvall, Sweden..
    Koskenvuo, Markku
    Univ Helsinki, Dept Publ Hlth, Helsinki 00140, Finland..
    Lunau, Thorsten
    Univ Dusseldorf, Fac Med, Inst Med Sociol, D-40225 Dusseldorf, Germany..
    Nielsen, Martin L.
    Frederiksberg Univ Hosp, Unit Social Med, DK-2000 Frederiksberg, Denmark..
    Nordin, Maria
    Stockholm Univ, Stress Res Inst, SE-10691 Stockholm, Sweden.;Umea Univ, Dept Psychol, S-90187 Umea, Sweden..
    Oksanen, Tuula
    Finnish Inst Occupat Hlth, Tampere 33100, Finland.;Finnish Inst Occupat Hlth, Turku 205200, Finland..
    Pejtersen, Jan H.
    Danish Natl Ctr Social Res, DK-1052 Copenhagen, Denmark..
    Pentti, Jaana
    Finnish Inst Occupat Hlth, Tampere 33100, Finland.;Finnish Inst Occupat Hlth, Turku 205200, Finland..
    Shipley, Martin J.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England..
    Steptoe, Andrew
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England..
    Suominen, Sakari B.
    Univ Turku, Dept Publ Hlth, Turku 20014, Finland.;Folkhalsan Res Ctr, Helsinki 00290, Finland.;Nord Sch Publ Hlth, S-42671 Gothenburg, Sweden..
    Theorell, Toeres
    Stockholm Univ, Stress Res Inst, SE-10691 Stockholm, Sweden..
    Vahtera, Jussi
    Finnish Inst Occupat Hlth, Tampere 33100, Finland.;Finnish Inst Occupat Hlth, Turku 205200, Finland.;Univ Turku, Dept Publ Hlth, Turku 20014, Finland.;Turku Univ Hosp, Turku 20521, Finland..
    Westerholm, Peter J. M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Westerlund, Hugo
    Stockholm Univ, Stress Res Inst, SE-10691 Stockholm, Sweden..
    Dragano, Nico
    Univ Dusseldorf, Fac Med, Inst Med Sociol, D-40225 Dusseldorf, Germany..
    Rugulies, Reiner
    Natl Res Ctr Working Environm, DK-2100 Copenhagen, Denmark.;Univ Copenhagen, Dept Publ Hlth, DK-2200 Copenhagen, Denmark.;Univ Copenhagen, Dept Psychol, DK-2200 Copenhagen, Denmark..
    Kawachi, Ichiro
    Harvard Univ, Sch Publ Hlth, Dept Soc Human Dev & Hlth, 665 Huntington Ave, Boston, MA 02115 USA..
    Batty, G. David
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.;Univ Edinburgh, Ctr Cognit Ageing & Cognit Epidemiol, Edinburgh EH8 9JZ, Midlothian, Scotland..
    Singh-Manoux, Archana
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.;INSERM, U1018, Ctr Res Epidemiol & Populat Hlth, F-94807 Villejuif, France..
    Virtanen, Marianna
    Finnish Inst Occupat Hlth, Tampere 33100, Finland.;Finnish Inst Occupat Hlth, Turku 205200, Finland..
    Kivimaki, Mika
    Finnish Inst Occupat Hlth, Tampere 33100, Finland.;Finnish Inst Occupat Hlth, Turku 205200, Finland.;UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.;Univ Helsinki, Fac Med, Clinicum, FI-00014 Helsinki, Finland..
    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.

  • 17. 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
    Oksanen, Tuula
    Pentti, Jaana
    Salo, Paula
    Rugulies, Reiner
    Steptoe, Andrew
    Suominen, Sakari
    Vahtera, Jussi
    Virtanen, Marianna
    Vaananen, Ari
    Westerholm, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    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.

  • 18.
    Johnsen, Anna M.
    et al.
    Jonkoping Univ, Dept Nat Sci & Biomed, Sch Hlth & Welf, Jonkoping, Sweden..
    Alfredsson, Lars
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden.;Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden..
    Knutsson, Anders
    Mid Sweden Univ, Dept Hlth Sci, Sundsvall, Sweden..
    Westerholm, Peter J. M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Fransson, Eleonor I.
    Jonkoping Univ, Dept Nat Sci & Biomed, Sch Hlth & Welf, Jonkoping, Sweden.;Karolinska Inst, Inst Environm Med, Stockholm, Sweden..
    Association between occupational physical activity and myocardial infarction: a prospective cohort study2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 10, article id e012692Article in journal (Refereed)
    Abstract [en]

    Objective: Recommendations regarding physical activity typically include both leisure time and occupational physical activity. However, the results from previous studies on occupational physical activity and the association with myocardial infarction have been inconsistent. The aim of this study was to investigate if occupational physical activity is associated with the risk of myocardial infarction. Design: Prospective cohort study. Participants: Data from the Swedish Work, Lipids and Fibrinogen (WOLF) study was used, comprising 9961 employees (6849 men, 3112 women, mean age 42.7 years) having no history of myocardial infarction. The participants were categorised into 3 groups according to their level of occupational physical activity. Outcome: Data regarding incident myocardial infarction were obtained from the Swedish National Patient Register and the Cause of Death Register. Cox proportional hazard regression was used for estimation of HRs for different levels of occupational physical activity in relation to the risk of myocardial infarction. Results: During a mean follow-up of 13.1 years, 249 cases of incident myocardial infarction were identified. In analyses adjusted for age, sex and socioeconomic status, participants standing and walking more than 50% of their working day had an HR of 1.13 (95% CI 0.83 to 1.54), compared with participants seated more than 50% of their working day. The corresponding HR for participants whose work included lifting or carrying was 0.86 (95% CI 0.59 to 1.24). Further adjustment did not alter the results. Stratified analyses resulted in a significantly decreased risk for young people whose work included lifting or carrying, HR 0.37 (95% CI 0.17 to 0.84), compared with younger persons who sat most of their working day. Conclusions: No significant association between occupational physical activity and the risk of myocardial infarction was observed in the total group of employees in this study. Based on the results from this study, occupational physical activity in general does not seem to be enough for reducing the risk of myocardial infarction.

  • 19. Kivimaeki, Mika
    et al.
    Nyberg, Solja T.
    Batty, G. David
    Fransson, Eleonor I.
    Heikkila, 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 E. H.
    Marmot, Michael G.
    Nielsen, Martin L.
    Nordin, Maria
    Oksanen, Tuula
    Pentti, Jaana
    Rugulies, Reiner
    Salo, Paula
    Siegrist, Johannes
    Singh-Manoux, Archana
    Suominen, Sakari B.
    Vaananen, Ari
    Vahtera, Jussi
    Virtanen, Marianna
    Westerholm, Peter J. M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Westerlund, Hugo
    Zins, Marie
    Steptoe, Andrew
    Theorell, Tores
    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.

