Diss. (sammanfattning) Stockholm : Univ., 2006. / Härtill 3 uppsatser.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2008. / Härtill 4 uppsatser.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2007. / Härtill 6 uppsatser.

The aim: The overall aim of this licentiate thesis was to describe and analyze oral health-related quality of life measured with OHIP-14. The thesis comprises two studies, each with a specific aim.   Study I: To describe oral health-related quality of life measured with OHIP-14 in an Swedish adult population Study II: To study the relationship between oral health-related quality of life, measured with OHIP-14, and subjective as well as objective dry mouth conditions in fragile old people. Furthermore, the aim was to study the reliability and validity of a new instrument (VAS) to measure dry mouth   Material and methods: Study I comprised a stratified random sample of 519 individuals 20-80 years of age. In Study II, 41 randomly selected fragile old people, residents at three different community care centers, participated. In both studies, the questionnaire OHIP-14 was used for measurement of oral health-related quality of life. The participants in Study II answered a questionnaire for subjectively experienced dry mouth (VAS). For objective dry mouth measurements, saliva was absorbed into a preweighted cotton roll. Results: In Study I, 21% of the respondents stated that they had no oral problems that had a negative impact on their well-being. In Study II, the corresponding figure was 71%. In study I the mean value for OHIP-14 was 6.4 (SD=7.1) for the entire population; 5.9 (SD=7.1) for men and 6.8 (SD=7.2) for women in. Subjects, who frequently experienced problems related to oral health, with scores ranging from 16 to 41 points, accounted for 10% of the study group. In Study II, significant associations were identified between both objectively measured respective subjectively experienced dry mouth and oral health-related quality of life. The validity of the VAS instrument was good for subjective mouth dryness, but poor for objectively measured dry mouth in fragile old people. Conclusion: From Study I it can be concluded that, in this Swedish population, a number of individuals, both young and old, experience oral problems that have a negative impact on their well-being. From Study II, the conclusion is that dry mouth (both objective and subjective) is significantly associated with poorer oral health-related quality of life, underlining the value of monitoring dry mouth conditions in the care of fraigile old people.

Evidence over the recent decades indicates that susceptibility to cardiovascular disease (CVD) may be established already prenatally and in early childhood, and that the aetiological processes of the disease involve biological and social influences occurring throughout a person’s life span. Numerous studies have shown that small size at birth is associated with increased risk of CVD later in life. This finding is suggested to reflect the influence of poor foetal nutrition on the body’s organ structure, physiology and metabolism. Surprisingly, there is little empirical evidence available to support the proposed causal mechanisms. The aim of this thesis is to study the mechanisms under­lying the inverse association of size at birth with CVD. Three studies in the thesis are based on Uppsala Birth Cohort Study (UBCoS), a prospective cohort study which includes men and women, who were born at the Uppsala Academic Hospital between 1915 and 1929. Information from birth records, school catalogues, Hospital Discharge Register, Cause of Death Register and Censuses is used. One study is based on Stockholm Heart Epidemiology Program (SHEEP), a population based case-control study of risk factors for acute myocardial infarction (AMI) with study base including all Swedish citizens aged 45-70 years with no prior clinically diagnosed AMI, who lived in Stockholm County during 1992-1994. Data from birth records, questionnaire, health examination and blood sampling is used. In both data materials small size at birth was associated with increased risk of disease. Further analyses showed that birth weight for gestational age in men was associated with ischemic heart disease (IHD) mortality within the non-manual class but not among the manual workers, even if the overall mortality rate was higher in the latter. There was no difference in the association by the men’s family’s social class at birth. For women, social class neither at birth nor in adulthood modified the association between birth weight for gestational age and IHD mortality. We found that there was a synergistic interaction between low weight for gestational age and overweight in adulthood on risk of AMI. The simultaneous analysis of foetal growth, cognitive ability and IHD mortality suggested that there is an indirect association between foetal growth and cognitive ability through childhood cognitive ability. Finally, men with very low and very high birth weight for gestational age had a higher risk of dying after an AMI than men with intermediate birth size. Case fatality in women was not associated with their size at birth. The results suggest that the effect of poor foetal nutrition on CVD may be modified by social exposures later in life. The synergistic interaction between small size at birth and high adult body mass index with respect to AMI risk supports the thrifty phenotype hypothesis according to which a mismatch between foetal and adult nutrition is causing the disease. The existence of an indirect association between foetal growth and IHD mortality through childhood cognitive ability implies that mechanisms related to brain development are contributing to the association between poor foetal nutrition and IHD, in addition to the effects on physiology and metabolism. As the association of size at birth with case fatality was different from the associations with incidence and mortality, the mechanisms that operate after the AMI event and determine the prognosis might partly be different from the mechanisms that drive the development of the disease. / At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 2: Accepted. Paper 3: Manuscript.