  • 20. 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
    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.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    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: 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 (I-2 = 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, I-2 = 0%, p = 0.4662), but was null in the high socioeconomic status group (1. 00, 95% CI 0.80-1.25, incidence diff erence zero per 10 000 person-years, I-2 = 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. Copyright (C) Kivimaki et al. Open Access article distributed under the terms of CC BY.

  • 21.
    Kivimaki, Mika
    et al.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.;Univ Helsinki, Fac Med, Helsinki, Finland..
    Jokela, Markus
    Univ Helsinki, Inst Behav Sci, Helsinki, Finland..
    Nyberg, Solja T.
    Finnish Inst Occupat Hlth, Helsinki, Finland.;Finnish Inst Occupat Hlth, Tampere, Finland.;Finnish Inst Occupat Hlth, Turku, Finland..
    Singh-Manoux, Archana
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.;Ctr Res Epidemiol & Populat Hlth, INSERM, U1018, Villejuif, France..
    Fransson, Eleonor I.
    Karolinska Inst, Inst Environm Med, S-10401 Stockholm, Sweden.;Jonkoping Univ, Sch Hlth Sci, Jonkoping, Sweden.;Stockholm Univ, Stress Res Inst, S-10691 Stockholm, Sweden..
    Alfredsson, Lars
    Karolinska Inst, Inst Environm Med, S-10401 Stockholm, Sweden.;Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden..
    Bjorner, Jakob B.
    Natl Res Ctr Working Environm, Copenhagen, Denmark..
    Borritz, Marianne
    Koege Hosp, Dept Occupat Med, Copenhagen, Denmark..
    Burr, Hermann
    Fed Inst Occupat Safety & Hlth BAuA, Berlin, Germany..
    Casini, Annalisa
    Univ Libre Bruxelles, Sch Publ Hlth, Brussels, Belgium..
    Clays, Els
    Univ Ghent, Dept Publ Hlth, B-9000 Ghent, Belgium..
    De Bacquer, Dirk
    Univ Ghent, Dept Publ Hlth, B-9000 Ghent, Belgium..
    Dragano, Nico
    Univ Dusseldorf, Fac Med, Inst Med Sociol, Dusseldorf, Germany..
    Erbel, Raimund
    Univ Duisburg Essen, West German Heart Ctr Essen, Dept Cardiol, Essen, Germany..
    Geuskens, Goedele A.
    TNO, Hoofddorp, Netherlands..
    Hamer, Mark
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England..
    Hooftman, Wendela E.
    TNO, Hoofddorp, Netherlands..
    Houtman, Irene L.
    TNO, Hoofddorp, Netherlands..
    Jockel, Karl-Heinz
    Univ Duisburg Essen, Fac Med, Inst Med Informat Biometry & Epidemiol, Essen, Germany..
    Kittel, France
    Univ Libre Bruxelles, Sch Publ Hlth, Brussels, Belgium..
    Knutsson, Anders
    Mid Sweden Univ, Dept Hlth Sci, Sundsvall, Sweden..
    Koskenvuo, Markku
    Univ Helsinki, Dept Publ Hlth, Helsinki, Finland..
    Lunau, Thorsten
    Univ Dusseldorf, Fac Med, Inst Med Sociol, Dusseldorf, Germany..
    Madsen, Ida E. H.
    Natl Res Ctr Working Environm, Copenhagen, Denmark..
    Nielsen, Martin L.
    Frederiksberg Univ Hosp, Unit Social Med, DK-2000 Copenhagen, Denmark..
    Nordin, Maria
    Stockholm Univ, Stress Res Inst, S-10691 Stockholm, Sweden.;Umea Univ, Dept Psychol, S-90187 Umea, Sweden..
    Oksanen, Tuula
    Finnish Inst Occupat Hlth, Helsinki, Finland.;Finnish Inst Occupat Hlth, Tampere, Finland.;Finnish Inst Occupat Hlth, Turku, Finland..
    Pejtersen, Jan H.
    Danish Natl Ctr Social Res, Copenhagen, Denmark..
    Pentti, Jaana
    Finnish Inst Occupat Hlth, Helsinki, Finland.;Finnish Inst Occupat Hlth, Tampere, Finland.;Finnish Inst Occupat Hlth, Turku, Finland..
    Rugulies, Reiner
    Natl Res Ctr Working Environm, Copenhagen, Denmark.;Univ Copenhagen, Dept Publ Hlth, Copenhagen, Denmark.;Univ Copenhagen, Dept Psychol, Copenhagen, Denmark..
    Salo, Paula
    Finnish Inst Occupat Hlth, Helsinki, Finland.;Finnish Inst Occupat Hlth, Tampere, Finland.;Finnish Inst Occupat Hlth, Turku, Finland.;Univ Turku, Dept Psychol, Turku, Finland..
    Shipley, Martin J.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England..
    Siegrist, Johannes
    Univ Dusseldorf, Fac Med, Inst Med Sociol, Dusseldorf, Germany..
    Steptoe, Andrew
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England..
    Suominen, Sakari B.
    Univ Turku, Dept Publ Hlth, Turku, Finland.;Folkhalsan Res Ctr, Helsinki, Finland.;Univ Skovde, Skovde, Sweden..
    Theorell, Tores
    Stockholm Univ, Stress Res Inst, S-10691 Stockholm, Sweden..
    Vahtera, Jussi
    Finnish Inst Occupat Hlth, Helsinki, Finland.;Finnish Inst Occupat Hlth, Tampere, Finland.;Finnish Inst Occupat Hlth, Turku, Finland.;Univ Turku, Dept Publ Hlth, Turku, Finland.;Turku Univ Hosp, FIN-20520 Turku, Finland..
    Westerholm, Peter J. M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Westerlund, Hugo
    Stockholm Univ, Stress Res Inst, S-10691 Stockholm, Sweden..
    O'Reilly, Dermot
    Queens Univ Belfast, Ctr Publ Hlth, Belfast, Antrim, North Ireland..
    Kumari, Meena
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.;Univ Essex, Inst Social & Econ Res, Colchester CO4 3SQ, Essex, England..
    Batty, G. David
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.;Univ Edinburgh, Ctr Cognit Ageing & Cognit Epidemiol, Edinburgh, Midlothian, Scotland.;Univ Edinburgh, Alzheimer Scotland Dementia Res Ctr, Edinburgh, Midlothian, Scotland..
    Ferrie, Jane E.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.;Univ Bristol, Sch Community & Social Med, Bristol, Avon, England..
    Virtanen, Marianna
    Finnish Inst Occupat Hlth, Helsinki, Finland.;Finnish Inst Occupat Hlth, Tampere, Finland.;Finnish Inst Occupat Hlth, Turku, Finland..
    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.