<p><em>The aim:</em> The overall aim of this licentiate thesis was to describe and analyze oral health-related quality of life measured with OHIP-14. The thesis comprises two studies, each with a specific aim.</p><p> </p><p><em>Study I: </em>To describe oral health-related quality of life measured with OHIP-14 in an Swedish adult population</p><p><em>Study II: </em>To study the relationship between oral health-related quality of life, measured with OHIP-14, and subjective as well as objective dry mouth conditions in fragile old people. Furthermore, the aim was to study the reliability and validity of a new instrument (VAS) to measure dry mouth</p><p> </p><p><em>Material and methods: </em>Study I comprised a stratified random sample of 519 individuals 20-80 years of age. In Study II, 41 randomly selected fragile old people, residents at three different community care centers, participated. In both studies, the questionnaire OHIP-14 was used for measurement of oral health-related quality of life. The participants in Study II answered a questionnaire for subjectively experienced dry mouth (VAS). For objective dry mouth measurements, saliva was absorbed into a preweighted cotton roll.</p><p><em> </em></p><p><em>Results:</em> In Study I, 21% of the respondents stated that they had no oral problems that had a negative impact on their well-being. In Study II, the corresponding figure was 71%. In study I the mean value for OHIP-14 was 6.4 (SD=7.1) for the entire population; 5.9 (SD=7.1) for men and 6.8 (SD=7.2) for women in. Subjects, who frequently experienced problems related to oral health, with scores ranging from 16 to 41 points, accounted for 10% of the study group. In Study II, significant associations were identified between both objectively measured respective subjectively experienced dry mouth and oral health-related quality of life. The validity of the VAS instrument was good for subjective mouth dryness, but poor for objectively measured dry mouth in fragile old people.</p><p><em>Conclusion:</em> From Study I it can be concluded that, in this Swedish population, a number of individuals, both young and old, experience oral problems that have a negative impact on their well-being. From Study II, the conclusion is that dry mouth (both objective and subjective) is significantly associated with poorer oral health-related quality of life, underlining the value of monitoring dry mouth conditions in the care of fraigile old people.</p>

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2007. / Härtill 4 uppsatser.