  • 22.
    Kivimaki, Mika
    et al.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.;Univ Helsinki, Fac Med, Clinicum, Tukholmankatu 8 B, FIN-00290 Helsinki, Finland.;Finnish Inst Occupat Hlth, Topeliuksenkatu 41 B, Helsinki 00250, Finland..
    Nyberg, Solja T.
    Univ Helsinki, Fac Med, Clinicum, Tukholmankatu 8 B, FIN-00290 Helsinki, Finland..
    Batty, G. David
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.;Univ Edinburgh, Ctr Cognit Ageing & Cognit Epidemiol, 7 George Sq, Edinburgh EH8 9JZ, Midlothian, Scotland..
    Kawachi, Ichiro
    Harvard TH Chan Sch Publ Hlth, Dept Social & Behav Sci, 677 Huntington Ave,Kresge Bldg,7th Floor, Boston, MA 02115 USA..
    Jokela, Markus
    Univ Helsinki, Fac Med, Dept Psychol & Logoped, Haartmaninkatu 3, FIN-00014 Helsinki, Finland..
    Alfredsson, Lars
    Stockholm Cty Council, Ctr Occupat & Environm Med, Solnavagen 4, S-11365 Stockholm, Sweden.;Karolinska Inst, Inst Environm Med, Nobels Vag 13, S-17177 Stockholm, Sweden..
    Bjorner, Jakob B.
    Natl Res Ctr Working Environm, Lerso Parkalle 105, DK-2100 Copenhagen O, Denmark..
    Borritz, Marianne
    Bispebjerg Univ Hosp Copenhagen, Dept Occupat & Environm Med, Bispebjerg Bakke 23_20F, DK-2400 Copenhagen NV, Denmark..
    Burr, Hermann
    Fed Inst Occupat Safety & Hlth BAuA, Noldnerstr 40-42, D-10317 Berlin, Germany..
    Dragano, Nico
    Univ Dusseldorf, Inst Med Sociol, Fac Med, Univ Str 1, D-40225 Dusseldorf, Germany..
    Fransson, Eleonor I.
    Jonkoping Univ, Sch Hlth & Welf, Barnarpsgatan 39, S-55111 Jonkoping, Sweden.;Stockholm Univ, Stress Res Inst, Frescati Hagvag 16 A, S-11419 Stockholm, Sweden..
    Heikkila, Katriina
    London Sch Hyg & Trop Med, Dept Hlth Serv Res & Policy, UK 15-17 Tavistock Pl, London WC1H 9SH, England.;Royal Coll Surgeons England, Clin Effectiveness Unit, 35-43 Lincolns Inn Fields, London WC2A 3PE, England..
    Knutsson, Anders
    Mid Sweden Univ, Dept Hlth Sci, Holmgatan 10, S-85170 Sundsvall, Sweden..
    Koskenvuo, Markku
    Univ Helsinki, Fac Med, Clinicum, Tukholmankatu 8 B, FIN-00290 Helsinki, Finland..
    Kumari, Meena
    Univ Essex, Inst Social & Econ Res, Wivenhoe Pk, Colchester CO4 3SQ, Essex, England..
    Madsen, Ida E. H.
    Natl Res Ctr Working Environm, Lerso Parkalle 105, DK-2100 Copenhagen O, Denmark..
    Nielsen, Martin L.
    AS3 Co, AS3 Employment, Hasselager Centervej 35, DK-8260 Viby J, Denmark..
    Nordin, Maria
    Stockholm Univ, Stress Res Inst, Frescati Hagvag 16 A, S-11419 Stockholm, Sweden.;Umea Univ, Dept Psychol, SE-90187 Umea, Sweden..
    Oksanen, Tuula
    Finnish Inst Occupat Hlth, Topeliuksenkatu 41 B, Helsinki 00250, Finland..
    Pejtersen, Jan H.
    Danish Natl Ctr Social Res, Herluf Trolles Gade 11, DK-1052 Copenhagen K, Denmark..
    Pentti, Jaana
    Univ Helsinki, Fac Med, Clinicum, Tukholmankatu 8 B, FIN-00290 Helsinki, Finland..
    Rugulies, Reiner
    Natl Res Ctr Working Environm, Lerso Parkalle 105, DK-2100 Copenhagen O, Denmark.;Univ Copenhagen, Dept Publ Hlth, Norregade 10,POB 2177, DK-1017 Copenhagen K, Denmark.;Univ Copenhagen, Dept Psychol, Norregade 10,POB 2177, DK-1017 Copenhagen K, Denmark..
    Salo, Paula
    Finnish Inst Occupat Hlth, Topeliuksenkatu 41 B, Helsinki 00250, Finland.;Univ Turku, Dept Psychol, Assistentinkatu 7, Turku 20014, Finland..
    Shipley, Martin J.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England..
    Suominen, Sakari
    Univ Skovde, Hgsk Vagen 28, S-54145 Skovde, Sweden.;Univ Turku, Dept Publ Hlth, Joukahaisenkatu 3-5 A, FIN-20520 Turku, Finland..
    Theorell, Tores
    Stockholm Univ, Stress Res Inst, Frescati Hagvag 16 A, S-11419 Stockholm, Sweden..
    Vahtera, Jussi
    Univ Turku, Dept Publ Hlth, Joukahaisenkatu 3-5 A, FIN-20520 Turku, Finland.;Turku Univ Hosp, Kiinamyllynkatu 4-8, Turku 20521, Finland..
    Westerholm, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Westerlund, Hugo
    Stockholm Univ, Stress Res Inst, Frescati Hagvag 16 A, S-11419 Stockholm, Sweden..
    Steptoe, Andrew
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England..
    Singh-Manoux, Archana
    Hop Paul Brousse, INSERM, U1018, Ctr Res Epidemiol & Populat Hlth, 16 Ave Paul Vaillant Couturier,Batiment 15-16, F-94807 Villejuif, France..
    Hamer, Mark
    Loughborough Univ Technol, Natl Ctr Sport & Exercise Med, Sch Sport Exercise & Hlth Sci, Epinal Way, Loughborough LE11 3TU, Leics, England..
    Ferrie, Jane E.
    Univ Bristol, Sch Social & Community Med, Oakfield House, Bristol BS8 2BN, Avon, England..
    Virtanen, Marianna
    Finnish Inst Occupat Hlth, Topeliuksenkatu 41 B, Helsinki 00250, Finland..
    Tabak, Adam G.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.;Semmelweis Univ, Fac Med, Dept Med 1, Ulloi Ut 26, H-1085 Budapest, Hungary..
    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.

  • 23. 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
    Oksanen, Tuula
    Pentti, Jaana
    Rugulies, Reiner
    Salo, Paula
    Siegrist, Johannes
    Suominen, Sakari B.
    Theorell, Tores
    Vahtera, Jussi
    Virtanen, Marianna
    Westerholm, Peter J. M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    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.

  • 24.
    Kivimäki, Mika
    et al.
    UCL, Dept Epidemiol & Publ Hlth, London, England; Univ Helsinki, Dept Publ Hlth, Fac Med, Helsinki, Finland; Finnish Inst Occupat Hlth, Helsinki, Finland.
    Kuosma, Eeva
    Univ Helsinki, Dept Publ Hlth, Fac Med, Helsinki, Finland.
    Ferrie, Jane E.
    UCL, Dept Epidemiol & Publ Hlth, London, England; Univ Bristol, Sch Social & Community Med, Bristol, Avon, England.
    Luukkonen, Ritva
    Univ Helsinki, Dept Publ Hlth, Fac Med, Helsinki, Finland.
    Nyberg, Solja T.
    Univ Helsinki, Dept Publ Hlth, Fac Med, Helsinki, Finland.
    Alfredsson, Lars
    Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden; Karolinska Inst, Inst Environm Med, Stockholm, Sweden .
    Batty, G David
    UCL, Dept Epidemiol & Publ Hlth, London, England.
    Brunner, Eric J.
    UCL, Dept Epidemiol & Publ Hlth, London, England.
    Fransson, Eleonor
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden; Stockholm Univ, Stress Res Inst, Stockholm, Sweden; Jönköping Univ, Sch Hlth Sci, Jönköping, Sweden.
    Goldberg, Marcel
    INSERM, UMS 011, Population Based Epidemiol Cohorts Unit, Villejuif, France.
    Knutsson, Anders
    Mid Sweden Univ, Dept Hlth Sci, Sundsvall, Sweden.
    Koskenvuo, Markku
    Univ Helsinki, Dept Publ Hlth, Helsinki, Finland.
    Nordin, Maria
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden; Umeå Univ, Dept Psychol, Umeå, Sweden.
    Oksanen, Tuula
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Pentti, Jaana
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Rugulies, Reiner
    Univ Copenhagen, Dept Publ Hlth, Copenhagen, Denmark; Univ Copenhagen, Dept Psychol, Copenhagen, Denmark; Natl Res Ctr Working Environm, Copenhagen, Denmark.
    Shipley, Martin J
    UCL, Dept Epidemiol & Publ Hlth, London, England.
    Singh-Manoux, Archana
    UCL, Dept Epidemiol & Publ Hlth, London, England; INSERM, U1018, Ctr Res Epidemiol & Populat Hlth, Villejuif, France.
    Steptoe, Andrew
    UCL, Dept Epidemiol & Publ Hlth, London, England.
    Suominen, Sakari B.
    Univ Turku, Dept Publ Hlth, Turku, Finland; Folkhälsan Res Ctr, Helsinki, Finland; Univ Skövde, Skövde, Sweden.
    Theorell, Töres
    INSERM, UMS 011, Population Based Epidemiol Cohorts Unit, Villejuif, France.
    Vahtera, Jussi
    Univ Turku, Dept Publ Hlth, Turku, Finland; Turku Univ Hosp, Turku, Finland.
    Virtanen, Marianna
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Westerholm, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Westerlund, Hugo
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Zins, Marie
    INSERM, UMS 011, Population Based Epidemiol Cohorts Unit, Villejuif, France.
    Hamer, Mark
    UCL, Dept Epidemiol & Publ Hlth, London, England; Loughborough Univ Technol, Natl Ctr Sport & Exercise Med, Loughborough, Leics, England.
    Bell, Joshua A
    UCL, Dept Epidemiol & Publ Hlth, London, England; Univ Bristol, MRC Integrat Epidemiol Unit, Bristol, Avon, England.
    Tabak, Adam G.
    UCL, Dept Epidemiol & Publ Hlth, London, England; Semmelweis Univ, Dept Med 1, Fac Med, Budapest, Hungary.
    Jokela, Markus
    Univ Helsinki, Inst Behav Sci, Helsinki, Finland.
    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 Europe.2017In: The 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/m2), overweight (25·0–29·9 kg/m2), class I (mild) obesity (30·0–34·9 kg/m2), and class II and III (severe) obesity (≥35·0 kg/m2). We used an inclusive definition of underweight (<20 kg/m2) 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; 71 445 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.

    Funding: NordForsk, Medical Research Council, Cancer Research UK, Finnish Work Environment Fund, and Academy of Finland.

  • 25. 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
    Suominen, Sakari B
    Theorell, Töres
    Vuoksimaa, Eero
    Westerholm, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Westerlund, Hugo
    Zins, Marie
    Kivipelto, Miia
    Vahtera, Jussi
    Kaprio, Jaakko
    Singh-Manoux, Archana
    Jokela, Markus
    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/m2 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.

  • 26. Knutsson, Anders
    et al.
    Alfredsson, Lars
    Karlsson, Berndt
    Åkerstedt, Torbjörn
    Fransson, Eleonor I
    Westerholm, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Westerlund, Hugo
    Breast cancer among shift workers: results of the WOLF longitudinal cohort study2013In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 39, no 2, p. 170-177Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to investigate whether shift work (with or without night work) is associated with increased risk of breast cancer. METHODS: The population consisted of 4036 women. Data were obtained from WOLF (Work, Lipids, and Fibrinogen), a longitudinal cohort study. Information about baseline characteristics was based on questionnaire responses and medical examination. Cancer incidence from baseline to follow-up was obtained from the national cancer registry. Two exposure groups were identified: shift work with and without night work. The group with day work only was used as the reference group in the analysis. Cox regression analysis was used to calculate relative risk. RESULTS: In total, 94 women developed breast cancer during follow-up. The average follow-up time was 12.4 years. The hazard ratio for breast cancer was 1.23 [95% confidence interval (95% CI) 0.70-2.17] for shifts without night work and 2.02 (95% CI 1.03-3.95) for shifts with night work. When including only women <60 years of age, the risk estimates were 1.18 (95% CI 0.67-2.07) for shifts without night work, and 2.15 (95% CI 1.10-4.21) for shifts with night work. CONCLUSIONS: Our results indicate an increased risk for breast cancer among women who work shifts that includes night work.