<p>Fahlén, G. (2008). Aspects on the Effort-reward Imbalance model of psychosocial stress in the work environments. Sundsvall, Sweden: Mid Sweden University, Department of Health Sciences. ISBN 978-91-85317-94-3.</p><p>Since the late 1970s, work related stress has increasingly been recognized as an important determinant for ill-health and disease. One of the most influential stress models is the Effort-Reward Imbalance model (ERI), which stipulates that an imbalance between the perceived effort spent at work and rewards received results in noxious stress. Those with a coping behaviour called Work-related Overcommitment (WOC), including an inability to withdraw from work obligations are especially vulnerable. The model has shown strong explanatory value for a large numbers of harmful health outcomes.</p><p>The general aim of this thesis was to contribute to the development of the ERI model by exploring the properties of this model in relation to its theoretical assumptions, construct, and application and to improve the knowledge of validity of the ERI-model.</p><p>The study sample that was used in three papers emanated from the WOLF study (Work, Lipids and Fibrinogen). The analyses were confined to the subset of individuals who answered the ERI questions (n=1174) with complete answers. In one paper, data from the SKA study (Sick leave, Culture and Attitudes) were used and they comprised all employees at the Swedish Social Insurance Agency responsible for management and compensation of illness in the working population (n=5700). All data are based on questionnaires.</p><p>The results indicate that ERI and WOC are risk factors for sleep disturbances and fatigue. A palpable threshold effect was seen between quartile three and four. Since these symptoms are strongly stress related, our results support the utility of the ERI and WOC scales in assessing stress in working life.</p><p>Agreement between single questions in the original and an approximate instrument for measuring ERI were low, whereas the agreement between the two ERI scales was reasonable. When approximate instruments are used, questions and scales must be presented thoroughly to facilitate comparisons and the results should be interpreted with caution. Today there are no reasons to use such instruments in the ERI model.</p><p>One statement in the ERI model is that individuals with the coping behaviour characterised as WOC are particularly vulnerable to an imbalance between perceived effort and reward; i.e., that ERI and WOC interact. No such effect was shown in relation to disturbed sleep and fatigue. There is no convincing evidence that ERI and WOC interact in synergy. Analysis demonstrated that WOC was relatively stable in perceived unchanged conditions as measured by the original, more comprehensive instrument as well as by the present, shortened instrument. Positively or negatively perceived changes in ERI correspond to changes in WOC. This result suggests that WOC, at least in part, may act as not only a coping strategy but also as an outcome from ERI. Taken together, these results concerning WOC, suggest that studies to clarify the role of the WOC dimension are needed.</p><p>The ERI model states that, when individuals stay in unfavourable conditions characterised as ERI, because there are few alternatives on the labour market or when the individual is at risk of being laid off or of facing downward mobility, they are in a “locked in position” (LIP). A strong association between LIP and ERI was shown, supporting this statement.</p> / <p>Fahlén, G. (2008). Aspects on the Effort-reward Imbalance model of psychosocial stress in the work environments. Sundsvall, Sweden: Mid Sweden University, Department of Health Sciences. ISBN 978-91-85317-94-3.</p><p>Arbetsrelaterad stress har sedan slutat av sjuttiotalet alltmer blivit uppmärksammat som en viktig bestämningsfaktor för ohälsa. En av de mest inflytelserika stressmodellerna är Ansträngning-belönings modellen (Effort-reward imbalance, ERI) som stipulerar att en obalans mellan ansträngning och belöning i arbetet orsakar en skadlig stress och att de som har ett särskilt coping-beteende som kännetecknas bland annat av oförmåga att dra sig tillbaka från sitt arbete (Work related overcommitment WOC) är särskilt sårbara. Modellen har visat ett starkt förklaringsvärde för många negativa hälsoutfall.</p><p>Det övergripande syftet med avhandlingen var att bidra till utvecklingen av ERI-modellen genom att utforska modellens egenskaper i relation till de teoretiska antagandena, uppbyggnad och tillämpning samt att öka kunskapen om modellens validitet.