  • 27. London, Leslie
    et al.
    Tangwa, Godfrey
    Matchaba-Hove, Reginald
    Mkhize, Nhlanhla
    Nwabueze, Remi
    Nyika, Aceme
    Westerholm, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Ethics in occupational health: deliberations of an international workgroup addressing challenges in an African context2014In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 15, p. 48-Article in journal (Refereed)
    Abstract [en]

    Background: International codes of ethics play an important role in guiding professional practice in developing countries. In the occupational health setting, codes developed by international agencies have substantial import on protecting working populations from harm. This is particularly so under globalisation which has transformed processes of production in fundamental ways across the globe. As part of the process of revising the Ethical Code of the International Commission on Occupational Health, an Africa Working Group addressed key challenges for the relevance and cogency of an ethical code in occupational health for an African context through an iterative consultative process. Discussion: Firstly, even in the absence of strong legal systems of enforcement, and notwithstanding the value of legal institutionalisation of ethical codes, guidelines alone may offer advantageous routes to enhancing ethical practice in occupational health. Secondly, globalisation has particularly impacted on health and safety at workplaces in Africa, challenging occupational health professionals to be sensitive to, and actively redress imbalance of power. Thirdly, the different ways in which vulnerability is exemplified in the workplace in Africa often places the occupational health professional in invidious positions of Dual Loyalty. Fourth, the particular cultural emphasis in traditional African societies on collective responsibilities within the community impacts directly on how consent should be sought in occupational health practice, and how stigma should be dealt with, balancing individual autonomy with ideas of personhood that are more collective as in the African philosophy of ubuntu. To address stigma, practitioners need to be additionally sensitive to how power imbalances at the workplace intersect with traditional cultural norms related to solidarity. Lastly, particularly in the African context, the inseparability of workplace and community means that efforts to address workplace hazards demand that actions for occupational health extend beyond just the workplace. Summary: A stronger articulation of occupational health practice with advocacy for prevention should be an ethical norm. Ethical codes should ideally harmonize and balance individual and community needs so as to provide stronger moral authority guidelines. There is a need to consider an African Charter on Bioethics as complementary and strengthening of existing codes for the region.

  • 28.
    Lundberg, Ingvar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Allebeck, P
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Westerholm, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Ågren, P
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Depressions- och ångesttillstånd som arbetsskada: En systematisk översikt över den vetenskapliga litteraturen med relevans för bedömningen2008In: Psykisk arbetsskada, Göteborg: Arbets- och miljömedicin vid Göteborgs universitet , 2008, Vol. 42, no 1, p. 24-75Chapter in book (Other academic)
  • 29. Madsen, I E H
    et al.
    Nyberg, S T
    Magnusson Hanson, L L
    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, M
    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
    Väänänen, A
    Westerholm, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Westerlund, H
    Fransson, E I
    Heikkilä, K
    Virtanen, M
    Rugulies, R
    Kivimäki, M
    Job strain as a risk factor for clinical depression: systematic review and meta-analysis with additional individual participant data.2017In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 47, no 8, p. 1342-1356Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: 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.

    METHOD: 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.

    RESULTS: 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).

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

  • 30. Nyberg, S T
    et al.
    Heikkilä, K
    Fransson, E I
    Alfredsson, L
    De Bacquer, D
    Bjorner, J B
    Bonenfant, S
    Borritz, M
    Burr, H
    Casini, A
    Clays, E
    Dragano, N
    Erbel, R
    Geuskens, G A
    Goldberg, M
    Hooftman, W E
    Houtman, I L
    Jöckel, K-H
    Kittel, F
    Knutsson, A
    Koskenvuo, M
    Leineweber, C
    Lunau, T
    Madsen, I E H
    Hanson, L L Magnusson
    Marmot, M G
    Nielsen, M L
    Nordin, M
    Oksanen, T
    Pentti, J
    Rugulies, R
    Siegrist, J
    Suominen, S
    Vahtera, J
    Virtanen, M
    Westerholm, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Westerlund, H
    Zins, M
    Ferrie, J E
    Theorell, T
    Steptoe, A
    Hamer, M
    Singh-Manoux, A
    Batty, G D
    Kivimäki, M
    Job strain in relation to body mass index: pooled analysis of 160 000 adults from 13 cohort studies2012In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 272, no 1, p. 65-73Article in journal (Refereed)
    Abstract [en]

    Background.

    Evidence of an association between job strain and obesity is inconsistent, mostly limited to small-scale studies, and does not distinguish between categories of underweight or obesity subclasses.

    Objectives.

    To examine the association between job strain and body mass index (BMI) in a large adult population.

    Methods. 

    We performed a pooled cross-sectional analysis based on individual-level data from 13 European studies resulting in a total of 161 746 participants (49% men, mean age, 43.7 years). Longitudinal analysis with a median follow-up of 4 years was possible for four cohort studies (n = 42 222).

    Results. 

    A total of 86 429 participants were of normal weight (BMI 18.5-24.9 kg m(-2) ), 2149 were underweight (BMI < 18.5 kg m(-2) ), 56 572 overweight (BMI 25.0-29.9 kg m(-2) ) and 13 523 class I (BMI 30-34.9 kg m(-2) ) and 3073 classes II/III (BMI ≥ 35 kg m(-2) ) obese. In addition, 27 010 (17%) participants reported job strain. In cross-sectional analyses, we found increased odds of job strain amongst underweight [odds ratio 1.12, 95% confidence interval (CI) 1.00-1.25], obese class I (odds ratio 1.07, 95% CI 1.02-1.12) and obese classes II/III participants (odds ratio 1.14, 95% CI 1.01-1.28) as compared with participants of normal weight. In longitudinal analysis, both weight gain and weight loss were related to the onset of job strain during follow-up.

    Conclusions. 

    In an analysis of European data, we found both weight gain and weight loss to be associated with the onset of job strain, consistent with a 'U'-shaped cross-sectional association between job strain and BMI. These associations were relatively modest; therefore, it is unlikely that intervention to reduce job strain would be effective in combating obesity at a population level.