</p><p>Den epidemiologiska studie som användes i tre artiklar var WOLF-studien (WOrk, Lipids and Fibrinogen) där analyserna genomfördes på den delmängd som hade svarat på ERI-frågorna (n=1174) och som hade kompletta svar. För en artikel användes material från SKA-studien (Sjukskrivning, Kultur och Attityder) och omfattade de som arbetade med ohälsoärenden vid Försäkringskassan (n=5700) i samtliga fall användes data från frågeformulär.</p><p>Resultaten visade att ERI och WOC utgör riskfaktorer för störd sömn och dagtrötthet. En tydlig tröskeleffekt kunde skönjas mellan tredje och fjärde kvartilen. Eftersom dessa symptom är starkt stressrelaterade, gav resultaten stöd för användbarheten av ERI och WOC instrumenten för att skatta stress i arbetslivet.</p><p>Överensstämmelsen mellan enskilda frågor i orginalinstrumentet för ERI och ett approximativt var låg, medan överensstämmelsen mellan de två ERI skalorna bedömdes som rimlig. När approximativa instrument används bör frågor och skalor presenteras utförligt för att jämförelser ska underlättas och resultaten bör tolkas med försiktighet.</p><p>En utgångspunkt i ERI-modellen är att individer som har ett coping-beteende som karakteriseras som WOC är särskilt sårbara för en obalans mellan ansträngning och belöning, d.v.s. att ERI och WOC interagerar i synergi. Ingen sådan effekt kunde styrkas i relation till störd sömn och dagtrötthet. Det saknas också övertygande bevis för att en sådan effekt finns. WOC-måttet är relativt stabilt i oförändrade arbetsförhållanden i såväl orginalinstrumentet som i det nuvarande förkortade. Upplevda positiva eller negativa förändringar i ERI påverkade WOC i samma riktning. Resultaten indikerade att WOC, åtminstone delvis kan utgöra ett utfall av ERI, inte endast en copingstrategi. Dessa resultat gör att studier för att tydliggöra WOC-dimensionens roll i ERI modellen är önskvärda.</p><p>En annan utgångspunkt i modellen är att en av de situationer man stannar i ogynnsamma arbetsförhållanden kännetecknade av ERI, är att man har små möjligheter att byta arbete beroende på att man har få möjligheter på arbetsmarknaden eller är utsatt för risk att bli uppsagd eller att få sämre arbete, man är ”inlåst”. Resultaten visade på en stark association mellan inlåsning och ERI och gav därmed stöd åt antagandet.</p>

<p><strong><em>Syfte och frågeställningar</em></strong></p><p>Syftet med studien är att undersöka om det finns fysiska hälsoskillnader mellan barn som bor i innerstaden jämfört med barn som bor i förorten. Frågeställningarna lyder:</p><p>Vilka skillnader finns i fysisk aktivitetsgrad mellan barn som bor i innerstaden och barn som bor i förorten, och vilka medicinska hälsoskillnader finns mellan barn som bor i innerstaden och barn som bor i förort. Vår hypotes är att barn som bor i förorten utsätts för färre hälsorisker och får mer hälsomässigt positiv stimulans än barn som bor i innerstaden och därmed får förortsbarnen en bättre fysisk hälsa.</p><p> </p><p><strong><em>Metod</em></strong></p><p>Studiens är utförd som en jämförande analytisk studie. Vi jämförde två grupper av barn som lever i olika miljöer i Stockholm, förort eller innerstad. Vi genomförde en enkätundersökning för att kunna samla in en stor mängd data under en begränsad tidsperiod. Vi använder oss av beprövade enkätfrågor från GIH:s forskningsprojekt Skola – Idrott – Hälsa riktade mot barn. Undersökningen genomfördes på 227 elever i årskurs 5 på fem skolor, tre i förort och två i innerstad. Vi har valt ut skolor i upptagningsområden som inte har alltför stora variationer i inkomstnivåer. Det främsta som skiljer skolorna åt är deras fysiska närmiljö, huvudsakligen tillgång till grönområden och luftkvalitet.</p><p> </p><p><strong><em>Resultat</em></strong></p><p>Studien visade att andelen barn som på fritiden är fysiskt aktiva med ledare i innerstaden är 73 %, i förorten 85 %. Andel barn som på fritiden är fysiskt aktiva utan ledare i är innerstad 54 %, i förorten 79 %. Förekomsten av allergi mot luftburna allergen är i innerstaden 22 % och motsvarande värde i förorten är 12 %. Resultaten för astma är i innerstaden 11 % jämfört med 5 % i förorten. I övrigt var skillnaderna små eller obefintliga.</p><p> </p><p><strong><em>Slutsats</em></strong></p><p>Det finns vissa hälsoskillnader mellan de förorts- och innerstadsbarn som deltagit i vår undersökning. Skillnaden ligger i hur fysiskt aktiva barnen är, särskilt när det kommer till spontant idrottsutövande. Detta borde på sikt bidra till en positiv hälsoeffekt och bättre hälsa. Det finns även anledning att tro att förortsmiljön skyddar mot utveckling av astma och allergi.</p> / <p><strong><em>Aims</em></strong><strong><em> </em></strong>The purpose of this study is to examine whether there are physical health disparities between children who live in the inner city compared with children living in the suburbs. Questions: How much difference is there in how physically active children are in the inner city compared to suburbs and what medical health disparities exist between children living in the inner city and children living in the suburbs? Our hypothesis is that suburban children suffer less negative health risks and may get more positive health stimulus than inner city children and thus the suburban children have a better physical health.</p><p><strong><em>Method </em></strong>The design of this study is a comparative analytical study; we compare two different groups of schoolchildren in Stockholm, Sweden who are exposed to different conditions. We have chosen to conduct surveys that allow us to collect a large amount of data in a limited period of time. The survey was conducted on 227 fifth grade students at five schools, three in suburban areas and two in the inner city. We have selected schools in areas that do not have excessive differences in income levels. The primary factor that distinguishes the schools is their surrounding environment, mainly air quality and access to green spaces.</p><p><strong><em>Results </em></strong>The study showed that the percentage of children who are physically active in their leisure time with the leaders is 73% in the inner city and 85% in the suburbs. The percentage of children who are physically active in their leisure time without leaders is 54% in the inner city and 79% in the suburbs. The prevalence of allergy is in the inner city is 22%, the equivalent value in the suburbs is 12%. Corresponding results for asthma in the inner city is 11%, the equivalent value in the suburbs is 5%. Otherwise, the differences were small or nonexistent.</p><p><strong><em>Conclusion </em></strong>There are health disparities between the suburban and inner city children who participated in our survey. The difference lies in how physically active children are, especially when it comes to spontaneous physical activity. There is also reason to believe that the suburban environment prevents development of asthma and allergy.</p>

Fahlén, G. (2008). Aspects on the Effort-reward Imbalance model of psychosocial stress in the work environments. Sundsvall, Sweden: Mid Sweden University, Department of Health Sciences. ISBN 978-91-85317-94-3. Since the late 1970s, work related stress has increasingly been recognized as an important determinant for ill-health and disease. One of the most influential stress models is the Effort-Reward Imbalance model (ERI), which stipulates that an imbalance between the perceived effort spent at work and rewards received results in noxious stress. Those with a coping behaviour called Work-related Overcommitment (WOC), including an inability to withdraw from work obligations are especially vulnerable. The model has shown strong explanatory value for a large numbers of harmful health outcomes. The general aim of this thesis was to contribute to the development of the ERI model by exploring the properties of this model in relation to its theoretical assumptions, construct, and application and to improve the knowledge of validity of the ERI-model. The study sample that was used in three papers emanated from the WOLF study (Work, Lipids and Fibrinogen). The analyses were confined to the subset of individuals who answered the ERI questions (n=1174) with complete answers. In one paper, data from the SKA study (Sick leave, Culture and Attitudes) were used and they comprised all employees at the Swedish Social Insurance Agency responsible for management and compensation of illness in the working population (n=5700). All data are based on questionnaires. The results indicate that ERI and WOC are risk factors for sleep disturbances and fatigue. A palpable threshold effect was seen between quartile three and four. Since these symptoms are strongly stress related, our results support the utility of the ERI and WOC scales in assessing stress in working life. Agreement between single questions in the original and an approximate instrument for measuring ERI were low, whereas the agreement between the two ERI scales was reasonable. When approximate instruments are used, questions and scales must be presented thoroughly to facilitate comparisons and the results should be interpreted with caution. Today there are no