  • 31. Nyberg, Solja T.
    et al.
    Fransson, Eleonor I.
    Heikkila, Katriina
    Ahola, Kirsi
    Alfredsson, Lars
    Bjorner, Jakob B.
    Borritz, Marianne
    Burr, Hermann
    Dragano, Nico
    Goldberg, Marcel
    Hamer, Mark
    Jokela, Markus
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Kouvonen, Anne
    Leineweber, Constanze
    Madsen, Ida E. H.
    Hanson, Linda L. Magnusson
    Marmot, Michael G.
    Nielsen, Martin L.
    Nordin, Maria
    Oksanen, Tuula
    Pejtersen, Jan H.
    Pentti, Jaana
    Rugulies, Reiner
    Salo, Paula
    Siegrist, Johannes
    Steptoe, Andrew
    Suominen, Sakari
    Theorell, Tores
    Vaananen, Ari
    Vahtera, Jussi
    Virtanen, Marianna
    Westerholm, Peter J. M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Westerlund, Hugo
    Zins, Marie
    Batty, G. David
    Brunner, Eric J.
    Ferrie, Jane E.
    Singh-Manoux, Archana
    Kivimaki, Mika
    Job Strain as a Risk Factor for Type 2 Diabetes: A Pooled Analysis of 124,808 Men and Women2014In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 37, no 8, p. 2268-2275Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE The status of psychosocial stress at work as a risk factor for type 2 diabetes is unclear because existing evidence is based on small studies and is subject to confounding by lifestyle factors, such as obesity and physical inactivity. This collaborative study examined whether stress at work, defined as "job strain," is associated with incident type 2 diabetes independent of lifestyle factors. RESEARCH DESIGN AND METHODS We extracted individual-level data for 124,808 diabetes-free adults from 13 European cohort studies participating in the IPD-Work Consortium. We measured job strain with baseline questionnaires. Incident type 2 diabetes at follow-up was ascertained using national health registers, clinical screening, and self-reports. We analyzed data for each study using Cox regression and pooled the study-specific estimates in fixed-effect meta-analyses. RESULTS There were 3,703 cases of incident diabetes during a mean follow-up of 10.3 years. After adjustment for age, sex, and socioeconomic status (SES), the hazard ratio (HR) for job strain compared with no job strain was 1.15 (95% CI 1.06-1.25) with no difference between men and women (1.19 [1.06-1.34] and 1.13 [1.00-1.28], respectively). In stratified analyses, job strain was associated with an increased risk of diabetes among those with healthy and unhealthy lifestyle habits. In a multivariable model adjusted for age, sex, SES, and lifestyle habits, the HR was 1.11 (1.00-1.23). CONCLUSIONS Findings from a large pan-European dataset suggest that job strain is a risk factor for type 2 diabetes in men and women independent of lifestyle factors.

  • 32. Nyberg, Solja T.
    et al.
    Fransson, Eleonor I.
    Heikkila, Katriina
    Alfredsson, Lars
    Casini, Annalisa
    Clays, Els
    De Bacquer, Dirk
    Dragano, Nico
    Erbel, Raimund
    Ferrie, Jane E.
    Hamer, Mark
    Joeckel, Karl-Heinz
    Kittel, France
    Knutsson, Anders
    Ladwig, Karl-Heinz
    Lunau, Thorsten
    Marmot, Michael G.
    Nordin, Maria
    Rugulies, Reiner
    Siegrist, Johannes
    Steptoe, Andrew
    Westerholm, Peter J. M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Westerlund, Hugo
    Theorell, Tores
    Brunner, Eric J.
    Singh-Manoux, Archana
    Batty, G. David
    Kivimaki, Mika
    Job Strain and Cardiovascular Disease Risk Factors: Meta-Analysis of Individual-Participant Data from 47,000 Men and Women2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 6, p. e67323-Article in journal (Refereed)
    Abstract [en]

    Background: Job strain is associated with an increased coronary heart disease risk, but few large-scale studies have examined the relationship of this psychosocial characteristic with the biological risk factors that potentially mediate the job strain - heart disease association. Methodology and Principal Findings: We pooled cross-sectional, individual-level data from eight studies comprising 47,045 participants to investigate the association between job strain and the following cardiovascular disease risk factors: diabetes, blood pressure, pulse pressure, lipid fractions, smoking, alcohol consumption, physical inactivity, obesity, and overall cardiovascular disease risk as indexed by the Framingham Risk Score. In age-, sex-, and socioeconomic status-adjusted analyses, compared to those without job strain, people with job strain were more likely to have diabetes (odds ratio 1.29; 95% CI: 1.11-1.51), to smoke (1.14; 1.08-1.20), to be physically inactive (1.34; 1.26-1.41), and to be obese (1.12; 1.04-1.20). The association between job strain and elevated Framingham risk score (1.13; 1.03-1.25) was attributable to the higher prevalence of diabetes, smoking and physical inactivity among those reporting job strain. Conclusions: In this meta-analysis of work-related stress and cardiovascular disease risk factors, job strain was linked to adverse lifestyle and diabetes. No association was observed between job strain, clinic blood pressure or blood lipids.

  • 33.
    Runeson, Roma
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    du Prel, Jean-Baptist
    Univ Ulm, Inst Hist Philosophy & Eth Med, Ulm, Germany.;Univ Wuppertal, Dept Occupat Hlth Sci, Wuppertal, Germany..
    Westerholm, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Nordin, Maria
    Umea Univ, Psychol, Umea, Sweden.;Stockholm Univ, Stress Res Inst, Stockholm, Sweden..
    Knutsson, Anders
    Mid Sweden Univ, Sundsvall, Sweden..
    Alfredsson, Lars
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden.;Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden..
    Fahlen, Goran
    Natl Agcy Special Needs Educ & Sch, Harnosand, Sweden..
    Peter, Richard
    Univ Ulm, Inst Hist Philosophy & Eth Med, Ulm, Germany..
    Age-related associations between work over-commitment and zest for work among Swedish employees from a cross-sectional and longitudinal perspective2017In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 57, no 2, p. 269-279Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In aging societies, zest for work may be pivotal when deciding to stay occupationally active longer. Psychosocial work stress is a prevalent public health problem and may have an impact on zest for work. Work over-commitment (WOC) is a personal coping strategy for work stress with excessive striving and a health risk. However, the long-term effect of WOC on zest for work is poorly understood. OBJECTIVE: To investigate the age-related associations of work over-commitment with zest for work. METHODS: During 1996-1998 and 2000-2003, predominantly industrial workers (n = 2940) participated in the WOLF-Norrland study and responded to a questionnaire referring to socio-demographics, WOC, zest for work, effort-reward imbalance proxies, and mental health. Age-adjusted multiple logistic regressions were performed with original and imputed datasets. RESULTS: Cross-sectionally, work overcommitted middle-aged employees had an increased prevalence of poor zest for work compared to their contemporaries without WOC (OR: 3.74 [95%-CI 2.19; 6.40]). However, in a longitudinal analysis associations between onset of 'poor zest for work' and the WOC subscales 'need for approval' (OR: 3.29 [95%-CI 1.04; 10.37]) and 'inability to withdraw from work' (OR: 5.14 [95%-CI 1.32; 20.03]) were observed. CONCLUSION: The longitudinal findings among older employees could be relevant regarding the expected need to remain occupationally active longer.