reasons to use such instruments in the ERI model. One statement in the ERI model is that individuals with the coping behaviour characterised as WOC are particularly vulnerable to an imbalance between perceived effort and reward; i.e., that ERI and WOC interact. No such effect was shown in relation to disturbed sleep and fatigue. There is no convincing evidence that ERI and WOC interact in synergy. Analysis demonstrated that WOC was relatively stable in perceived unchanged conditions as measured by the original, more comprehensive instrument as well as by the present, shortened instrument. Positively or negatively perceived changes in ERI correspond to changes in WOC. This result suggests that WOC, at least in part, may act as not only a coping strategy but also as an outcome from ERI. Taken together, these results concerning WOC, suggest that studies to clarify the role of the WOC dimension are needed. The ERI model states that, when individuals stay in unfavourable conditions characterised as ERI, because there are few alternatives on the labour market or when the individual is at risk of being laid off or of facing downward mobility, they are in a “locked in position” (LIP). A strong association between LIP and ERI was shown, supporting this statement. / Fahlén, G. (2008). Aspects on the Effort-reward Imbalance model of psychosocial stress in the work environments. Sundsvall, Sweden: Mid Sweden University, Department of Health Sciences. ISBN 978-91-85317-94-3. Arbetsrelaterad stress har sedan slutat av sjuttiotalet alltmer blivit uppmärksammat som en viktig bestämningsfaktor för ohälsa. En av de mest inflytelserika stressmodellerna är Ansträngning-belönings modellen (Effort-reward imbalance, ERI) som stipulerar att en obalans mellan ansträngning och belöning i arbetet orsakar en skadlig stress och att de som har ett särskilt coping-beteende som kännetecknas bland annat av oförmåga att dra sig tillbaka från sitt arbete (Work related overcommitment WOC) är särskilt sårbara. Modellen har visat ett starkt förklaringsvärde för många negativa hälsoutfall. Det övergripande syftet med avhandlingen var att bidra till utvecklingen av ERI-modellen genom att utforska modellens egenskaper i relation till de teoretiska antagandena, uppbyggnad och tillämpning samt att öka kunskapen om modellens validitet. Den epidemiologiska studie som användes i tre artiklar var WOLF-studien (WOrk, Lipids and Fibrinogen) där analyserna genomfördes på den delmängd som hade svarat på ERI-frågorna (n=1174) och som hade kompletta svar. För en artikel användes material från SKA-studien (Sjukskrivning, Kultur och Attityder) och omfattade de som arbetade med ohälsoärenden vid Försäkringskassan (n=5700) i samtliga fall användes data från frågeformulär. Resultaten visade att ERI och WOC utgör riskfaktorer för störd sömn och dagtrötthet. En tydlig tröskeleffekt kunde skönjas mellan tredje och fjärde kvartilen. Eftersom dessa symptom är starkt stressrelaterade, gav resultaten stöd för användbarheten av ERI och WOC instrumenten för att skatta stress i arbetslivet. Överensstämmelsen mellan enskilda frågor i orginalinstrumentet för ERI och ett approximativt var låg, medan överensstämmelsen mellan de två ERI skalorna bedömdes som rimlig. När approximativa instrument används bör frågor och skalor presenteras utförligt för att jämförelser ska underlättas och resultaten bör tolkas med försiktighet. En utgångspunkt i ERI-modellen är att individer som har ett coping-beteende som karakteriseras som WOC är särskilt sårbara för en obalans mellan ansträngning och belöning, d.v.s. att ERI och WOC interagerar i synergi. Ingen sådan effekt kunde styrkas i relation till störd sömn och dagtrötthet. Det saknas också övertygande bevis för att en sådan effekt finns. WOC-måttet är relativt stabilt i oförändrade arbetsförhållanden i såväl orginalinstrumentet som i det nuvarande förkortade. Upplevda positiva eller negativa förändringar i ERI påverkade WOC i samma riktning. Resultaten indikerade att WOC, åtminstone delvis kan utgöra ett utfall av ERI, inte endast en copingstrategi. Dessa resultat gör att studier för att tydliggöra WOC-dimensionens roll i ERI modellen är önskvärda. En annan utgångspunkt i modellen är att en av de situationer man stannar i ogynnsamma arbetsförhållanden kännetecknade av ERI, är att man har små möjligheter att byta arbete beroende på att man har få möjligheter på arbetsmarknaden eller är utsatt för risk att bli uppsagd eller att få sämre arbete, man är ”inlåst”. Resultaten visade på en stark association mellan inlåsning och ERI och gav därmed stöd åt antagandet.