  • 34. Virtanen, Marianna
    et al.
    Jokela, Markus
    Nyberg, Solja T.
    Madsen, Ida E. H.
    Lallukka, Tea
    Ahola, Kirsi
    Alfredsson, Lars
    Batty, G. David
    Bjorner, Jakob B.
    Borritz, Marianne
    Burr, Hermann
    Casini, Annalisa
    Clays, Els
    De Bacquer, Dirk
    Dragano, Nico
    Erbel, Raimund
    Ferrie, Jane E.
    Fransson, Eleonor I.
    Hamer, Mark
    Heikkil, Katriina
    Joeckel, Karl-Heinz
    Kittel, France
    Knutsson, Anders
    Koskenvuo, Markku
    Ladwig, Karl-Heinz
    Lunau, Thorsten
    Nielsen, Martin L.
    Nordin, Maria
    Oksanen, Tuula
    Pejtersen, Jan H.
    Pentti, Jaana
    Rugulies, Reiner
    Salo, Paula
    Schupp, JRgen
    Siegrist, Johannes
    Singh-Manoux, Archana
    Steptoe, Andrew
    Suominen, Sakari B.
    Theorell, Tores
    Vahtera, Jussi
    Wagner, Gert G.
    Westerholm, Peter J. M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Westerlund, Hugo
    Kivimaki, Mika
    Long working hours and alcohol use: systematic review and meta-analysis of published studies and unpublished individual participant data2015In: BMJ-BRITISH MEDICAL JOURNAL, ISSN 1756-1833, Vol. 350, article id g7772Article, review/survey (Refereed)
    Abstract [en]

    Objective To quantify the association between long working hours and alcohol use. Design Systematic review and meta-analysis of published studies and unpublished individual participant data. Data sources A systematic search of PubMed and Embase databases in April 2014 for published studies, supplemented with manual searches. Unpublished individual participant data were obtained from 27 additional studies. Review methods The search strategy was designed to retrieve cross sectional and prospective studies of the association between long working hours and alcohol use. Summary estimates were obtained with random effects meta-analysis. Sources of heterogeneity were examined with meta-regression. Results Cross sectional analysis was based on 61 studies representing 333 693 participants from 14 countries. Prospective analysis was based on 20 studies representing 100 602 participants from nine countries. The pooled maximum adjusted odds ratio for the association between long working hours and alcohol use was 1.11 (95% confidence interval 1.05 to 1.18) in the cross sectional analysis of published and unpublished data. Odds ratio of new onset risky alcohol use was 1.12 (1.04 to 1.20) in the analysis of prospective published and unpublished data. In the 18 studies with individual participant data it was possible to assess the European Union Working Time Directive, which recommends an upper limit of 48 hours a week. Odds ratios of new onset risky alcohol use for those working 49-54 hours and >= 55 hours a week were 1.13 (1.02 to 1.26; adjusted difference in incidence 0.8 percentage points) and 1.12 (1.01 to 1.25; adjusted difference in incidence 0.7 percentage points), respectively, compared with working standard 35-40 hours (incidence of new onset risky alcohol use 6.2%). There was no difference in these associations between men and women or by age or socioeconomic groups, geographical regions, sample type (population based v occupational cohort), prevalence of risky alcohol use in the cohort, or sample attrition rate. Conclusions Individuals whose working hours exceed standard recommendations are more likely to increase their alcohol use to levels that pose a health risk.

  • 35. Virtanen, Marianna
    et al.
    Nyberg, Solja T.
    Batty, G. David
    Jokela, Markus
    Heikkila, Katriina
    Fransson, Eleonor I.
    Alfredsson, Lars
    Bjorner, Jakob B.
    Borritz, Marianne
    Burr, Hermann
    Casini, Annalisa
    Clays, Els
    De Bacquer, Dirk
    Dragano, Nico
    Elovainio, Marko
    Erbel, Raimund
    Ferrie, Jane E.
    Hamer, Mark
    Joeckel, Karl-Heinz
    Kittel, France
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Lunau, Thorsten
    Madsen, Ida E. H.
    Nielsen, Martin L.
    Nordin, Maria
    Oksanen, Tuula
    Pahkin, Krista
    Pejtersen, Jan H.
    Pentti, Jaana
    Rugulies, Reiner
    Salo, Paula
    Shipley, Martin J.
    Siegrist, Johannes
    Steptoe, Andrew
    Suominen, Sakari B.
    Theorell, Tores
    Toppinen-Tanner, Salla
    Vaananen, Ari
    Vahtera, Jussi
    Westerholm, Peter J. M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Westerlund, Hugo
    Slopen, Natalie
    Kawachi, Ichiro
    Singh-Manoux, Archana
    Kivimaki, Mika
    Perceived job insecurity as a risk factor for incident coronary heart disease: systematic review and meta-analysis2013In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 347, p. f4746-Article in journal (Refereed)
    Abstract [en]

    Objective To determine the association between self reported job insecurity and incident coronary heart disease. Design A meta-analysis combining individual level data from a collaborative consortium and published studies identified by a systematic review. Data sources We obtained individual level data from 13 cohort studies participating in the Individual-Participant-Data Meta-analysis in Working Populations Consortium. Four published prospective cohort studies were identified by searches of Medline (to August 2012) and Embase databases (to October 2012), supplemented by manual searches. Review methods Prospective cohort studies that reported risk estimates for clinically verified incident coronary heart disease by the level of self reported job insecurity. Two independent reviewers extracted published data. Summary estimates of association were obtained using random effects models. Results The literature search yielded four cohort studies. Together with 13 cohort studies with individual participant data, the meta-analysis comprised up to 174 438 participants with a mean follow-up of 9.7 years and 1892 incident cases of coronary heart disease. Age adjusted relative risk of high versus low job insecurity was 1.32 (95% confidence interval 1.09 to 1.59). The relative risk of job insecurity adjusted for sociodemographic and risk factors was 1.19 (1.00 to 1.42). There was no evidence of significant differences in this association by sex, age (<50 v >= 50 years), national unemployment rate, welfare regime, or job insecurity measure. Conclusions The modest association between perceived job insecurity and incident coronary heart disease is partly attributable to poorer socioeconomic circumstances and less favourable risk factor profiles among people with job insecurity.

  • 36.
    Wagman, Petra
    et al.
    Jonkoping Univ, Sch Hlth & Welf, Box 1026, SE-55111 Jonkoping, Sweden..
    Nordin, Maria
    Umea Univ, Dept Psychol, Umea, Sweden.;Stockholm Univ, Stress Res Inst, Stockholm, Sweden..
    Alfredsson, Lars
    Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden.;Karolinska Inst, Inst Environm Med, Stockholm, Sweden..
    Westerholm, Peter J. M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Fransson, Eleonor I.
    Jonkoping Univ, Sch Hlth & Welf, Box 1026, SE-55111 Jonkoping, Sweden.;Karolinska Inst, Inst Environm Med, Stockholm, Sweden..
    Domestic work division and satisfaction in cohabiting adults: Associations with life satisfaction and self-rated health2017In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 24, no 1, p. 24-31Article in journal (Refereed)
    Abstract [en]

    Background: The amount and perception of domestic work may affect satisfaction with everyday life, but further knowledge is needed about the relationship between domestic work division and health and well-being. Aim: To describe the division of, and satisfaction with, domestic work and responsibility for home/family in adults living with a partner. A further aim was to investigate the associations between these aspects and self-rated life satisfaction and health. Method: Data from the Work, Lipids and Fibrinogen survey collected 2009 were used, comprising 4924 participants living with a partner. Data were analyzed using logistic regression. Results: The majority shared domestic work and responsibility for home/family equally with their partner. However, more women conducted the majority of the domestic work and were less satisfied with its division. When both division and satisfaction with division was included in the analysis, solely satisfaction with the division and the responsibility were associated with higher odds for good life satisfaction. Regarding health, higher odds for good self-rated health were seen in those who were satisfied with their division of responsibility. Conclusion and significance: The results highlight the importance of taking into account not solely the actual division of domestic work but also the satisfaction with it.

  • 37.
    Westerholm, P
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences. Arbets- och miljömedicin.
    Att förändra arbetsorganisationer - om skadlig stress och brist på inflytande: Preventiv Medicine2008In: Preventiv Medicine, 2008Chapter in book (Other (popular scientific, debate etc.))
  • 38.
    Westerholm, p
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Closing the Swedish National Institute for Working life2007In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 64, no 12, p. 787-788Article in journal (Refereed)
  • 39.
    Westerholm, P
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences. Arbets- och miljömedicin.
    Lindenger, G
    Arbetsförmåga - det humana kapitalets värd2008Chapter in book (Other (popular scientific, debate etc.))
  • 40.
    Westerholm, P
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences. Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences. Arbets- och miljömedicin.
    Lundberg, Ingvar
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences. Arbets- och miljömedicin.
    Överväganden - Psykisk arbetsskada2008In: Arbete och hälsa, Vol. 42, no 1Article in journal (Other scientific)
  • 41.
    Westerholm, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Depression eller depressiva symtom - orsakade av arbete?2017In: Best Practice Psykiatri/Neurologi, no 31, p. 8-11Article in journal (Other academic)
  • 42.
    Westerholm, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Psykisk arbetsskada2008Collection (editor) (Other academic)
  • 43.
    Westerholm, Peter
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Lundberg, Ingvar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Anderzén, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Lytsy, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Fredriksson, Kerstin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Rehfisch, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Helgesson, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Zaar, Kajsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Gustafsson, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Aktivitetsersättning - en väg till arbete?: En systematisk litteraturöversikt2013Report (Refereed)
  • 44.
    Westerholm, Peter
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Lundberg, Ingvar
    Anderzén, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Lytsy, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Rehfisch, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Helgesson, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Gustafsson, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Palmer, Edward
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Economics.
    Evidence-based methods for enhancing the labour-force entrance of people with mental disabilities: A systematic literature review2015Report (Other academic)
  • 45.
    Westerholm, Peter
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Remaéus, Bertil
    Svartengren, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    The Tale of Asbestos in Sweden 1972-1986: The Pathway to a Near-Total Ban2017In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 14, no 11, article id E1433Article in journal (Refereed)
    Abstract [en]

    This paper provides a narrative of the national intervention strategy in Sweden aimed to restrict the industrial use of asbestos. For many years, asbestos was imported for widespread industrial use, resulting in large amounts throughout Swedish society. In 1972, the whistle was blown in a Communist Party parliamentary motion describing asbestos as a health hazard and requesting action to prohibit its use. Although the motion was rejected, it initiated the extensive charting of asbestos sources on a tripartite basis, involving government agencies, and employer and trade-union organizations. Restrictive asbestos management practices were enforced from July 1982. The year 1985 saw the Government Asbestos Commission review, covering use-determining factors, international regulations, and assessments of cancer risks. The relative risks of chrysotile and amphibole were considered internationally (by the IARC), since chrysotile (a Canadian export) was regarded as unharmful in Canada at that time. Prohibiting asbestos use resulted in its virtual disappearance as an import to Sweden from the early 1980s. However, asbestos has undergone a transition from an occupational to a public-health hazard (although some work-related hazards, such as handling and disposal, remain). The transition reflects the public's exposure to existing stocks, in homes, workplaces, etc. Mesothelioma incidence has come to be regarded as an indicator of prevention effectiveness.

  • 46. Åkerstedt, Torbjörn
    et al.
    Nordin, Maria
    Alfredsson, Lars
    Westerholm, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Kecklund, Göran
    Predicting changes in sleep complaints from baseline values and changes in work demands, work control, and work preoccupation: The WOLF-project2012In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 13, no 1, p. 73-80Article in journal (Refereed)
    Abstract [en]

    Study objective: Stress as a cause of disturbed sleep is often taken for granted, but the longitudinal evidence is limited. The aim of this study was to evaluate new cases of poor sleep as a function of changes in reported work demands, work control, and work preoccupation. Methods: Longitudinal study of change with measures occurring twice within a 5-year interval during a period when the prevalence of impaired sleep was increasing in Sweden. The sample of companies was taken from northern Sweden (Norrland) and included 3637 individuals from the "WOLF Norrland" longitudinal cohort, collected through company health services. Measurement and results: During the measurement period, 16% of those studied developed new cases of impaired sleep. Logistic regressions adjusted for demographics, work environment factors, and disturbed sleep at T1 period one showed a significant increase in new cases for high work demands and high work preoccupation (OR = 1.37; Ci = 1.09-1.72 and OR = 1.80; CI = 1.42-2.28, respectively). The analysis of change in the predictors showed effects of a change from low to high work demands (OR = 1.39; Ci = 1.00-1.95) on new cases of impaired sleep. Consistent high work demands (high at both points) showed a similar increase (OR = 1.49; Ci = 1.06-2.11) but no effect was seen for reduced demands. Change in work preoccupation yielded stronger effects with OR = 2.47 (1.78-2.47) for increased work preoccupation and OR = 3.79 (2.70-5.31) for consistent high work preoccupation. Also, a reduction in work preoccupation was associated with a reduction in new cases of disturbed sleep. Control at work was not related to sleep. Stratification with respect to gender mainly led to fewer significant results (particularly for women) due to larger confidence intervals. Conclusions: It was concluded that self-reported work preoccupation predicts subsequent impairment of sleep and that increased preoccupation is associated with new cases of impaired sleep. Similar, but weaker, results were obtained for work demands.

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